Imaging of Cervical Lymphadenopathy in Children and Young Adults

Abstract

Cervical lymph node abnormalities are commonly encountered clinically and on imaging in children and young adults. Although imaging findings can lack specificity, nodal characteristics and associated head and neck imaging findings can assist in determining the underlying cause.

Ultrasonography-guided fine-needle aspiration with concurrent small core biopsy of neck masses and lymph nodes yields adequate material for HPV testing in head and neck squamous cell carcinomas

“…When interrogated with color Doppler US, central hilar vascular flow is visualized [19]. A long axis length of 10 mm or less is normal in the neck with the exception of the level I and II nodes, where the upper limit of normal is 15 mm [20]. These normal characteristics can be evaluated across imaging modalities, but are easily seen on US.…”

Paediatric cervical lymphadenopathy

“…Ultrasound is recommended as the initial imaging modality in children, as it avoids exposure to ionizing radiation, is readily available with rapid interpretation, and can usually be performed without the need for sedation or general anaesthesia [4,10,11]. Ultrasound has better resolution in the paediatric neck than in adults [10] and can determine the shape, size, internal composition, vascularity and status of surrounding soft tissues of an enlarged lymph node.…”

“…Athough specific size criteria for enlarged lymph nodes have not been established for the paediatric population, the numbers for adults are often accepted for children. Lymph nodes greater than 1 cm in the head and neck are considered enlarged, with the exception of jugulodigastric nodes in which greater than 1.5 cm is considered abnormal [4][5][6]. Supraclavicular lymph nodes of any size are considered pathologic until proven otherwise and are associated with an increased risk for malignancy [3 & ,5].…”

Streptococcal carriage in children with cervical lymphadenopathy

“…It can determine the shape, size, internal composition, vascularity, and status of surrounding soft tissues of an enlarged lymph node [20]. Benign reactive lymph nodes tend to be solid, oval structures with a fatty echogenic hilum and minimal to no hilar vascularity [21]. When suspicious characteristics are seen on US, computed tomography (CT) and/or MRI can provide additional information and confirm the sonographic findings [21].…”