Traditionally, ultrasound images normal lymph nodes are difficult or impossible to demonstrate on ultrasound. However, with good-resolution equipment, and using a suitable acoustic window, such as normal liver tissue normal lymph nodes can be demonstrated in the hepatoduodenal ligament at the porta hepatis (Fig.below),
particularly in younger patients. The search for lymphadenopathy should include the para-aortic and paracaval regions, the splanchnic vessels and epigastric regions, and the renal hila (Fig. 6.9). Ultrasound has a low sensitivity for demonstrating lymphadenopathy, in the retroperi toneum, as bowel contents frequently obscure the relevant areas. CT or MRI is better able to define the extent of lymphadenopathy, particularly in the pelvis. The presence of lymphadenopathy is highly non-specific, being associated with a wide range of conditions including malignancy, infections and inflammatory disorders. Benign lymphadenopathy is commonly seen in conjunction with hepatitis and other inflammatory disorders such as pancreatitis, cholangitis and colitis.
ultrasound images Lymphadenopathy in the epigastrium (arrows) can be seen anterior to the inferior vena cava (IVC).
ultrasound images TS through the left upper quadrant (LUQ) showing lymphadenopathy at the splenic hilum of a patient with lymphoma.
ultrasound images A large hyperechoic lymph mass at the porta hepatis, causing obstructive jaundice Nodes of 1.5 cm or over are generally considered pathological. Enlarged nodes are most often hypoechoic, rounded or oval in shape and welldefined. Larger nodes display colour or power Doppler flow. Less frequently nodes are hyperechoic, or may combine to form large, lobulated masses. There is some evidence that colour Doppler may assist in differentiating benign from malignant superficial nodes (Fig. 6.9E), the latter displaying a significantly higher resistance on spectral analysis. Lymphadenopathy at the porta may occasionally cause obstructive jaundice due to compression of the common bile duct.
Ultrasound images Blood flow in a malignant lymph node in a patient with renal carcinoma
ultrasound images showing a high resistance index of
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