Radiology- Pathology Conference 4/29/2012. Lymph Nodes. John McGrath

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1 Radiology- Pathology Conference 4/29/2012 Lymph Nodes John McGrath 1 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 1 of 24

2 Case 1: 51 year-old male presents with palpable right axillary lump 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 2 of 24

3 3 years prior! 3 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 3 of 24

4 Diagnosis? 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 4 of 24

5 Lymphatics! lymph nodes scattered throughout the body! Common drainage pathways via the right and (left) thoracic duct, into the venous system! Assess size, morphology, and interval change on imaging 5 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 5 of 24

6 Abnormal Lymph Nodes C T! > 1 cm (short axis) generally considered abnormal! Inguinal: > 1.5 cm! Epitrochlear: > 0.5 cm! Subcarinal: > 1.5 cm! May see necrosis, calcifications, etc. U S! Obliteration of echogenic hilum! Long-axis to short-axis ratio < 1.5! Cystic changes! Microcalcifications 6 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 6 of 24

7 Case 2: 24 year old male status post assault Presentation material is for education purposes only. All rights reserved URMC Radiology Page 7 of 24

8 Normal or Abnormal? Presentation material is for education purposes only. All rights reserved URMC Radiology Page 8 of 24

9 Neck Classification- Adenopathy Som P M et al. AJR 2000;174: Presentation material is for education purposes only. All rights reserved URMC Radiology Page 9 of 24

10 ! 27 year-old male with left-sided neck swelling for 6 months, worsening! Presentation material is for education purposes only. All rights reserved URMC Radiology Page 10 of 24

11 CT Neck, same date! Presentation material is for education purposes only. All rights reserved URMC Radiology Page 11 of 24

12 Left supraclavicular and cervical lymphadenopathy, plus! Differential Diagnosis? Presentation material is for education purposes only. All rights reserved URMC Radiology Page 12 of 24

13 Thoracic Duct Right Thoracic Duct! Drains:! Right arm and right side of chest! Neck and head! Left lower lobe (Left) Thoracic Duct! Drains into systemic circulation at left brachiocephalic vein! Virchow s node- left supraclavicular node, vicinity of entrance of thoracic duct into circulation! Drains much of the remainder of the body 13 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 13 of 24

14 Virchow s Node! Left supraclavicular lymphadenopathy! Especially concerning for malginancy! Differential considerations (especially if unilateral):!lymphoma!thoracic or retroperitoneal cancer!bacterial or fungal infections Presentation material is for education purposes only. All rights reserved URMC Radiology Page 14 of 24

15 Lytic Metastases! Renal cell carcinoma! expansile! Thyroid carcinoma! Lung! Breast Presentation material is for education purposes only. All rights reserved URMC Radiology Page 15 of 24

16 60 year-old with right neck pain and fullness for several months! Presentation material is for education purposes only. All rights reserved URMC Radiology Page 16 of 24

17 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 17 of 24 17

18 Post Chemoradiation! 18 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 18 of 24

19 Regional Nodal Metastases! NX- regional lymph nodes cannot be assessed! N0- no regional node metastasis! N1- single ipsilateral node < 3 cm! N2a- single ipsilateral node (3-6 cm)! N2b- multiple ipsilateral nodes, all < 6 cm! N2c- bilateral or contralateral nodes, < 6 cm! N3- metastasis in a lymph node > 6 cm 19 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 19 of 24

20 26 year-old female presents with neck swelling! 20 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 20 of 24

21 Normal or Abnormal? 21 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 21 of 24

22 Normal or Abnormal? 22 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 22 of 24

23 Thyroid Cancer Benign Characteristic Malignant Characteristics! Cystic Elements! Hyper/isoechoic! Eggshell calcification! Inspissated colloid! Entirely solid! Hypoechoic! Microcalcifications! Associated cervical adenopathy 23 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 23 of 24

24 Thyroid Cancer Metastasis!!!! Papillary Lymphatic dissemination more common than hematogenous spread Cervical nodal metastases often present at diagnosis! Cystic degeneration! microcalcifications Metastatic cervical nodes does not affect prognosis Distant metastases rare! Follicular Hematogenous spread! Bone, brain lung, liver! Metastases to cervical nodes uncommon! Distanat metastases in 20-40% of widely invasive variant 24 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 24 of 24

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