Sometimes, a change in frequency or the type of ultrasound transducer allows visualization of previously unseen pathology.
The knowledge on the course of lymphatic vessels and ducts, the location of lymph nodes as well as the junctions between them allows paying particular attention to the regions of lymph node location during ultrasound imaging. It seems advisable to include the type of encountered difficulties in US imaging description so that the doctor responsible for referring the patient for the diagnostic procedure would be aware of potentially limited reliability of the performed scan and could recommend additional tests, such as computed tomography or magnetic resonance in the case of non-compliance with the clinical picture. Evaluation of deeper-located tissues can be impossible due to subcutaneous emphysema. The available US options to improve image quality can be particularly useful in such cases ( 1). obesity, postoperative lesions or other causes of steatosis, fibrosis and impaired tissue architecture.
Ultrasound beam penetration may be worse in some patients. rapid and deep breathing, can also hinder proper evaluation, Doppler measurements in particular. The clinical condition of the patient, e.g. talking and moving during the diagnostic procedure). Furthermore, reliable imaging can be significantly hindered or even impossible due to the lack of communication or cooperation with the patient (e.g. Ultrasound of neck lymph nodes can be significantly hindered by: a short and thick patient’s neck poor ultrasound penetration of the tissues or limited mobility of the neck causing insufficient head extension or lateral turning. It seems that the safest management is to refer patients diagnosed with lymph node abnormalities for ultrasound-guided targeted fine needle aspiration biopsy followed by a total lymph node resection for histopathological examination in the case of suspected lymphoma.ĭifficult conditions of the ultrasound examination The overall ultrasound picture along with all criteria for the assessment of a lymph node should be taken into account during ultrasound imaging. Lymph nodes in lymphomas, metastatic and reactive lymph nodes can adopt the classical characteristics of a simple cyst. Anechoic or hypoechoic areas in a lymph node can represent necrosis or metastatic hemorrhages, but also suppuration in inflamed lymph nodes. The appearance of lymph nodes in granulomatous diseases, such as tuberculosis or sarcoidosis, can be very similar to that of typical metastatic lymph nodes or lymphomas. nodular, separated postoperative thyroid fragments, a lateral neck cyst, chemodectoma (carotid body tumor) or neuroma. Lymph nodes in lymphomas may be indistinguishable from reactive lymph nodes, even when using Doppler option, as well as morphologically difficult to distinguish from metastases. For instance, a lymph node, whether normal or abnormal, may be mimicked by anatomical structures, such as a partially visible, compressed vein. The first group of mistakes includes inappropriate interpretation of images of anatomical structures, while the latter group includes, among other things, similar ultrasound images of different pathologies. The causes of mistakes can be either dependent or independent of the performing physician. Ultrasound is the first imaging method used in the diseases of superficial organs and tissues, including lymph nodes.
The article discusses basic mistakes that can occur during ultrasound imaging of superficial lymph nodes.