Skip to main content

Advertisement

SpringerLink
Log in

Head and neck lymph nodes in children: the spectrum from normal to abnormal

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20

Similar content being viewed by others

References

  1. Nield LS, Kamat D (2004) Lymphadenopathy in children: when and how to evaluate. Clin Pediatr (Phila) 43:25–33

    Article  Google Scholar 

  2. Twist CJ, Link MP (2002) Assessment of lymphadenopathy in children. Pediatr Clin North Am 49:1009–1025

    Article  PubMed  Google Scholar 

  3. Chong V (2004) Cervical lymphadenopathy: what radiologists need to know. Cancer Imaging 4:116–120

    Article  PubMed  Google Scholar 

  4. Chan JM, Shin LK, Jeffrey RB (2007) Ultrasonography of abnormal neck lymph nodes. Ultrasound Q 23:47–54

    Article  PubMed  Google Scholar 

  5. Hajek PC, Salomonowitz E, Turk R et al (1986) Lymph nodes of the neck: evaluation with US. Radiology 158:739–742

    PubMed  CAS  Google Scholar 

  6. Som PM (1987) Lymph nodes of the neck. Radiology 165:593–600

    PubMed  CAS  Google Scholar 

  7. Camita BM (2004) Lymphadenopathy. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 17th edn. Saunders, Philadelphia, pp 1677–1678

    Google Scholar 

  8. Na DG, Lim HK, Bvun HS et al (1997) Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR 168:1311–1316

    PubMed  CAS  Google Scholar 

  9. Ahuja AT, Ying M (2005) Sonographic evaluation of cervical lymph nodes. AJR 184:1691–1699

    PubMed  Google Scholar 

  10. Toma P, Granata C, Rossi A et al (2007) Multimodality imaging of Hodgkin disease and non-Hodgkin lymphomas in children. Radiographics 27:1335–1354

    Article  PubMed  Google Scholar 

  11. Suwatanapongched T, Gierada DS (2006) CT of thoracic lymph nodes. Part II: diseases and pitfalls. Br J Radiol 79:999–1000

    Article  PubMed  CAS  Google Scholar 

  12. Solbiati L, Osti V, Cova L et al (2001) Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 11:2411–2424

    Article  PubMed  CAS  Google Scholar 

  13. Evans RM, Ahuja A, Metreweli C (1993) The linear echogenic hilus in cervical lymphadenopathy – a sign of benignity or malignancy? Clin Radiol 47:262–264

    Article  PubMed  CAS  Google Scholar 

  14. Ying M, Ahuja A, Brook F (2004) Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 30:441–447

    Article  PubMed  Google Scholar 

  15. Steinkamp HJ, Maurer J, Cornehl M et al (1994) Recurrent cervical lymphadenopathy: differential diagnosis with color-duplex sonography. Eur Arch Otorhinolaryngol 521:404–409

    Google Scholar 

  16. Silvers AR, Som PM (1998) Salivary glands. Radiol Clin North Am 36:941–966, vi

    Article  PubMed  CAS  Google Scholar 

  17. Kelly CS, Kelly RE Jr (1998) Lymphadenopathy in children. Pediatr Clin North Am 45:875–888

    Article  PubMed  CAS  Google Scholar 

  18. Hudgins PA (2000) Nodal and non-nodal inflammatory processes of the pediatric neck. Neuroimaging Clin N Am 10:181–192, ix

    PubMed  CAS  Google Scholar 

  19. Ridder GJ, Richter B, Disko U et al (2001) Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. J Clin Ultrasound 29:140–145

    Article  PubMed  CAS  Google Scholar 

  20. Ying M, Ahuja A, Brook F (2002) Sonographic appearances of cervical lymph nodes: variations by age and sex. J Clin Ultrasound 30:1–11

    Article  PubMed  Google Scholar 

  21. Bagla S, Tunkel D, Kraut MA (2003) Nontuberculous mycobacterial lymphadenitis of the head and neck: radiologic observations and clinical context. Pediatr Radiol 33:402–406

    PubMed  Google Scholar 

  22. Lindeboom JA, Smets AM, Kuijper EJ et al (2006) The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol 36:1063–1067

    Article  PubMed  Google Scholar 

  23. Marais BJ, Ca W, Schaaf HS et al (2006) Tuberculous lymphadenitis as a cause of persistent cervical lymphadenopathy in children from a tuberculosis-endemic area. Pediatr Infect Dis J 25:142–146

    Article  PubMed  Google Scholar 

  24. Manson DE, Sikka S, Reid B et al (2000) Primary immunodeficiencies: a pictorial immunology primer for radiologists. Pediatr Radiol 30:501–510

    Article  PubMed  CAS  Google Scholar 

  25. Wetzler SB, Gagnon GA, Williams HJ (2003) Pathologic quiz case: a 15-year-old adolescent boy with a groin mass present for 18 months. Arch Pathol Lab Med 127:e251–e252

    PubMed  Google Scholar 

  26. Ruggiero A, Attina G, Maurizi P et al (2006) Rosai-Dorfman disease: two case reports and diagnostic role of fine-needle aspiration cytology. J Pediatr Hematol Oncol 28:103–106

    Article  PubMed  Google Scholar 

  27. Gupta P, Babyn P (2008) Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): a clinicoradiological profile of three cases including two with skeletal disease. Pediatr Radiol 38:721–728

    Article  PubMed  Google Scholar 

  28. Tsang WY, Chan JK (1994) Fine-needle aspiration cytologic diagnosis of Kikuchi's lymphadenitis. A report of 27 cases. Am J Clin Pathol 102:454–458

    PubMed  CAS  Google Scholar 

  29. Ramanan AV, Wynn RF, Kelsey A et al (2003) Systemic juvenile idiopathic arthritis, Kikuchi's disease and haemophagocytic lymphohistiocytosis – is there a link? Case report and literature review. Rheumatology (Oxford) 42:596–598

    Article  CAS  Google Scholar 

  30. Chakrabartty S, Pramanik S, Thapa R (2006) Difficulties in the diagnosis of Kawasaki disease. Indian Pediatr 43:728–731

    PubMed  Google Scholar 

  31. Tashiro N, Matsubara T, Uchida M (2002) Ultrasonographic evaluation of cervical lymph nodes in Kawasaki disease. Pediatrics 109:E77

    Article  PubMed  Google Scholar 

  32. Stamos JK, Corydon K, Donaldson J et al (1994) Lymphadenitis as the dominant manifestation of Kawasaki disease. Pediatrics 93:525–528

    PubMed  CAS  Google Scholar 

  33. Gujar S, Gandhi D, Mukherji SK (2004) Pediatric head and neck masses. Top Magn Reson Imaging 15:95–101

    Article  PubMed  Google Scholar 

  34. Steinkamp HJ, Teichgraber UK, Mueffelmann M et al (1999) Differential diagnosis of lymph node lesions. A semiquantitative approach with power Doppler sonography. Invest Radiol 34:509–515

    Article  PubMed  CAS  Google Scholar 

  35. Brennan B (2006) Nasopharyngeal carcinoma. Orphanet J Rare Dis 1:23

    Article  PubMed  Google Scholar 

  36. Stambuk HE, Patel SG, Mosier KM et al (2005) Nasopharyngeal carcinoma: recognizing the radiographic features in children. AJNR 26:1575–1579

    PubMed  Google Scholar 

  37. Kane AG, Reilly KC, Murphy TF (2004) Swimmer's CT: improved imaging of the lower neck and thoracic inlet. AJNR 25:859–862

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Radiology Department, Miami Children’s Hospital, 3100 SW 60th Ave., Miami Beach, FL, 33140, USA

    Ricardo Restrepo, Julieta Oneto, Kathleen Lopez & Kamlesh Kukreja

Authors
  1. Ricardo Restrepo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julieta Oneto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathleen Lopez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kamlesh Kukreja
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julieta Oneto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Restrepo, R., Oneto, J., Lopez, K. et al. Head and neck lymph nodes in children: the spectrum from normal to abnormal. Pediatr Radiol 39, 836–846 (2009). https://doi.org/10.1007/s00247-009-1250-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-009-1250-5

Keywords

Search

Navigation