Ch 17: Neck, post-surgical neck, and cervical lymph nodes

What is a Thyroglossal Duct Cyst

Congenital anomally that develops in remnant of thyroglossal duct, which courses from base of the tongue to suprasternal region

Thyroglossal Duct Cyst Sonographic Appearance

Anechoic, homogeneously hypoechoic with internal debris (within mid region of neck), pseudosolid (fluid-filled structure (like a cyst) that visually mimics a solid lump/mass because fluid isn’t perfectly clear), could be heterogeneous, and posterior enhancement

Branchial Cleft Cyst

Also termed lateral cervical cyst, is formed during development and its a cyst within clefts or pouches on medial neck

Branchial Cleft Cyst Sonographic Appearance

Anechoic, homogeneously hypoechoic with internal debris, heterogeneous, posterior enhancement, and may be difficult to distinguish from other neck cysts/masses (so its important to take multiple pictures, with and without color doppler, and cine loops)

Varying Locations of Branchial Cleft Cyst

Posterior to submandibular gland, superficially to CCA and IJV, or closely related to sternocleidomastoid muscle

Cystic Hygroma

Benign congenital modification in cervical lymphatic system. over 60% associated with chromosomal abnormality.

What chromosomal abnormalities are associated with cystic hygroma

turner syndrome and trisomy 18 and trisomy 21

Where does cystic hygroma most often appear

from posterior occipital region

Cystic Hygroma Sonographic Appearance

Large cystic mass on lateral aspect of neck, thin-walled, multilocular, and multiseptated

Hematoma appearance/cause

Appear cystic, solid, or complex depending on age of it and result from surgery or trauma

Deep Neck Space Infections definition and origins

Are abscesses with purulent (pus) fluid collection. originate from odontogenic (adults), tonsilitis (children), drug use, and post Bx

Deep Neck Space Infections symptoms

They present with pain, dysphagia (difficulty swallowing), immunosuppression, recent trauma, or surgery

Deep Neck Space Infections locations

Submandibular (lower part of jaw), and retropharyngeal or parapharyngeal (area around the tonsils)

Deep Neck Space Infection Sonographic Appearance

Partially or full fluid-filled, thick walled, enlarged lymph nodes (from trying to fight infection)

Cervical Lymph Nodes location

Located along lymphatic channels (run along blood vessels) and are normally found in submandibular, parotid, upper cervical, and posterior triangular regions

Cervical Lymph Node Normal Sonographic Appearance

Hypoechoic with echogenic hilus (should see some blood flow in hilus region) and predominantly oval shaped

Common sites/causes of pathologic involvement with cervical lymph node

Metastasis, lymphoma, lymphadenitis, or TB

Cervical Lymph Node Map

Know this

Cervical Lymphadenopathy definition and causes

Abnormal enlargement of lymph nodes, usually >1cm. caused by malignancies, infections, autoimmune conditions, or anything that activates immune system will activate lymph nodes and then they’ll enlarge

Cervical Lymphadenopathy Sonographic Appearance

Hypoechoic, rounded shape, absent echogenic hilus, intranodal necrosis (dead cells/breakdown), increasing size of serial exams, and peripheral vascularity. could have lobulated edges

Post Surgical Neck scan protocol

evaluate for residual thyroid tissue after thyroidectomy. thyroid bed should have images in sagittal and transverse, and should evaluate for abnormal lymph node and document by location using 7-region breakdown of neck