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Abnormal

lymph node enlargment tendes to commonly result from:Infection Immune response Cancer Infected lymph nodes tendes to firm, tender and warm. Overlying skin apper reddned.

Lymph

nodes harboring malignant disease tend to be

tender non tender matted fixed Sometime infection of lymph nodes occasionally remain permanently enlarged thought they should be non tender, rubbery consistency. (SHOTTY LYMPH NODES)

Nodes are generally considered normal up to 1 cm.

PAIN/TENDERNESS:

lymphnode increases increased in size

capsule streches pain

Presence or absence of tenderness not reliably differentiate benign from malignant nodes.

CONSISTENSY:

Stony hard cancer Rubber nodes lymphoma Softer nodes inflammatory condition

MATTING: Benign tuberculosis , sarcoidosis ,lymphogranuloma. Malignant metastatic carcinoma or lymphoma.


CONSTITUTIONAL SYMPTOMS: Fever, weight loss ,fatigue ,night sweats .. Commonly associated infection.

Neck

is divided into six surgical level based on anatomic structures:

LEVEL

I: submental and submandibular

LEVEL IA: (submental LN)


INFERIORLY hyoid bone
SUPERIORLY-mandible symphysis LATERALLY-ant. Belly of digastric

LEVEL IB:(submandibular LN)


INFERIORLY-post belly of digastric SUPERIORLY-mandibular body ANTERIORLY-ant belly of digastric POSTERIORLY- stylohyoid muscles

LEVEL

II- upper jugular lymph node surrounding the internal jugular vein and adjacent spinal accessory nerve

LEVEL IIA:
INFERIORLY: hyoid bone SUPERIORLY: skull base ANTERIORLY: stylohyoid muscle POSTERIORLY: spinal accessory nerve

LEVEL IIB:
INFERIORLY:hyoid bone SUPERIORLY:skullbase ANTERIORLY: spinal acessory nerve. POSTERIORLY: lateral border of SCM.

LEVEL

III: include middle jugular lymph node

INFERIORLY: inf.border of cricoid cartilage. SUPERIORLY: inf. Body of hyoid bone ANTERIORLY: lateral border of sternohyoid musculature POSTERIORLY: lateral border of SCM

LEVEL

IV: (lower jugular lymphnodes surrounding the

internal jugular vien) INFERIORLY: clavicle SUPERIORLY: inf. Body of cricoid cartilage ANTERIORLY: lateral border of sternohyoid muscle POSTERIORLY: lateral border of SCM

LEVEL

V: include all node in posterior triangle.

LEVEL VA:
INFERIORLY: inferior border of cricod cartilage SUPERIORLY: converging of SCM, trapezius. ANTERIORLY: post. Belly of SCM
POSTERIORLY: ant. belly of trapezius

LEVEL VB:
INFERIORLY:clavical SUPERIORLY:lower border of hyoid bone ANTERIORLY:post.belly of SCM
POSTERIORLY: ant.belly of trapezius M.

LEVEL

VI: includes pretracheal and paratracheal ,

prelaryngeal. INFERIORLY: suprasternal notch SUPERIORLY: hyoid bone LATERALLY: common carotid arteries (ANTERIOR COMPARTMENT)

PALPATION:

in the case of cervical lymph nodes enlargment palpation has low sensitivity and specificity 60-70% ULTRASONOGRAPHY: grey scale and power doppler sonographic feature are useful to identify the cause of cervical lymphadenopathy. GREY SCALE FEATURE: include size, shape , micro nodular, intranodal necrosis. POWER DOPPLER FEATURE : vascular pattern , displacement of vascularity.

CT

SCAN: CT scan can detect the presence of enlarged cervical lymph node with a short axis diameter.

ULTRASONOGRAPHY

CT- SCAN