Enlarged Cervical Lymph Nodes

24-year-old male presented with nontender, enlarged cervical lymph nodes associated with weight loss and fever.

Figure 1. Grey Scale US image of the studied L.N reveals enlarged right upper cervical (at region 4) lymph node, measures 2 x 2.5 cm with S/L ratio = 0.86, rounded in shape, with partially-defined borders, lost central fat hilum and displays heterogeneous echotexture with areas of intranodal necrosis.

Figure 2. Color and pulsed Doppler US image reveals peripheral pattern of perfusion with RI = 0.85.

Figure 3. Color and pulsed Doppler US image reveals peripheral pattern of perfusion with RI = 0.85.

Figure 4. Axial T2W-MR image shows bilateral multiple enlarged cervical LNs at levels IIA and IIB with ill-defined borders and heterogeneous high SI. The studied LN lies at level IIA on the right side (arrow).

Figure 5. DW-MR image at (b=0); shows that the studied LN appears hyperintense (arrow) with small hyperintense areas of necrosis.

Figure 6. DW-MR image at (b=1000) shows that the studied LN appears hyperintense (arrow) with small hypointense areas of necrosis.

Figure 7. ADC map showing low SI of the solid part (arrow) of the studied lymph node while necrotic part shows high signal intensity. The ADC value of the nodal solid part is (0.74 x10-3 mm2/s) while the ADC value of the nodal necrotic part is (1.79 x10-3 mm2/s).

Diagnosis: Hodgkin lymphoma

Lymphomatous nodes tend to be round in shape, well-defined, appear hypoechoic and are usually without an echogenic hilus, features which are similar to most metastatic lymph nodes.

Vascular distribution: the presence of peripheral vessels in lymph nodes is a useful indicator of malignance.

Diffusion-weighted MRI (DWI) is a non-invasive functional technique which allows the characterization of tissues and lesions by difference in microstructure based on the analysis of water motion as architectural changes in the water molecule movement will alter the apparent diffusion coefficient and the signal intensity in DWI and apparent diffusion coefficient maps.

In lymphoma, the increate cellularity and the reduced extracellular space have an important role.