Ultrasound lymph node examination of the lower extremities

Abstract

Sonography is used to detect and characterize palpable resistance or accidentally discovered lymph nodes (LN) of the lower extremities. In most cases, these are chronically inflammatory or reactive lymph nodes without clinical relevance. They are almost always found only in the groin, while LN only occur very rarely in the popliteal. In addition to the patient’s medical history and clinic, B-scan sonography and vascular architecture also play a decisive role in differential diagnosis. Due to the unspecific sonographic findings, it is not always possible to differentiate reliably between inflammatory and lymphoma diseases in a singular LN: Therefore, a thickening of the cortex with preserved vascular architecture, for example, is found in lymphomas as well as in inflammation-reactive LN. An US targeted biopsy can be diagnostically helpful. A metastatic transformation often goes hand in hand with the destruction of the LN architecture and the orderly vascular image. Also important is the LN delimitation and central ischemia in the color-coded and contrast-enhanced sonography.

Key words

lymph nodes - differential diagnosis - lower extremity

Schlüsselwörter

Lymphknoten - Differenzialdiagnose - untere Extremität

Publication History

Article published online:
08 December 2020

• Literatur

• 1 Willard-Mack CL. Normal Structure, Function, and Histology of Lymph Nodes. Toxicologic Pathology 2006; 34: 409-424
• 2 Kubik S, Wirth W. Histology, Anatomy and Lymphograpohic Appearace. Aus: Atlas of Lymphography, Viamonte M, Jr, Rüttimann A. ed. Thieme; 1980
• 3 Weskott HP. B-flow-a new method for detecting blood flow. Ultraschall in Med 2000; 21 (02) 59-65 . German
• 4 Sim JK, Lee JY, Hong HS. Differentiation Between Malignant and Benign Lymph Nodes: Role of Superb Microvascular Imaging in the Evaluation of Cervical Lymph Nodes. J Ultrasound Med 2019; 38 (11) 3025-3036
• 5 Weskott HP, Ioanitescu ES. Diagnostic approach to lymph node diseases in ultrasound. In Dietrich C, ed. In: EUS Course Book; 2012
• 6 Weskott HP. Kontrastverstärkte Sonografie in der Lymphknotendiagnostik. Der Radiologe 2018; 58 (06) 563-571
• 7 Eigentler TK, Mühlenbein C, Follmann M. et al. S3-Leitlinie Diagnostik, Therapie und Nachsorge des Melanoms – Update 2015/2016, Kurzversion 2.0. J Dtsch Dermatol Ges 2017; 15 (06) e1-e41
• 8 Dippel E, Assaf C, Becker JC. et al. S2k-Leitlinie – Kutane Lymphome Update 2016 – Teil 1: Klassifikation und Diagnostik (ICD10 C82 – C86). J Dtsch Dermatol Ges 2017; 15 (12) 1266-1273
• 9 Solbiati L, Rizatto G, Bellotti E. et al. High resolution sonography of cervical lymph nodes in head and neck cancer: criteria for differentiation of reactive versus malignant nodes. Radiology 1988; 169: 113
• 10 Vassallo P, Wernecke K, Roos N. et al. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 1992; 183 (01) 215-220
• 11 Nagy JA, Chang SH, Dvorak AM. et al. Why are tumour blood vessels abnormal and why is it important to know?. Br J Cancer 2009; 100 (06) 865-869
• 12 Bertolli E, Bevilacqua JL, Molina AS. et al. Popliteal sentinel lymph node involvement in melanoma patients. J Surg Oncol 2015; 112 (02) 179-182
• 13 Catalano O, Caracò C, Mozzillo N. et al. Locoregional spread of cutaneous melanoma: sonography findings. Am J Roentgenol 2010; 194 (03) 735-745
• 14 Al Hmada Y, Schaefer IM, Fletcher CDM. Hibernoma Mimicking Atypical Lipomatous Tumor: 64 Cases of a Morphologically Distinct Subset. Am J Surg Pathol 2018; 42 (07) 951-957
• 15 Bazemore AW, Smucker DR. Lymphadenopathy and malignancy. Am Fam Physician 2002; 66 (11) 2103-2110
• 16 Klebl FH, Gelbmann CM, Lammert I. et al. Palpatorische und sonografische Detektion von Lymphknotenmetastasen bei lokal fortgeschrittenem malignen Melanom [Detection of lymph node metastases of malignant melanoma by palpation and ultrasound]. Med Klin (Munich) 2003; 98 (12) 783-787
• 17 Hobbs SK, Monsky WL, Yuan F. et al. Regulation of transport pathways in tumor vessels: role of tumor type and microenvironment. Proc Natl Acad Sci U S A 1998; 95 (08) 4607-4612
• 18 Lunt SJ, Kalliomaki TM, Brown A. et al. Interstitial fluid pressure, vascularity and metastasis in ectopic, orthotopic and spontaneous tumours. BMC Cancer 2008; 8: 2
• 19 van de Schoot L, Aronson DC, Behrendt H. et al. The role of fine-needle aspiration cytology in children with persistent or suspicious lymphadenopathy. J Pediatr Surg 2001; 36 (01) 7-11
• 20 Weskott HP. Ultraschall im klinischen Management maligner Lymphome. Radiologe 2012; 52 (04) 347-359