Reactive vs malignant lymph nodes (ultrasound features)

Radiopaedia • CC-by-nc-sa 3.0 • de

A number of sonographic features are helpful in distinguishing reactive versus malignant lymph nodes.

Grey scale features

Features that favor reactive/infective nodes over malignancy include:

  • nodal matting
  • surrounding soft tissue edema
Doppler features

Doppler examination is particularly useful in helping distinguish reactive nodes from metastatic disease . Reactive nodes (including those in tuberculous lymphadenitis) demonstrate:

  • prominent hilar vascularity

Conversely features that favor malignancy includes:

  • peripheral/capsular vascularity
  • avascular areas
  • displacement of vessels
  • the aberrant course of hilar vessels