Kallol Prasad Das1, Pronami Borah2, Mondita Borgohain3, Rudra Kanta Gogoi4, Raamseena N.A.5
BACKGROUND
Neck swellings consists of a wide spectrum of pathological entities. These swelling
can occur due to a variety of aetiologies consisting of congenital, acquired
inflammatory, neoplastic, or vascular origin. It is essential to have an extensive
knowledge of the anatomy and contents of each cervical compartment to achieve
a diagnosis. The age of presentation and clinical findings often narrows down the
differential diagnosis. Ultrasonography (USG) is helpful in differentiating the
nature of the lesions and differentiating solid from cystic neck lesions. Ultrasound
is often used as an initial modality for pre-treatment assessment of any neck
swelling.
METHODS
Patients with clinically palpable / non-palpable neck swellings were scanned using
7.5 - 11 MHz transducers, excluding patients with diagnosed thyroid swellings.
RESULTS
In total 120 cases were studied; the mean age of patients was 34 years with a
male to female ratio of 1.1:1. The age wise categorisation included paediatric
population (34.2 %) and adult population (65.8 %). 96 (80 %) cases presented
with painless neck swelling, 76 (63.3 %) cases were non-neoplastic and 44 (36.7
%) cases were neoplastic in nature. Cervical lymphadenopathy being the most
common ultrasound finding in both paediatric and adult population. Malignant
lesions were most common in adult age group. Heterogeneous echotexture,
rounded nodes, intranodal necrosis, loss of echogenic hila, peripheral nodal blood
flow and increased pulsatility index (PI) and resistive index (RI) were important
features of malignant lymph nodes. Sensitivity and specificity of USG and Doppler
in differentiating neoplastic from non-neoplastic lesions were 97.7 % and 98.3 %
respectively and for differentiating benign from metastatic nodes were 97.7 % and
98.3 % respectively.
CONCLUSIONS
Considering the study results and observations, USG is the best initial investigation
for the evaluation of inflammatory, cystic and neoplastic swellings in various age
groups. It is non-invasive, cost effective readily available and repeatable
technique. It is relatively easier to use and does not involve radiation hazards.
Colour Doppler can evaluate the vascularity of the lesions and provide details of
any vascular invasion of metastatic lesions. Ultrasound can differentiate aetiology
of lymph node enlargement to a significant extent.
