eRadiograph Volume 7: Imaging of Oral Cavity | Page 347

Size – Adenopathy larger than 10 mm in short axis are considered to be pathologic.
Retropharyngeal nodes are considered pathologic if they exceed 6mm.
Shape – Normal lymph nodes are bean shaped or flat with a prominent fatty hilum.
Pathologic nodes are round with loss of fatty hilum.
Density – A focal central hypodensity representing necrosis with peripheral
enhancement of the adenopathy indicates a pathologic adenopathy. This may be as a
result of central necrosis due to tuberculosis or due to a malignancy.
Extracapsular spread – This is a significant sign of extension of disease process beyond
the margins of the lymph. The margins of the lymph nodes are ill defined the adjacent
fat muscles can be infiltrated. This is usually seen in metastatic disease. A high
likelihood of recurrence and a poor prognosis.
Invasion of adjacent structures

Neck Nodes

Advanced nodal disease may cause conglomeration of nodes and encasement of
adjacent structures particularly the internal jugular vein and carotid artery.
The encasement is usually more than 270 degree of circumferential involvement.

347