Interactive Transcript
0:01
The fourth clinical scenario that we often see in the
0:04
emergency department as a neuroradiologist,
0:07
is a neck or face mass.
0:10
And this is new evaluation of a neck or face mass.
0:14
Now, these are generally separated into those that are
0:17
associated with fever and those that are afebrile.
0:20
So, this is not pharyngitis. This is not airway narrowing,
0:23
This is not drooling and difficulty swallowing.
0:26
This is a patient who presents with a neck mass. In the adult,
0:30
the two most common neck masses that we see are thyroid
0:36
lesions and lymphadenopathy. In children,
0:41
far and away,
0:42
the most common lesions that we see in the neck are lymph nodes,
0:46
and they are usually just inflammatory
0:48
lymph nodes in children.
0:50
So let's look at a typical case under this scenario.
0:55
So here we have a patient and we mark that the patient is febrile
1:00
and we notice that we have the carotid artery and
1:03
the jugular vein. Carotid artery and jugular vein.
1:05
We're at the level of the aryepiglottic folds.
1:08
So we're at the superglotic level,
1:10
probably around the C3-C4 level.
1:13
And you see the lymph nodes here that are present
1:17
and showing peripheral enhancement.
1:19
So these are inflammatory lymph nodes
1:22
in the left side of the neck.
1:24
Based on the fact that we are below the level of the hyoid
1:28
bone, but above the level of the cricoid cartilage,
1:31
we would call these Level III lymph nodes.
1:33
Remember that for Level V lymph nodes,
1:37
the lymphadenopathy has to be completely behind the
1:40
posterior margin of the sternocleidomastoid muscle.
1:43
This lymph node is just a little bit superimposed on the
1:47
posterior margin and the sternocleidomastoid, and
1:50
therefore would still be called Level III lymph node.
1:52
This necrotic lymph node would be called a Level V
1:55
lymph node. Here you can see, for example,
1:58
a Level V lymph node, small in size, within normal limits.
2:02
Here are these tiny little Level III lymph nodes because they
2:05
are not completely behind the posterior margin
2:08
of the sternocleidomastoid muscle.
2:10
That's how we name the lymph nodes.
2:13
So, in an adult with these type of lymph nodes,
2:18
our considerations are, is this secondary to an infection, or is
2:22
this secondary to a primary head and neck aerodigestive
2:26
system carcinoma? With the history of fever,
2:30
we're going to be much more concerned about
2:32
an infectious etiology. And worldwide,
2:36
we'd probably consider tuberculosis as one of the more
2:40
common of the causes of necrotic lymphadenitis in an adult.
2:47
In America,
2:48
we don't see tuberculosis nearly as
2:50
much as other areas of the world,
2:52
and therefore the most common etiology in our situation would
2:56
probably still be staph. or strep. infection and/or those
3:00
individuals who may have IV drug abuse and/or AIDS that can have
3:06
any number of necrotic lymph nodes on an infectious basis.
© 2024 Medality. All Rights Reserved.