Rajesh C Kamble^1*, Alpana N Joshi²and Pravin Mestry¹

¹MBBS MD Radiodiagnosis, Shobha Diagnostic Centre, Dhiraj Apartments, OPP Shanti Park, Poddar Road, Malad (East), Mumbai 400097, India
²MBBS, MD Radiodiagnosis, DNB, Shobha Diagnostic Centre, Dhiraj Apartments, OPP Shanti Park, Poddar Road, Malad (East), Mumbai 400097, India

*Corresponding Author: Rajesh C Kamble, MBBS MD Radiodiagnosis, Shobha Diagnostic Centre, Dhiraj Apartments, OPP Shanti Park, Poddar Road, Malad (East), Mumbai 400097, India.

Received: July 28, 2026; Published: August 31, 2026

Background and Objective: Evaluation of cervical lymphadenopathy is a frequent clinical challenge. High-frequency ultrasound (US) equipped with B-mode and Colour/Power Doppler capabilities serves as the primary non-invasive modality to differentiate benign, infective, inflammatory, and malignant cervical lymph nodes. This pictorial review aims to synthesize classic sonographic patterns, detail diagnostic metrics and cut-offs, address imaging pitfalls, and provide a comprehensive diagnostic roadmap for head and neck ultrasonography.

Narrative Scope and Search Strategy: A literature search of PubMed and MEDLINE databases (up to 2026) was performed using search terms including "Neck Ultrasound", "Cervical Lymphadenopathy", "Ultrasonography, Doppler", and "Lymph Nodes". Key diagnostic studies evaluating sensitivity, specificity, and Doppler characteristics were reviewed along with representative clinical case studies.

Findings and Conclusion: Key ultrasound features—including long-to-short axis ratio ($L/S$), fatty hilum integrity, cortical thickness, margin definition, and vascular flow patterns—allow reliable differentiation across nodal pathologies. While classical patterns exist (e.g., central hilar vascularity in benign/reactive nodes vs. chaotic peripheral vascularity and microcalcifications in metastatic malignancy), overlapping features necessitate US-guided Fine Needle Aspiration Cytology (FNAC) or core-needle biopsy for definitive histopathological confirmation.

Keywords: Neck Ultrasound; Cervical Lymphadenopathy; Pattern Recognition; Head and Neck Imaging; Fine-Needle Aspiration Cytology; Differential Diagnosis

Abbreviations CEUS: Contrast-Enhanced Ultrasound; CT: Computed Tomography; FNAC: Fine-Needle Aspiration Cytology; KFD: Kikuchi-Fujimoto Disease; L/S: Long-to-Short Axis Ratio; MRI: Magnetic Resonance Imaging; PI: Pulsatility Index; RI: Resistive Index; SCC: Squamous Cell Carcinoma; TB: Tuberculosis; US: Ultrasound.

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Citation

Citation: Rajesh C Kamble., et al. “Ultrasound Pattern Recognition to Evaluate Lymph Nodes in the Neck: A Pictorial Review". Acta Scientific Otolaryngology 8.5 (2026): 16-27.

Copyright

Copyright: © 2026 Rajesh C Kamble., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.