Cervical lymph nodes

This article is about lymph nodes in the neck. For lymph nodes near the cervix, see external iliac lymph nodes and inguinal lymph nodes.

Cervical lymph nodes
Regional lymph tissue. (Cervical near top, in green.)⋅
File:Illu lymph chain02.jpg Deep Lymph Nodes 1. Submental 2. Submandibular (Submaxillary) Anterior Cervical Lymph Nodes (Deep) 3. Prelaryngeal 4. Thyroid 5. Pretracheal 6. Paratracheal Deep Cervical Lymph Nodes 7. Lateral jugular 8. Anterior jugular 9. Jugulodigastric Inferior Deep Cervical Lymph Nodes 10. Juguloomohyoid 11. Supraclavicular (scalene)
Details
Latin	Nodi lymphoidei cervicales
Identifiers
TA
TH	{{#property:P1694}}
TE	{{#property:P1693}}
FMA	{{#property:P1402}}
Anatomical terminology [[[d:|edit on Wikidata]]]

Cervical lymph nodes are lymph nodes found in the neck.

Structure

There are approximately 300 lymph nodes in the neck, and they can be classified in many different ways.

Commonly used systems have been devised by the American Academy of Otolaryngology and the American Joint Committee on Cancer.

One system divides the nodes as follows:

• Level I: Submental and submandibular nodes
  • Level Ia: Submental - found between the anterior belly of the digastric muscles
  • Level Ib: Submandibular triangle - found around submandibular glands in submandibular space
• Level II: Upper jugular nodes - Between posterior belly of digastric muscles superiorly and hyoid bone inferiorly
  • Level IIa: Anterior, medial, lateral or posterior to internal jugular vein, or if posterior, must not have an intervening fat plane
  • Level IIb: Posterior to internal jugular vein with fat plane between nodes and internal jugular vein
• Level III: Middle jugular nodes - between the hyoid bone and cricoid cartilage
• Level IV: Lower jugular nodes - between the cricoid cartilage and the clavicle
• Level V: Posterior cervical or spinal accessory nodes, posterior to the sternocleidomastoid muscle
  • Level VA: Spinal accessory nodes from skull base to bottom of cricoid cartilage
  • Level VB: Spinal accessory nodes between cricoid and clavicle
• Level VI: Visceral space lymph nodes - midline group of cervical nodes from hyoid to sternal manubrium, includes prelaryngeal, pretracheal, and paratracheal subgroups
• Level VII: Superior mediastinal nodes - between carotid arteries from top of manubrium superiorly to innominate vein inferiorly

Features of malignancy

The characterization of neoplastic lymph nodes on CT, MRI or ultrasound is difficult, and usually requires confirmation by further imaging such as PET scans, and ultimately tissue diagnosis by fine needle aspiration, core biopsy, or surgical excision. Indirect features have been extensively researched however, including a ratio of long:short axis of less than 2 (subjectively round as opposed to oval shape), loss of the fatty hilum, necrosis, ill defined margin (implying extra capsular spread), peripherally increased flow on Doppler ultrasound, punctate calcifications in patients with primary papillary thyroid cancer and a reticulated appearance in patients with lymphoma.

History

Henri Rouvière produced an influential classification in 1938. However, this system was based upon anatomical landmarks found in dissection, making it imperfectly suited to the needs of clinicians, which led to new terminology for the lymph nodes that could be palpated.

More recently, classification systems have been proposed organized around what can be observed via diagnostic imaging.

Additional images

• 

  Superficial lymph glands and lymphatic vessels of head and neck.

• Gray603.png

  Lymphatics of pharynx.

• Gray604.png

  The lymphatics of the face.

External links

• MedEd at Loyola medicine/pulmonar/PD/pstep23.htm
• http://www.patient.co.uk/showdoc/27000835/
• anatomy of the cervical lymphatics