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Imaging of palpable masses in the head and neck: a practical approach using high resolution ultrasound

¹ Department of Diagnostic Imaging, Bart's and The London NHS Trust, Queen Elizabeth II Wing, St Bartholomew's Hospital, London EC1A 7BE, UK

• Head and neck lumps are common and a significant proportion are malignant.
  
• Quick Early Diagnosis is best achieved in the setting of a "One Stop Clinic".
  
• A relevant clinical history is frequently critical to narrowing the differential diagnosis or establishing the significance of radiological findings.
  
• Ultrasound±fine needle aspiration cytology (FNAc) will make the diagnosis in the majority of cases.
  
• Distinguishing normal structures from lymphadenopathy and non-nodal pathologies is an important step in differential diagnosis.
  
• Additional cross-sectional imaging may be required to characterize deep seated disease, markedly inflammatory or infiltrative processes, and stage malignancy.
  

High-resolution ultrasound is now the imaging modality of choice for the assessment of the vast majority of palpable swellings in the head and neck. In experienced hands, it is frequently the only imaging technique required for diagnosis, as it can be performed rapidly, safely and permits accurate tissue sampling. A systematic approach to the sonographic assessment of neck lumps is provided, with practical advice including tips and pitfalls on scanning and fine-needle aspiration techniques. Reflecting the cumulative experience using sonography within a busy Quick Early Diagnosis clinic for patients with suspected head and neck cancer, emphasis is placed on the evaluation of the entire neck, including nodal drainage sites, the meticulous assessment of lymph nodes to identify often subtle features indicative of abnormality, the appreciation of typical features of common non-nodal pathologies, and the recognition of normal structures commonly mimicking neck lumps. In practice, additional imaging techniques, including CT and MRI, are not routinely required, and indications for these are outlined.