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Ultrasound signs of normal and pathologic lymph nodes

Medical expert of the article

Vascular surgeon, radiologist
, medical expert
Last reviewed: 06.07.2025

Color duplex sonography criteria for lymph node evaluation

  • Degree of vascularization
  • Picture of vascular spread
  • Pulsation of intranodal blood flow

Signs of normal lymph nodes

  • Dimensions less than 1.5 cm
  • Oblong shape (M/P ratio more than 2)
  • Bright echoes in the gates
  • Clear boundaries
  • No vascularization is observed in color mode

Signs of malignant lymphoma

  • Spherical shape (M/P ratio less than 2)
  • Significant decrease in echogenicity
  • Frequent absence of echo in the gate
  • Clear boundaries
  • Significant hypervascularization
  • Arborescent intranodal vascular pattern
  • Intra-node IS less than 0.8

Signs of metastatic lymph node involvement in squamous cell carcinoma

  • Spherical shape of the node (M/P ratio less than 2)
  • Hypoechoic regressive changes
  • No echo in the gate
  • Fuzzy boundaries
  • Moderate vascularization
  • Uneven vascular pattern
  • Intra-node IS more than 0.8

Signs of acute lymphadenitis

  • Oblong shape (M/P ratio more than 2)
  • The cortex is slightly hypoechoic.
  • Central echoes are present
  • Clear boundaries
  • Hypervascularization
  • Presence of central vessels in the gates
  • Intra-node IS less than 0.8

Signs of chronic lymphadenitis

  • Oblong shape (M/P ratio significantly greater than 2)
  • The cortex is slightly hypoechoic.
  • Clear edges
  • Vascularization is not determined.


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