A 20 year-old young man with enlarging painless neck mass



Doctor's Information

Name : Maryam
Family :Noori
Affiliation : Teb Azma Imaging Center,Ghom,Iran
Academic Degree: Radiologist
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.


Patient's Information

Gender : Male
Age : 20


Case Section

Head & Neck Imaging


Clinical Summary

A 20 year-old young man with enlarging painless neck mass



Imaging Procedures and Findings

The young man with neck mass underwent cervical spiral CT scan with contrast. Performed images depict multiple enlarged lymph nodes in middle & high internal jugular chains bilaterally. Also you can see nodal cluster in right jugulo-digastric, high spinal accessory & high internal jugular chains. She underwent excisional biopsy.



The best diagnostic clue is a young patient with neck & mediastinal adenopathy. Hodgkin Lymphoma most commonly involves mediastinal & cervical nodes. Internal jugular, spinal accessory & transverse cervical nodal chains are mostly involved. Waldeyer ring or other extranodal sites rarely involves (« 1%). Nodes are variable in size (2-10 cm). Single nodal chain may involve or may spread to contiguous nodes or nodal chain. When an enlarged node is encountered on CT or MR, differentiation between a benign reactive node and a malignant one can be difficult. Several features that suggest malignancy are: peripheral nodal enhancement with central necrosis, extracapsular spread with infiltration of adjacent tissues, and a matted conglomerate mass of nodes. Nodal size itself is a less reliable indicator of malignancy, but it is used because the other more reliable differentiating features are frequently not present. Reactive adenopathies are not as large as Hodgkin nodes & has clinical history of upper respiratory tract infection. HIV-related adenopathy may appear identical with diffusely enlarged nodes. Diagnosis suggested by adenoidal & tonsillar enlargement or parotid lymphoepithelial lesions. Thyroid carcinoma adenopathy favor lower neck & superior mediastinum & mediastinal nodes are not usually bulky. Imaging studies cannot distinguish HL & NHL adenopathy, but NHL more frequently extranodal (30%). Squamous cell carcinoma adenopathy has central nodal necrosis, extranodal spread is common & primary tumor usually known.


Final Diagnosis

Hodgkin Lymphoma (Nodular Sclerosis type).



1. Brant WE, Helms CA: Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

2. Diagnostic Imaging Head & Neck, Harnsberger, et al.



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