Cervical Lymph Node Map - The Radiology Assistant

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Abdomen
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  - CT in Abdominal Trauma
  - Practical approach to Acute Abdomen
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  - Anal cancer staging
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  - Abdominal wall hernias
- Adrenals
  - Characterization of Adrenal lesions
- Aorta
  - Aortic Aneurysm Rupture
- Biliary system
  - Gallbladder obstruction
  - Biliary duct pathology
  - Gallbladder wall thickening
- Bladder
  - Bladder Cancer - VI-RADS
- Bowel
  - Bowel Ischemia - Video Lectures
  - CT-pattern of Bowel wall thickening
  - Closed Loop in Small bowel obstruction
  - Closed Loop Obstruction with video
  - Crohn's disease - role of MRI
  - Crohn's disease - role of Ultrasound
  - Small Bowel Tumors
  - Sharp foreign bodies in GI tract
- Chest radiology for Abdominal radiologists
  - Thoracic Ultrasound in Acute Abdomen
- Gynaecology
  - Acute Abdomen in Gynaecology - Ultrasound
  - Endometriosis - MRI detection
  - Cervical Cancer - MR staging
  - Endometrial Cancer - MR staging
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  - Ovarian cystic lesions
  - Roadmap to evaluate ovarian cysts
  - Ovarian cystic lesions.
- Kidney
  - Bosniak Classification 2019
  - Solid Renal Masses
- Liver
  - Characterisation of liver masses
  - Common Liver Tumors
  - Incidentalomas in the liver
  - Liver - Segmental Anatomy
  - LI-RADS
- Ovarium
  - Roadmap to evaluate ovarian cysts.
- Pancreas
  - Acute Pancreatitis
  - Pancreatic Cancer - CT staging 2.0
  - Pancreatic cystic Lesions
- Peritoneum
  - Anatomy of Peritoneum and Mesentery
  - Peritoneal Carcinomatosis
  - Peritoneal Pathology
- Prostate
  - Prostate Cancer - PI-RADS v2.1
  - Prostate Anatomy
- Rectum
  - Rectal Cancer MR staging 3.0
  - Perianal Fistulas
  - Dynamic Rectal examination
- Ultrasound
  - Transvaginal Ultrasound for Non-Gynaecological Conditions
  - Ultrasound in Acute Abdomen
  - US of the GI tract - Technique
  - US of the GI tract - Normal Anatomy
Breast
- BI-RADS
  - Bi-RADS for Mammography and Ultrasound 2013
- Calcifications
  - Differential of Breast Calcifications
- Breast Cancer
  - Staging and Treatment of Breast Cancer
- Breast Prosthesis
  - Breast Implants
- Mammography
  - Test
- Male Breast
  - Pathology of the Male Breast
- MRI
  - MRI of the Breast
- Ultrasound
  - Ultrasound of the Breast
Cardiovascular
- Anatomy
  - Cardiac Anatomy
  - Coronary anatomy and anomalies
- CAD-RADS
  - Coronary Artery Disease-Reporting and Data System 2.0
- Cardiomyopathy
  - Ischemic and non-ischemic cardiomyopathy
- Devices
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- Peripheral MRA
  - Contrast-enhanced MRA of peripheral vessels
- Pearls...
  - Cardiovascular Pearls on Chest CT...
- Pulmonary Hypertension
  - Pulmonary Hypertension and Thromboembolic disease
- Thoracic Aorta
  - Acute Aortic Syndrome
  - Vascular Anomalies of Aorta, Pulmonary and Systemic vessels
Chest
- Airways
  - Large airway disease
- Chest X-Ray
  - Chest X-Ray - Basic Interpretation
  - Chest X-Ray - Heart Failure
  - Chest X-Ray - Lung disease
- COVID-19
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  - Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions
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  - HRCT - Common diagnoses
  - Pulmonary Fibrosis
- Lung anatomy
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- Lung Cancer
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- Mediastinum
  - Mediastinal Lymph Node Map
  - Mediastinal Masses - differential diagnosis
- Pearls
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- Pulmonary nodules
  - BTS guideline of pulmonary nodules
  - Fleischner 2017 guideline
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  - Pulmonary nodule - Benign versus Malignant
- Tuberculosis
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- Thymus
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Head/Neck
- Cervical Nodes
  - Cervical Lymph Node Map
- Esophagus
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  - Esophagus II: Strictures, Acute syndromes, Neoplasms and Vascular impressions.
- Horner syndrome
- Infra- and suprahyoid neck
  - Anatomy and Pathology of the Infrahyoid Neck
- Tumors
  - Neck Masses in Children
  - Head Neck tumors - When to think of malignancy
- Orbita
  - CT and MRI of the Eye
- Paranasal Sinuses
  - MRI of the Paranasal Sinuses
- Swallowing
  - Swallowing disorders update
- Temporal Bone
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  - Temporal Bone Anatomy 2.0
  - Temporal Bone Pathology
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- Trigeminus
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- Ankle
  - Ankle Fracture Mechanism and Radiography
  - Algoritm for Ankle Fractures 2.0
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  - Special Ankle Fractures
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- Arthritis
  - Arthritis
- Bone Tumors
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  - Bone tumors - Differential diagnosis
  - Osteolytic - ill defined bone tumors
  - Osteolytic - well defined bone tumors
  - Sclerotic bone tumors
  - Cartilage tumors
- Cases - pearls in radiology
  - Foot and Ankle cases
- Diabetic foot
  - MRI examination
- Elbow
  - MRI examination of the Elbow
  - Elbow fractures in Children
- Hip
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  - Femoroacetabular impingement syndrome
- Knee
  - Meniscal pathology
  - Non-Meniscal pathology
  - Meniscus special cases
- Muscle
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  - Non-traumatic changes
  - Hamstring injury
- Shoulder
  - Shoulder Anatomy and Variants on MRI
  - Shoulder instability - MRI
  - Shoulder Rotator cuff injury
  - Shoulder Ultrasound
- Spine
  - Spine fractures - TLICS Classification
  - AO Spine Classification of Thoracolumbar Fractures
- Stress fractures
  - Stress fractures
- Ultrasound
  - US-guided injection of joints
- Wrist
  - Carpal instability
  - Fractures
  - ...
Neuroradiology
- Anatomy
  - Brain Anatomy
- Brain Ischemia
  - Imaging in Acute Stroke
  - Vascular territories of the Brain
- Brain Tumor
  - Systematic Approach to Brain Tumors
- Carotid Pathology
  - How to Differentiate Carotid Obstructions
- Dementia
  - Dementia - Role of MRI
- Enhancement Patterns
  - Enhancement Patterns in CNS disease
- Epilepsy
  - Epilepsy - Role of MRI
- Hemorrhage
  - Traumatic Intracranial Hemorrhage
  - Non-traumatic Intracranial Hemorrhage
- Horner syndrome.
- Multiple Sclerosis
  - Multiple Sclerosis 2.0
- Sella Turcica
  - Sella Turcica and Parasellar Region
- Sinus Thrombosis
  - Cerebral Venous Sinus Thrombosis
- Spine
  - Cervical injury
  - Lumbar Disc Herniation
  - Lumbar Disc Nomenclature 2.0
  - Myelopathy
  - Thoracolumbar injury
  - TLICS Classification of fractures
- Intracranial Hypotension
  - Spontaneous Intracranial Hypotension
Pediatrics
- Abdomen
  - Acute Abdomen in Neonates
  - Cystic Abdominal Masses in Children
  - Solid Abdominal Masses in Children
  - Renal Tumors in Children
  - Acute Scrotum in Children
  - Lines and tubes in Neonates
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- Chest
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  - Neonatal Chest X-Ray
  - Pediatric Chest CT 2
- Child Abuse
  - Child abuse - Diagnostic Imaging 2.0
- Head/neck
  - Neck Masses in Children.
  - Craniosynostosis
- Musculoskeletal
  - Developmental Dysplasia of the Hip
  - Elbow fractures in Children.
  - Hip pathology in Children
- Neuro
  - Neonatal Brain US
  - Ultrasound of the Neonatal spine
- Normal values
  - Normal Values in Pediatric Ultrasound
More
- ANBI
  - Jaarverslagen en financiële rapporten
- Radiology Assistant
  - Information
- Video-Lectures
- Apps
  - Radiology Assistant 2.0 app
  - Radiology.expert
- How to make videos and illustrations
  - How to make illustrations in Keynote
  - How to make videos in Quicktime Player
- CT Protocols
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- RECIST 1.1
  - RECIST 1.1 - examples
  - RECIST 1.1 - and more
  - RECIST 1.1 - the basics

Overview

In this cervical lymph node map the levels were extended to 10.

Some of these are being divided into sub-levels to correspond more completely with the TNM atlas.

Borders

Important landmarks are:

Hyoid bone
Cricoid
Carotids
Sternocleidomastoid muscle
Manubrium of sternum

Axial CT

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Axial CT slices in correlation to overview illustration.

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Axial CT slices in more detail.Enlarge images by clicking on them.

Levels

I - Submental and submandibular

Nodes in level I are at risk of developing metastases from cancers of the oral cavity, anterior nasal cavity and the soft tissues of the mid-face and the submandibular gland.

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Level Ia is a median region located between the anterior belly of the digastric muscles, which contains the submental nodes.

Level Ib contains the submandibular nodes located in the space between the inner side of the mandible laterally and the digastric muscle medially, from the symphysis menti anteriorly to the submandibular gland posteriorly.

II - Upper jugular

Level II receives lymphatics from the face, the parotid gland, and the submandibular, submental and retropharyngeal nodes. Level II also directly receives the collecting lymphatics from the nasal cavity, the pharynx, the larynx, the external auditory canal, the middle ear, and the sublingual and submandibular glands [1].

Level II can be divided into level IIa and level IIb by drawing a line at the posterior edge of the internal jugular vein.

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The nodes in level IIa and IIb are at risk of harboring metastases from cancers of the nasal and oral cavity, nasopharynx, oropharynx, hypopharynx, larynx and major salivary glands.

Level IIb is more likely associated with primary tumors of the oropharynx or nasopharynx, and less frequently with tumors of the oral cavity, larynx or hypopharynx [1].

III - Mid jugular

Level III receives efferent lymphatics from levels II and V, and some efferent lymphatics from the retropharyngeal, pretracheal and recurrent laryngeal nodes. It collects the lymphatics from the base of the tongue, tonsils, larynx, hypopharynx and thyroid gland.

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The inferior border of the cricoid is the border between level III and IVA.

Nodes in level III are at risk of harboring metastases from cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.

IV - Lower jugular and medial supraclavicular

The border between level IVa and IVb is set arbitrarily 2 cm cranial to the sterno-clavicular joint.

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Level IVa These nodes are at risk for harboring metastases from cancers of the hypopharynx, larynx, thyroid and cervical esophagus.Rarely metastases from the anterior oral cavity may manifest in this location with minimal or no proximal nodal disease.

Level IVb These nodes are at risk for harboring metastases from cancers of the hypopharynx, subglottic larynx, trachea, thyroid and cervical esophagus.

V - Posterior triangle and Supraclavicular

Level V contains the nodes of the posterior triangle group located posteriorly to the sternocleidomastoid muscle around the lower part of the spinal accessory nerve and the transverse cervical vessels.

Nodes in level V are most often associated with primary cancers of the nasopharynx, the oropharynx, the cutaneous structures of the posterior scalp, and the thyroid gland.

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Level Vc - Supraclavicular

This level contains the lateral supraclavicular nodes located in the continuation of the posterior triangle nodes (level Va and Vb) from the cervical transverse vessels down to a limit set arbitrarily 2 cm cranial to the sternal manubrium. It corresponds partly to the area known as the supraclavicular fossa.

Level Vc receives efferent lymphatics from the posterior triangle nodes (level Va and Vb) and is more commonly associated with nasopharyngeal tumors [1].

Transverse cervical arteryScroll through the images for the anatomy of the transverse cervical artery.

VI - Anterior cervical

This level contains the superficial anterior jugular nodes (level VIa) and the deeper prelaryngeal, pretracheal, paratracheal and recurrent laryngeal nerve nodes (level VIb).

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Level VIa This level contains the superficially located anterior jugular nodes.

Level VIbThis level is contained between the medial borders of the common carotid arteries. The nodes in this area are:

pre-laryngeal nodes in front of the larynx and cricoid
pre-tracheal nodes in front of the trachea
paratracheal nodes also called recurrent laryngeal nerve nodes

Delphian lymph node

The Delphian lymph node derived its name from the oracle of Delphi, whose prophecy would be a death secondary to laryngeal cancer.

It is a pretracheal node in level VIa located anterior to the cricoid and in between the cricothyroid muscles.

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The recurrent laryngeal nerves branch off the vagus, the left at the aortic arch, and the right at the right subclavian artery.

The left laryngeal nerve can be compressed by subaortic lymph node metastases in the aorto-pulmonary window as seen in patients with lung cancer.

VII - Retropharyngeal and retrostyloid

Retropharyngeal nodes receive lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate.

These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

Level VIIa - retropharyngeal

These nodes lie within the retropharyngeal space, extending cranially from the upper edge of the first cervical vertebrae (massa lateralis) to the cranial edge of the body of the hyoid bone caudally (figure).

This space is bounded anteriorly by the pharyngeal constrictor muscles and posteriorly by the longus capitis and longus colli muscles. Laterally, the retropharyngeal nodes are limited by the medial edge of the internal carotid artery.

Retropharyngeal nodes receive efferent lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate. These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

Level VIIb - retrostyloid

The retro-styloid nodes are the cranial continuation of the level II nodes. They are located in the fatty space around the jugulo-carotid vessels up to the base of skull at the jugular foramen.

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The retro-styloid space is delineated by the internal carotid artery medially, by the styloid process and the deep parotid lobe laterally, by the vertebral body of C1 and the base of skull posteriorly and by the pre-styloid para-pharyngeal space anteriorly.

VIII - Parotid

This level contains the parotid node group, which includes the subcutaneous pre-auricular nodes, the superficial and deep intraparotid nodes and the subparotid nodes.

These nodes extend from the zygomatic arch and the external auditory canal down to the mandible.

They extend from the subcutaneous tissue laterally to the styloid process medially, and from the posterior edge of the masseter and the pterygoid muscles anteriorly to the anterior edge of the sternocleidomastoid muscle and the posterior belly of the digastric muscle posteriorly [1].

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The parotid group receive lymphatic from the frontal and temporal skin, the eyelids, the conjunctiva, the auricle, the external acoustic meatus, the tympanum, the nasal cavities, the root of the nose, the nasopharynx, and the Eustachian tube.

They are at risk of harboring metastases from cancers of the frontal and temporal skin, orbit, external auditory canal, nasal cavities and parotid gland.

IX - Buccofacial

Level IX contains the malar and bucco-facial node group, which includes inconsistent superficial lymph nodes around the facial vessels on the external surface of the buccinator muscle. These nodes extend from the caudal edge of the orbit (cranially) down to the caudal edge of the mandible (caudally) where they reached level Ib.

They lay on the buccinators muscle (medially) in the sub-cutaneous tissue, from the anterior edge of the masseter muscle and the Bichat’s fat pad (posteriorly) to the anterior sub-cutaneous tissue of the face.

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The bucco-facial nodes receive efferent vessels from the nose, the eyelids, and the cheek.

They are at risk of harboring metastases from cancers of the skin of the face, the nose, the maxillary sinus (infiltrating the soft tissue of the cheek) and the buccal mucosa.

X - Retroauricular and occipital

Level Xa contains the retroauricular (also called mastoid) and subauricular nodes, which includes superficial nodes lying on the mastoid process from the cranial edge of the external auditory canal cranially to the tip of the mastoid caudally.

Level Xb contains the occipital lymph nodes, which are the cranial and superficial continuation of the level Va nodes up to the cranial protuberance. They lie from the posterior edge of the sternocleidomastoid muscle to the anterior (lateral) edge of the trapezius muscle.

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Lymph node metastases in level X are from skin cancers of the retro-auricular area (Xa) and skin cancers of the occipital area (Xb).

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Tag » Where Are The Occipital Lymph Nodes

Cervical Lymph Node Map - The Radiology Assistant

Acute Abdomen

Anal cancer

Abdominal wall

Adrenals

Aorta

Biliary system

Bladder

Bowel

Chest radiology for Abdominal radiologists

Gynaecology

Kidney

Liver

Ovarium

Pancreas

Peritoneum

Prostate

Rectum

Ultrasound

BI-RADS

Calcifications

Breast Cancer

Breast Prosthesis

Mammography

Male Breast

MRI

Ultrasound

Anatomy

CAD-RADS

Cardiomyopathy

Devices

Peripheral MRA

Pearls...

Pulmonary Hypertension

Thoracic Aorta

Airways

Chest X-Ray

COVID-19

Cystic Lung Disease

Esophagus

HRCT

Lung anatomy

Lung Cancer

Mediastinum

Pearls

Pulmonary nodules

Solitary Pulmonary Nodule

Tuberculosis

Thymus

Cervical Nodes

Esophagus

Infra- and suprahyoid neck

Tumors

Orbita

Paranasal Sinuses

Swallowing

Temporal Bone

Tinnitus

TI-RADS

Trigeminus

Ankle

Arthritis

Bone Tumors

Cases - pearls in radiology

Diabetic foot

Elbow

Hip

Knee

Muscle

Shoulder

Spine

Stress fractures

Ultrasound

Wrist

Anatomy

Brain Ischemia

Brain Tumor

Carotid Pathology

Dementia

Enhancement Patterns