Salivary Gland Cancer Stages & Treatment – Dana-Farber Cancer Institute

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About Salivary Gland Cancer

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  Salivary gland cancer: a rare disease in which malignant
  (cancer) cells form in the tissues of the salivary glands

  Salivary gland cancer is a rare cancer that forms in
  tissues of the gland in the mouth that makes saliva. Most salivary gland
  cancers occur in older people. Being exposed to certain types of radiation may
  increase the risk of salivary cancer. Signs of salivary gland cancer include a
  lump or trouble swallowing.

  Learn about salivary gland cancer, and find information
  on how we support and care for adults with salivary gland cancer before,
  during, and after treatment.

  The following information is from the National Cancer
  Institute (NCI).




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Secondary cancer and the lymph nodes

About the lymph nodes

The lymphatic system helps protect us from infection and disease. It is made up of fine tubes called lymphatic vessels. These vessels connect to groups of small lymph nodes throughout the body.

The lymphatic system drains lymph fluid from the body’s tissues before returning it to the blood.

Image: The lymphatic system

Lymph nodes are sometimes called lymph glands. They filter bacteria (germs) and disease from the lymph fluid. When you have an infection, some lymph nodes may swell as they fight the infection.

About secondary cancer in the lymph nodes

The place where a cancer starts in the body is called a primary cancer. Sometimes, cancer cells spread to other parts of the body through the bloodstream or the lymphatic system.

Secondary cancer in the lymph nodes happens when cancer cells spread to the lymph nodes from cancer that started somewhere else in the body.  

This may be lymph nodes near to where the cancer started. Or it may be lymph nodes further away in a different part of the body.

Primary cancer of the lymph nodes is when cancer starts in the lymph nodes. This is called lymphoma.

Secondary cancer in nearby lymph nodes

Sometimes, cancer is found in lymph nodes near to where the cancer started. For example, breast cancer cells may travel to lymph nodes in the armpit (axilla) or above the collar bone (clavicle).

If a surgeon removes a primary cancer, they often also remove some of the nearby lymph nodes. The lymph nodes are examined under a microscope to see if there are any cancer cells in them.

The risk of the cancer coming back may be higher if the nearby lymph nodes contain cancer cells. Your doctor may suggest you have more treatment after surgery to reduce this risk.

Secondary cancer in nearby lymph nodes is often treated differently to secondary cancer in distant lymph nodes – these are lymph nodes further away from the primary cancer.

Secondary cancer in distant lymph nodes

Cancer cells can travel through the lymphatic system to lymph nodes further away from where the cancer started. These are called distant lymph nodes. If cancer cells have spread to distant lymph nodes, it is called secondary or metastatic cancer.

Sometimes, cancer cells can be in distant lymph nodes even when no cancer cells are found in nearby lymph nodes. But this is less common.

Under a microscope, cancer cells in the distant lymph nodes look like cells from the primary cancer. For example, when lung cancer spreads to distant lymph nodes, the cancer cells look like lung cancer cells.

The aim of treatment in this situation is usually to destroy as many cancer cells as possible. This can help control the cancer.

Related pages

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  What is cancer?
  

The most common symptom of cancer in the lymph nodes is that 1 or more lymph nodes become swollen or feel hard. But if there are only a few cancer cells in the lymph nodes, you may not notice any changes.

If the swollen lymph nodes are deep inside the chest or tummy (abdomen), you will not be able to see or feel them. But they may be visible on a CT scan.

Often there are no symptoms of cancer. But sometimes swollen lymph nodes press on nearby organs or tissue. This can cause symptoms. For example, lymph nodes pressing on the lungs may cause breathlessness.

If lymph nodes press on the blood vessels, they can slow the flow of blood. This can cause the area to become swollen. It can sometimes lead to a blood clot forming. Symptoms of a blood clot include pain and redness or swelling in a leg or arm.

If you have any of these symptoms, contact your doctor straight away.

Sometimes, cancer in the lymph nodes can block the flow of lymph fluid in that part of the body. If this happens in the arm or groin, a build-up of fluid can cause swelling in the arm or leg. This is called lymphoedema.

Some people may also notice general symptoms of cancer, such as:

• loss of appetite
• weight loss
• tiredness.

Always contact your doctor straight away if you have symptoms. It is important to remember that lymph nodes can be swollen for other reasons, such as infections. But if you are worried, talk to your doctor or nurse.

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Secondary cancer in the lymph nodes may be diagnosed at the same time as the primary cancer. It may also be found during routine tests and scans after treatment.

If a lymph node close to the surface of the skin is affected, your doctor may be able to see it or feel it. If the lymph node is deep inside the chest, tummy or pelvis, only a scan can find it.

If you have had cancer before, you may only need a scan to diagnose secondary cancer in the lymph nodes. This may be one or more of the following:

• A CT scan takes a series of x-rays, which build up a 3D picture of the inside of the body.

• An MRI scan uses magnetism to build up a detailed picture of the inside of your body.

• An ultrasound scan uses sound waves to build up a picture of internal organs.

• A PET-CT scan is a combination of a CT scan and a PET scan. PET-CT scans give more detailed information about the part of the body being scanned. 

Some people may have a sample of cells taken from the lymph node. This is called a biopsy. This test checks for cancer cells.

You may have a biopsy if it has been a long time since you were first diagnosed with cancer.

Your cancer doctor or nurse will tell you what tests you will have and when you might get the results.

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  Going for tests
  
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  Just been diagnosed?
  

Treatment for secondary cancer in the lymph nodes depends on your situation. Your cancer doctor will look at the type of primary cancer and your general health.

Treatments aim to destroy as many of the cancer cells as possible. You may have a combination of treatments, which can be more effective. Treatment may include:

• surgery
• chemotherapy
• hormonal therapy
• radiotherapy
• targeted therapy
• immunotherapy.

Supportive or palliative care is also used to manage symptoms caused by cancer.

Many people think this type of care is only given to people at the end of life. Supportive and palliative care is more common in people with advanced cancer. But you may also have it if your symptoms are more difficult to control.

Your cancer doctor or GP can refer you to doctors and nurses who specialise in symptom control.

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  Your treatment options
  
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  Preparing for treatment
  

Finding out that the cancer has spread or come back may be even more upsetting than hearing for the first time that you have cancer. You may have many different feelings, including:

• anxiety
• uncertainty
• fear
• anger.

These are all normal reactions.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends. Others would rather get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is available if you need it.

We have more information about:

• cancer and your emotions
• coping with advanced cancer.

Macmillan is also here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online
• Visit our secondary lymph nodes cancer forum to talk with people who have been affected by secondary cancer in the lymph nodes – you can also share your experience, and ask an expert your questions.

We are committed to making our website as accessible as possible, to make sure that everyone can use it.

For braille and large print on request, please email [email protected].

Explore our alternative formats

Find accessible cancer information in a format that works for you.

• Below is a sample of the sources used in our secondary cancer in the lymph nodes information. If you would like more information about the sources we use, please contact us at [email protected]

  Mercadante AA, Tadi P. Histology, Lymph Nodes. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. PMID: 32644479.

  BMJ Best Practice Online Assessment of lymphadenopathy. Updated Jan 2023.

• This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

  Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
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We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

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What does USDG and DS of the neck show?

Contents

• 1 What can be seen during ultrasound and DS of the neck?
  • 1.1 Anatomy of the neck
  • 1.2 Duplex ultrasound of the head and neck vessels
  • 1.3 Diagnosis of thyroid diseases
  • tissue density in the neck
  • 1.6 Determining the presence of cysts and tumors in the neck
  • 1.7 Identification of disorders in the blood supply to the head and neck
  • 1.8 Determination of the causes of pain in the neck
  • 1.9 Establishment of pathological changes in the cervical spine
  • 1. 10 Assessment of the condition of the muscular tissue of the neck
  • 1.11 Identification of herniated discs
  • 1.12 Diagnosis atherosclerosis of the carotid arteries
  • 1.13 Study of the degree of narrowing of the carotid arteries
  • 1.14 Determining the presence of blood clots in the head and neck vessels
  • 1.15 Diagnosing complications from head and neck injuries
  • 1.16 Identification of disorders in the functioning of the nervous system responsible for the innervation of the head and neck
  • 1.17 Recommendations for the treatment of diseases and pathological conditions detected by ultrasound and DS of the neck
  • 1.18 Video on the topic:
  • 1.19 Question-answer:
    • • 1.19.0.1 What diseases can USG and DS of the neck detect?
      • 1.19.0.2 How often is it recommended to undergo an ultrasound scan and DS of the neck?
      • 1.19.0.3 Is it necessary to prepare for an ultrasound scan and DS of the neck?
      • 1. 19.0.4 Can ultrasound and DS of the neck be painful?
      • 1.19.0.5 Who performs ultrasound and DS of the neck?
      • 1.19.0.6 Is hospitalization required after undergoing an ultrasound scan and DS of the neck?
      • 1.19.0.7 Is it possible to get a false-positive result of USG and DS of the neck?

Ultrasound and DS of the neck are diagnostic methods that allow you to see the condition of the thyroid and esophagus, arteries and veins, lymph nodes, the presence of cysts and tumors. Find out what they can show and how to prepare for the study.

Neck ultrasound (ultrasound) is a diagnostic method used to examine the internal organs of the neck, such as the thyroid gland, lymph nodes, esophagus and blood vessels.

USG of the neck allows to assess the functioning of the thyroid gland, the presence of a tumor in it, to determine the size and structure of the lymph nodes, to assess the condition of the blood vessels and the esophagus.

Ultrasonography of the neck can detect various diseases, such as inflammation of the thyroid gland, severe iodine deficiency, thyroid tumor, cervical cancer, disease of the lymph nodes and much more.

In addition, neck ultrasound is non-invasive and has no side effects, which makes it possible to use this method for diagnosis even during pregnancy.

Neck DS (Duplex Scan) is a neck vascular examination that is performed to evaluate the functioning of the arteries and veins of the neck.

Neck DS allows you to assess the condition of blood vessels, determine the presence of nodes and tumors, as well as detect the presence of blood flow disorders in venous and arterial vessels.

Additionally, the method is non-invasive, has no side effects and can help detect various diseases such as thrombosis, varicose veins, atherosclerosis, arteritis, etc.

Anatomical information about the neck

. It is made up of many elements such as vertebrae, muscles, blood vessels, lymph nodes, and nerves. It is also a key part of the muscular and skeletal system that provides head movement and provides support for many other important organs.

The neck is made up of seven vertebrae, which are separated by intervertebral discs. These vertebrae are responsible for the flexibility and support of the head. In addition, they also protect the spinal cord and the nerves that pass through the spinal canal.

Neck muscles are located both medially (internal) and laterally (external). The oropharynx, laryngothreal ligaments, and pharyngeal muscles are also found in the neck. The muscles of the neck and larynx work together to enable vocal communication and breathing. The blood vessels of the neck are venous and arterial vessels that provide blood supply to the head and neck. The lymph nodes in the neck are able to detect and filter out harmful bacteria and other microorganisms.

Information about the anatomy of the neck is essential for understanding the results of USG and DS of the neck, since only knowledge of the complete anatomical structure of the neck allows one to understand the measurements and their meanings.

Ultrasound duplex scanning of the head and neck vessels

Ultrasound duplex scanning (USDG) is one of the most informative methods for diagnosing diseases of the head and cervical vessels. It allows you to assess the state of blood vessels with high accuracy, visualize blood flow and determine the speed of blood flow.

Ultrasound of the neck is used to diagnose stenosis (narrowing) and occlusion (closure) of the internal and external carotid arteries, as well as to assess the condition of the thyroid gland and lymph nodes. It allows you to identify the ability of blood flow to pass through constrictions, as well as determine the presence of blood clots and tumors.

Ultrasound of the head is performed to diagnose brain diseases, as well as to assess the condition of the internal and external carotid arteries. It allows you to determine the degree of vasoconstriction and determine the cause of impaired blood supply to the brain.

When performing ultrasound, the patient lies on the couch, the specialist conducts an examination using a special device that transmits ultrasonic waves through the skin to the vessels. In this case, a gel is used for better signal transmission. The study is absolutely painless and does not require special preparation.

In general, ultrasound is a safe and effective method for diagnosing diseases of the head and neck. The results of the study help the doctor choose the right treatment and decide on the need for additional studies.

Diagnosis of thyroid disease

The thyroid gland is a hormonal gland located in the neck that plays a key role in regulating metabolism. Various thyroid diseases can cause significant changes in the body, so early diagnosis is very important.

There are several methods for diagnosing thyroid disorders, including:

• Diagnostic ultrasound (US) is a commonly used method to determine the size, shape, texture and structure of the thyroid gland. This method can also be used to detect nodules and small tumors inside the thyroid gland.
• Advanced Scan (DS) is a method that is used to evaluate thyroid function. It allows you to determine the level of thyroid hormones in the blood and detect the presence of autoimmune thyroid diseases, such as heshimoto thyroiditis.
• Biopsy is a test used to detect thyroid cancer. This involves taking a small sample tissue under ultrasound guidance and then examining it in a laboratory.

Your doctor may recommend one or more of these tests to diagnose thyroid problems and determine the most effective treatment for each individual case.

Cervical Lymph Node Examination

Neck ultrasound and DS are used to study the lymph nodes in the neck, which are important elements of the body’s immune system. They act as a filter, protecting the body from bacteria, viruses and other microorganisms. If the lymph nodes are inflamed, this may indicate an infection or other disease.

During an ultrasound scan of the neck, the scientist uses ultrasound waves to image the lymph nodes in the neck. This allows you to determine their size, structure and shape. If the lymph node is enlarged or has an atypical shape, this may indicate a possible disease.

DS neck allows you to study the condition of the lymph nodes, arteries, veins and other tissues in the neck. The data obtained can help in the diagnosis of diseases and the choice of optimal treatment.

Usually USDG and DS of the neck are prescribed in the following cases: in the presence of pain in the neck, swollen lymph nodes, signs of infection or oncological pathology. It is necessary to conduct regular examinations to identify possible deviations in the work of the body.

• The study of the cervical lymph nodes allows:
• Early detection of a possible disease
• Determine the optimal treatment
• Prevent the development of serious complications

Ultrasound and DS of the neck does not cause much discomfort. They are considered safe and do not require special preliminary preparations. However, in case of pain and discomfort in the neck area, it is necessary to consult a doctor.

Examination of the cervical lymph nodes is an important component of the examination for suspected disease. Only timely and effective treatment can achieve good results and restore health.

Determination of the size, structure and density of tissues in the neck

USG and DS of the neck allow to determine the size, structure and density of the tissues of the patient’s neck. Using the ultrasound method, you can examine the thyroid gland, lymph nodes, blood vessels and soft tissues.

Particular attention is paid to the size and structure of the thyroid gland, which may be enlarged or have nodules. The presence and characteristics of superficial and deep lymph nodes and vessels of the neck, which can be affected by various diseases, are also determined.

Determination of tissue density makes it possible to differentiate healthy tissues from tumor or inflammatory changes, which is an important diagnostic criterion.

• USG and DS of the neck can be used for:
• — Diagnosis of diseases of the thyroid gland, lymph nodes and vessels of the neck
• — Control of the effectiveness of treatment and the dynamics of changes in the tissues of the neck
• — Planning of surgical interventions and biopsy

9000 2 In general, UZDG and DS of the neck are non-invasive, painless and safe diagnostic methods that allow you to get maximum information about the state of neck tissues, which makes them very valuable in clinical practice.

Determination of the presence of cysts and tumors in the neck

Ultrasound examination (ultrasound) of the neck is one of the key methods for detecting cysts and tumors in this area. It can be done for both diagnosis and treatment.

Ultrasound allows you to assess the patient’s anatomy, determine the location of cysts and tumors, their size, diameter, shape and consistency. In addition, by combining ultrasound and Doppler ultrasound, it is possible to determine the presence of blood flow in the tumor and its type, which makes it possible to conduct an accurate differential diagnosis of various types of tumors, both malignant and benign.

Since cysts and tumors can be hidden and lead to serious complications, regular ultrasound of the neck is essential in the prevention and treatment of these conditions.

Important note: If you have any symptoms such as lumps, swollen lymph nodes, tenderness or pain when you turn your head, you should see a doctor for further evaluation and determine the necessary treatment measures.

Detection of disorders in the blood supply to the head and neck

UZDG and DS of the neck are research methods that allow to detect circulatory disorders in the head and neck. These methods can be used both for preliminary diagnosis and for monitoring the effectiveness of treatment.

Ultrasound allows you to evaluate blood flow in the vessels of the neck and head, as well as to detect the presence of blood clots and vasoconstriction, which can cause various diseases, such as osteochondrosis, migraine, dizziness, atherosclerosis, etc.

DS of the neck is a more detailed method of examination, which allows to detect the presence of circulatory disorders in the brain, such as cerebral atherosclerosis, hypoxia and strokes. This method allows you to get a more accurate diagnosis and choose the appropriate treatment.

Identification of disorders in the blood supply to the head and neck is an important step in the diagnosis and treatment of many diseases. Early detection and proper treatment can significantly increase the effectiveness of therapy and reduce the risk of complications.

Determination of the causes of neck pain

Neck pain can be caused by various causes, such as osteochondrosis, muscle spasms, injuries and even thyroid pathologies. To determine the exact diagnosis and choose the optimal method of treatment, it is necessary to conduct a full examination, which includes ultrasound examination of the neck (USDG) and dopplerography of the vessels of the neck (DS).

Ultrasound allows you to assess the condition of various tissues of the neck, such as muscles, tendons and blood vessels. With the help of ultrasound, pathologies such as tumors, cysts, lymph nodes and hernias of the cervical spine can be detected.

Neck vascular Doppler can detect blood flow disorders in the neck vessels such as stenosis, occlusion or atherosclerosis. These disorders can be caused by various causes, such as hypertension or thrombophilia. Identification of these disorders allows you to correctly assess the risk of stroke or heart attack.

Thus, USDG and DS of the neck are an integral part of a comprehensive examination of patients complaining of neck pain. These methods allow you to accurately determine the cause of pain and choose the best method of treatment.

Establishment of pathological changes in the cervical spine

Ultrasound diagnosis of the cervical spine (USDG) allows you to accurately determine the presence of pathological changes in the spine. The main causes of violations of the structure of the spine are herniated intervertebral discs, deformities of the vertebrae, nodular enlargement of the cervical lymph nodes.

With the help of ultrasound, specialists detect the following changes in the cervical spine:

1. Herniated discs. Ultrasound helps to determine the shape, size, location and degree of compression of the surrounding tissues of the hernia. To control the dynamics of the disease, repeated ultrasound is performed after a certain period of time.
2. Vertebral deformities. Ultrasound scan allows you to identify various deformations of the vertebrae: curvature, deflections, scoliosis and others.
3. Nodular enlargement of the cervical lymph nodes. Ultrasound allows you to accurately determine the size, number and structure of the nodules. This helps specialists to establish a diagnosis and choose the most effective treatment.

Additionally, Doppler ultrasound (DS) is used to more accurately detect pathological changes in the cervical spine. This is a method that allows you to see the blood flow in the vessels of the head and cervical spine, which is important information for diagnosing the disease.

Thus, the use of ultrasound and DS allows to detect pathological changes in the cervical spine at the früher stage, clarify the diagnosis, control the dynamics of the disease and choose the most effective treatment.

Evaluation of the state of the muscular tissue of the neck

Ultrasound and DS of the neck allow the evaluation of the state of the muscular tissue of the neck. Using ultrasound, you can determine the degree of tension and expansion of the muscles, as well as the presence of inflammatory processes in them.

When the muscle tissue of the neck is imbalanced, various disorders may occur, such as headache, neck tension, movement restriction, nausea, etc. These methods help to identify such disorders and take measures for their treatment.

When assessing the state of muscle tissue, such indicators as the thickness of the muscle layer, echostructure, echogenicity level, etc. are usually used. Based on the results of the values ​​of these parameters, conclusions can be drawn about the degree of changes in the muscles and the need for treatment.

It is important to note that USG and DS of the neck are not the only methods for evaluating neck muscle tissue. The doctor may use other methods, depending on the individual characteristics of the patient and the nature of his disease.

Detection of herniated discs

Ultrasound and DS of the neck are one of the most popular methods for detecting herniated discs in the cervical spine. These are non-invasive diagnostic methods that allow you to get a detailed image of soft tissues and determine the presence of a hernia.

A herniated disc occurs when the heart-shaped medial part of the disc protrudes beyond its edges during degeneration or injury. The main symptoms of a hernia are pain in the neck, shoulder, and arm, numbness in the fingers, and weakness in the muscles.

Ultrasound and DS of the neck allow you to accurately determine the location and nature of the hernia, as well as assess the condition of the surrounding tissues and blood vessels. This helps to choose the most effective treatment method and prevents possible complications.

Ultrasound and DS of the neck do not require special preparation of the patient, and the procedures themselves are safe and do not interrupt the normal rhythm of life.

It is important to note that USDG and DS of the neck are not the only methods for diagnosing herniated intervertebral discs and cannot replace a full examination and consultation with a specialist. However, they effectively complement complex diagnostics and provide a more accurate diagnosis.

Diagnosis of atherosclerosis of the carotid arteries

Atherosclerosis of the carotid arteries is a serious disease that can lead to cardiovascular disease, stroke and even death. But how can you determine the presence of this disease?

One of the methods for diagnosing atherosclerosis of the carotid arteries is ultrasound (doppler ultrasound). This method allows you to evaluate the speed of blood flow in the carotid arteries and identify abnormalities in the work of this blood vessel. The doctor can also detect the presence of atherosclerotic plaques and assess the extent of their development.

In addition, another method for diagnosing carotid atherosclerosis is DS (duplex scanning). This method also uses ultrasonic waves and allows a more accurate assessment of the degree of atherosclerosis of the carotid arteries. This method allows you to get an image of the vessels, which makes the diagnosis more efficient and accurate.

After diagnosing atherosclerosis of the carotid arteries, the doctor can prescribe the necessary treatment for the patient. This can usually be a lifestyle change, medication, or surgery to remove atherosclerotic plaque from the carotid arteries.

In general, the diagnosis of carotid atherosclerosis is an important process that helps to identify the disease at an early stage and prevent possible complications in the future.

Examination of the degree of narrowing of the carotid arteries

Ultrasound examination of the carotid arteries (USA of the neck) is a non-invasive diagnostic method that allows you to determine the degree of narrowing of the carotid arteries and identify possible causes of swelling and noises in the head.

During an ultrasound scan of the neck, the doctor evaluates the diameter of the carotid arteries, the speed of blood flow and the presence of bends and narrowings. This method makes it possible to determine the percentage of arterial wall area and free space, which is a key indicator of the degree of narrowing.

The Doppler velocity curve obtained with ultrasound reveals the presence of turbulent bleeding in the narrowed part of the artery. This indicator is important for assessing the degree of risk of blood clots and high blood pressure.

Ultrasound of the neck is a fast and safe method that does not cause pain and does not require special training. This type of diagnosis allows you to timely detect the presence of stenosis of the carotid arteries, which can cause a stroke and other serious disorders in the body.

Determining the presence of blood clots in the head and neck vessels

Dopplerography of the vessels of the head and neck is one of the methods for diagnosing the presence of blood clots and their degree. The method is based on the use of ultrasonic waves to visualize blood vessels and determine the presence of possible obstructions.

Doppler ultrasound can detect the following changes:

• slower blood flow in the blood vessels;
• vasoconstriction;
• the presence of blood clots in the vessels;
• violation of normal blood flow.

If these changes are present, a specialist can make a diagnosis and prescribe the necessary treatment. Doppler ultrasound is safe and does not require special training, and its results are highly accurate and reliable.

Thus, Doppler sonography becomes an indispensable method for diagnosing the presence of blood clots in the head and neck vessels, providing early detection and prevention of possible complications.

Diagnosis of complications from head and neck injuries

After a head and neck injury, various complications are possible, which are important to identify as soon as possible. For this, special diagnostic methods are carried out, including ultrasound (ultrasound) and duplex scanning (DS).

Ultrasound examines the soft tissue and blood vessels of the head and neck. With this procedure, doctors can detect the presence of bruising, the presence of tumors and pathological formations in the vessels. Ultrasound can also help determine traumatic burns, hemorrhages, and the extent of tissue damage.

DS is a procedure for examining blood flow in blood vessels. With the help of DS, it is possible to detect violations of the blood supply to the brain and determine the degree of vascular permeability. DS is also used to diagnose thrombosis, vasodilation and narrowing, and other pathologies.

Thus, ultrasound and DS are important tools for diagnosing complications after head and neck trauma. The results of these procedures can help doctors prescribe the most effective therapy and prevent possible complications in the future.

Identification of disorders in the nervous system responsible for the innervation of the head and neck

Ultrasound and dopplerography of the neck can detect disorders in the nervous system responsible for the innervation of the head and neck. Most often, such studies are prescribed for headaches, tinnitus, dizziness, visual and hearing impairments.

In order to conduct such an examination, it is necessary to prepare: do not eat 2-3 hours before the procedure, come with an empty bladder. The study itself is carried out on a special couch, the patient lies on his back and turns his head towards the vessel under study. During the procedure, the doctor will apply a glossy gel to the neck, this will allow you to get a clearer image of the cervical vessel.

Ultrasound and DS of the neck can detect such changes in the cervical vessels as: a change in the diameter of the vessel, the presence of folds, thickenings or blood clots. The reason for such changes can be different: from metabolic disorders to hypertensive crisis.

Also, with the help of such a study, it is possible to identify disorders in the work of the nervous system, which is responsible for the innervation of the head and neck. For example, vascular obstruction can lead to headaches, and changes in vascular diameter can cause dizziness. However, it is impossible to make a diagnosis only on the basis of ultrasound and DS of the neck, since the same changes can be observed in other diseases, so the doctor will definitely prescribe additional studies and make a final diagnosis.

Recommendations for the treatment of diseases and pathological conditions detected during ultrasound and DS of the neck

Cysts and tumors

If cysts and tumors are detected, monitoring of the dynamics is required and if growth is detected, consultation with an oncologist. If the cysts cause discomfort or are rough to the touch, surgical treatment is indicated.

Lymph nodes

If there is an increase in echogenicity or enlargement of the lymph nodes detected by ultrasound, a consultation with a pulmonary or oncological specialist is required. A biopsy may be needed.

Thyroid disease

If nodules, adenomas, cysts or masses with low echogenicity are found, an endocrinologist consultation is required. Depending on the extent of the lesion, treatment by thyroid users or surgery may be possible.

Inflammatory processes

If inflammatory processes are detected, laboratory diagnostics and, possibly, antibiotic therapy are required.

Hernia of the esophagus

If a hernia of the esophagus is detected, it is recommended to consult a surgeon and determine the need for surgical intervention.

Related videos:

Q&A:

What diseases can be detected by USG and DS of the neck?

Ultrasound and DS of the neck can show various diseases, including various types of tumors, hematomas, inflammation of the lymph nodes, cysts and abscesses.

How often is it recommended to undergo an ultrasound scan and DS of the neck?

The frequency of ultrasound examination and DS of the neck depends on age, symptoms and risk of the disease. It is usually recommended to do them once a year for people over 40 or those at risk of developing diseases such as thyroid or throat cancer.

Do I need to prepare for an ultrasound scan and DS of the neck?

Yes, for the most accurate results, it is recommended to follow some rules, such as not eating 8 hours before the examination, not smoking one hour before the procedure, and not applying creams or lotions to the neck.

Can USG and DS of the neck be painful?

No, the procedure is painless and non-invasive. In fact, most people don’t experience any sensations in the process.

Who performs ultrasound and DS of the neck?

Ultrasound and DS of the neck are performed by a specially trained ultrasound doctor who uses special equipment to obtain images of internal organs.

Is hospitalization required after USG and neck DS?

No, the procedure does not require hospitalization, and the patient can immediately return to normal life after its completion.

Is it possible to get a false-positive result of USG and DS of the neck?

Yes, some diseases can cause a false positive result, so it is recommended to perform several additional tests to confirm the result of ultrasound and neck DS.

Status of regional lymph nodes in chronic tonsillitis according to ultrasound data

Chronic tonsillitis (CT) is characterized by a significant prevalence (especially among children, people of working age) and an active role in the pathogenesis of numerous complications and comorbid diseases. Therefore, the timely diagnosis of CT, as well as the identification of adverse trends in the course of focal infection of the palatine tonsils, is an urgent task of modern otorhinolaryngology.

A number of pharyngoscope signs are traditionally used to diagnose CT [1]. However, their occurrence may be due not only to the presence of CT, but also to the peculiarities of the individual structure of the palatine tonsils, changes in the mucous membrane of various origins – due to limited pharyngitis, pharyngo-laryngeal reflux, postnasal syndrome, which to a certain extent reduces the diagnostic significance of these symptoms [1, 2 ].

Cicatricial adhesions of the tonsils with the palatine arches are considered as a consequence of constant irritation of the mucous membrane by the secreted pathological contents of the lacunae, and also as a consequence of previous exacerbations of chemotherapy. However, such changes may also be due to other factors, in particular, the features of the anatomy of the pre-, post- and supra-almond spaces, resulting in the impression of “fusion” of the tonsils with the arches [3].

A change in the consistency of the palatine tonsils is also not considered as a significant diagnostic sign, since chronic inflammation can develop both in tuberous, loosened, and in dense tonsils with a smooth surface. It is believed that such changes may be the result of not only pathological changes, but also the individual structure of the tonsils [4].

The presence of caseous or purulent contents in the lacunae of the palatine tonsils is a frequent but not constant sign of CT. The composition of lacunar “plugs” in patients with CT is represented by an accumulation of neutrophilic leukocytes and does not differ from the content of lacunae in healthy people. Often, when pressing on the palatine tonsils, the pathological discharge in the lacunae is not detected or, conversely, the presence of such changes is not associated with periodic exacerbations or complications of chemotherapy. In addition, attempts to detect pathological contents in the lacunae by pressing on the amygdala are not a safe procedure. It is noted that after such extrusion of “plugs” from the tonsil, there is a possibility of injury to the palatine arch, exacerbation of tonsillitis, the occurrence of an attack of rheumatism, and the development of tonsillogenic sepsis [4].

The results of bacteriological examination also have no significant diagnostic value in CT, since a diverse, including pathogenic, microflora (in particular, group A beta-hemolytic streptococcus) is found not only in CT patients, but in healthy carriers [5] .

Peripheral blood tests did not reveal any changes typical of CT, as a rule, outside the period of exacerbation of the disease, there are no diagnostically significant changes in the leukocyte formula, ESR, C-reactive protein [6].

Thus, the known clinical signs of a chronic inflammatory process in the pharynx are not typical for chemotherapy. Their occurrence may be due not only to CHT itself, but also to a number of other reasons, in particular, the anatomical structure of the pharynx, extraesophageal manifestations of gastroesophageal reflux disease, postnasal syndrome. This significantly complicates the diagnosis of CT, the determination of its clinical form and treatment tactics.

Currently, several methods have been proposed to improve the diagnosis of CT and determine its clinical form.

A method for diagnosing CT has been developed based on measuring the active resistance of the mucous membrane of the palatine tonsils using a passive electrode (under the tongue) and an active one – alternately on the surface of the right, then the left palatine tonsils [7]. Certain disadvantages of this method are the complexity of its implementation, the need to use electrodes in the oral cavity and oropharynx, as well as the fact that the values ​​of the measured parameters can be affected by changes in the mucous membrane of the oral cavity and pharynx that are not associated with chemotherapy.

For the purpose of differential diagnosis of compensated and decompensated forms of CT, a method of saliva infrared spectroscopy was proposed [8]. Depending on the values ​​of the indicator of the average transmittance of infrared radiation in the corresponding range, the authors differentiate the compensated or decompensated form of CT. However, this does not take into account the fact that, as in the previous case, the composition of saliva and, consequently, the values ​​of the infrared radiation transmittance can be affected not only by the presence or absence of CT, but also by the state of the oral cavity (teeth), the presence of diseases of the digestive system. , inflammatory changes in the pharynx of another etiology.

A method for diagnosing CT based on ultrasonic visualization of the palatine tonsils, in particular, the determination of the structure of the palatine tonsils, the presence of a compacted capsule, and various inclusions using ultrasound [9]. Noting the rather high information content of the method, it should be emphasized that these changes, detected by ultrasound, do not reflect the features of the clinical course of CT, the degree of compensation for the inflammatory process in the palatine tonsils.

At the same time, it is well known that one of the manifestations of CT is regional lymphadenitis, which is an increase in the mandibular (tonsillar) lymph nodes [4, 10, 11]. This, in particular, is due to the fact that the cervical lymph nodes are the first collectors for the palatine tonsils [12]. Deterioration of the drainage function of the lacunae during inflammation of the palatine tonsils is accompanied by a violation of lymphoepithelial symbiosis, the functional activity of the lymphoid tissue, and an inflammatory reaction, which leads to pathological changes in the regional lymph nodes [13], the frequency of which in CT, for example, in children reaches 86. 1% [14 ].

Thus, regional (upper-lateral cervical) lymph nodes are characterized by a reaction to infectious and autoimmune processes occurring in the palatine tonsils during CT, and the determination of the state of the lymph nodes in combination with other (anamnestic, pharyngoscopic) signs of a chronic infectious-inflammatory process in the palatine tonsils has important in the diagnosis of HT. However, the detection and adequate assessment of the state of the lymph nodes by palpation is not possible in all cases. The sensitivity and specificity of palpation detection of lymph nodes, according to some data, reaches 50-88% [15, 16], according to others, it ranges from 51.7 to 96.7% [17], and determining the state of deep lymph nodes during physical examination is almost impossible.

The low sensitivity and specificity of computed tomography in the study of lymph nodes, which are 65% and 86.7%, respectively, are emphasized [17].

Currently, one of the most informative methods for assessing the condition of the lymph nodes is ultrasound, the accuracy of which is more than 2 times higher than the results of palpation (73% and 32%, respectively) [18].

Given the above circumstances, it can be assumed that depending on the characteristics of the reactivity of the body, the severity of the infectious and inflammatory process in the palatine tonsils (simple and toxic-allergic forms of CT), the characteristics of the image of regional lymph nodes may also change.

The purpose of the study was to develop a method for the differential diagnosis of complicated (toxic-allergic) and uncomplicated (simple) forms of CT.

Patients and Methods

147 patients with CT were examined: 61 (42%) with simple form (Group 1) and 86 (58%) with toxic-allergic form of CT II degree (Group 2). Criteria for inclusion in the study: the presence of chronic inflammation of the palatine tonsils, the age of patients over 18 years. Criteria for exclusion from the study: the presence of inflammatory diseases of other localization, decompensated course of comorbidities, conditions that make it difficult to perform the study, the patient’s refusal to participate in the study, a history of tonsillectomy, age under 18 years.

The average age of the examined patients was 31.5±0.7 years. The ratio of men and women is 1:1.5.

All patients underwent ultrasonography of the upper lateral cervical lymph nodes located at the angle of the mandible and/or along the sternocleidomastoid muscle.

The study was carried out on a Toshiba Aplio 500 apparatus with linear sensors with an operating frequency of 5–12 MHz. Scanning was performed on both sides, determining the localization of the lymph nodes, their number (single, multiple), as well as the shape, size and structure.

The position of the patient during the examination is lying on his back, while the neck is extended, and the head is turned in the opposite direction from the examined half. When scanning, the sensor was placed above the skin in the submandibular region of the neck. The submandibular region was examined by transverse scanning along the lower border of the body of the mandible. The transducer was placed on the skin in the submandibular region of the neck, medially to the angle of the lower jaw in the posterior direction and cranially.

Deep lymph nodes were examined on a transverse scan along the internal jugular vein and common carotid artery from the parotid tail to the junction between the internal jugular vein and the subclavian vein.

When analyzing the ultrasound of the lymph nodes, their diameter (longitudinal, transverse), shape (bean-shaped, oval, ribbon-shaped), number, structure, characteristics of the central sections of the gate were evaluated; contours, vascularization of the lymph node; the state of the tissues of the perinodular zone.

At the same time, it was taken into account that chronic nonspecific lymphadenitis is characterized, in particular, by an increase (hyperplasia) of the lymphoid elements of the node, the multiplicity of lymph nodes involved in the process [19].

Statistical analysis of the study results was carried out using the IBM SPSS Statistics v.23 program. Fisher’s exact test was used to determine the statistical significance of differences in the frequency of occurrence of each feature in the study groups. When identifying the conjugation of several relative indicators among themselves, the criterion χ ² Pearson was used.

Results

Ultrasound of regional lymph nodes distinguished bean-shaped, oval and irregular shapes (Table 1) .

From the data of tab. 1 it can be seen that the irregular shape of the lymph nodes occurred with the same frequency in all examined patients ( p >0.05). For patients with a simple form of CT, the bean-shaped shape of the lymph nodes was more characteristic, and in patients with the toxic-allergic form of CT, the oval shape of the lymph nodes was significantly more common ( p <0.05).

Solitary superolateral cervical lymph nodes were found in 68.85±5.93% of patients with simple CT, with toxic-allergic CT in 46.51±5.38% ( p <0.05). Multiple regional lymph nodes were detected in 31.15±5.93% of patients in the 1st study group and in 53. 49±5.38% of patients in the 2nd group ( p <0.05).

Thus, according to ultrasound data, the simple form of CT is characterized by the presence of single cervical lymph nodes, while the toxic-allergic form of CT is characterized by multiple.

The cortex was clearly visualized in 96.72±2.28% of patients with simple CT and in 94.19±2.52% with toxic-allergic form. A less pronounced cortical substance was found in 3.28±2.28% and 5.81±2.52% of patients with simple and toxic-allergic forms of chemotherapy, respectively.

This indicator did not differ statistically in the study groups ( p >0.05).

The homogeneous zone of the hilum occurred with the same frequency in both study groups, and this indicator did not show statistically significant differences ( p >0.05).

However, the irregular shape of the hilum of the lymph nodes was absent in all patients with a simple form of CT, and among patients with a toxic-allergic form, this sign was detected in 12. 79±3.6% of patients ( p <0.05).

A clear contour of the lymph nodes was visualized in all patients with a simple form and in 95.35±2.27% of patients with a toxic-allergic form of chemotherapy. Blurred contours of the lymph node were not found in any patient of the 1st group and were observed in 4.65±2.27% of patients of the 2nd group. Differences in the frequency of occurrence in patients of the studied groups were not statistically significant ( p >0.05).

Ultrasound characteristic of the lymph node capsule was characterized by the predominance of a clearly differentiated capsule in patients of both groups – the differences in this indicator also did not reach statistical significance ( p >0.05).

In the study of the central parts of the lymph nodes, the following characteristics were distinguished: homogeneous, hyperechoic and hypoechoic (Table 2) .

Table 2. The frequency of occurrence of various characteristics of the central parts of the lymph nodes in patients with chronic tonsillitis

From the data of tab. 2 it follows that hyperechoic central parts of the lymph nodes occurred with the same frequency in patients of the 1st and 2nd groups ( p >0.05). However, homogeneous central lymph nodes were found significantly more often in patients with simple CT ( p <0.05), while hypoechoic central parts were more often observed in patients with toxic-allergic CT ( p <0.05 ).

When analyzing the ratio between the cortical and medulla of the lymph node, no statistically significant relationship was found between the form of CT and the quantitative ratio of the cortical and medulla ( p > 0.05) (Table 3) .

Table 3. Ratio of the cortex and medulla of the lymph node in patients with simple and toxic-allergic forms of chronic tonsillitis according to ultrasound data

The perinodular zone was characterized as normal, and also with signs of edema and fibrosis. In both studied groups, the normal state of the tissue of the perinodular zone of the lymph nodes occurred in most cases: group 1 — 96. 72±2.28%, group 2 — 97.67±1.63%. Edema was observed in isolated cases: group 1 — 3.28±2.28%, group 2 — 1.16±1.15% ( p >0.05).

When assessing the microangioarchitectonics of the lymph nodes, 3 main types of vascularization were differentiated: hypovascular type — in the Doppler study, the vessels in the lymph nodes are not visualized due to their small caliber and/or low blood flow velocity; normal type (with moderate blood flow) – single vessels are visualized in the lymph nodes – from 1 to a maximum of 5; hypervascular type (increased vascularization) – more than 5 vessels are determined (Table 4) .

Table 4. Types of lymph node vascularization in patients with simple and toxic-allergic forms of chronic tonsillitis according to ultrasound data

As can be seen from the data tab. 4 , the normal type of vascularization occurs with the same frequency in both forms of CT.

However, the simple form of CT is characterized by a hypovascular type, while the toxic-allergic form is characterized by a hypervascular type of lymph nodes.

When analyzing the association between the types of vascularization of the lymph nodes and the form of CT, their statistical relationship was revealed ( p <0.001).

B tab. 5 shows the frequency of detection of enlarged lymph nodes during palpation and analysis of the frequency of detection of enlarged lymph nodes (longitudinal diameter more than 10 mm) by ultrasound.

Table 5. Frequency of occurrence of enlarged lymph nodes in patients with various forms of chronic tonsillitis on palpation and ultrasound examination

In simple form of CT, enlarged lymph nodes were detected in 6.56±3.17% of patients on palpation and in 83.61±4.74% of patients on ultrasound — the difference is statistically significant (significance level of Fisher’s exact test p <0, 05).

In the toxic-allergic form of CT, enlarged lymph nodes were detected more often on palpation (27.91±4.84%), but they were found in 80.