Nekrotik lenf nodu

Özet

Nodal nekroz, lenf nodu içindeki dokunun düşük atenüasyonlu veya sıvılaşmış hale gelmesidir ve kontrastlı BT'de çoğu kez çevresel canlı doku ile sınır oluşturur. Bu görünüm metastaz, tüberküloz ve süpüratif enfeksiyon gibi farklı süreçlerde oluştuğu için tek başına etiyolojik tanı değildir. Kontrastlı BT'de lenf nodu çevresindeki infiltrasyon, nekroz odaklarının sayısı ve nekrozun derecesi servikal nekrotik lenfadenopatinin ayırıcı tanısında yardımcı olabilir. Apseleşmeyi ya da ekstranodal yayılımı gözden kaçırmak komşu boşluklara uzanan hastalığın kapsamını eksik gösterebilir.

Faz ve pencere

Portal tanısal

Kontrastlı venöz görüntüde nekrotik merkez canlı periferik nodal dokudan düşük atenüasyonla ayrılır; halka tarzı kontrastlanma, çevre yağlı dokuda inflamasyon ve komşu koleksiyon aranır. Kontrastsız seride merkez-perifer kontrast farkı değerlendirilemediğinden tanısal değerlendirme kontrastlı faza dayanır.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Mediasten (G 350 / M 50), Batın (G 400 / M 50).

BT bulguları

• Nod merkezinde kontrastlanmayan düşük atenüasyon; çevresinde korunmuş veya kalınlaşmış kontrastlanan yumuşak doku halkası.
• Tek ya da çok odaklı nekroz; odakların sayısı ve merkezdeki sıvılaşmanın yaygınlığı etiyolojik ipucu sağlar ama tek başına tanı koydurmaz.
• Tüberküloz lenfadenitinde birden fazla nekrotik lenf nodu konglomere görünüm oluşturabilir.
• Nod kapsülü dışına taşan bulanık kontur ve çevre yağ dokuda çizgilenme ekstranodal inflamasyon ya da tümör uzanımını düşündürür.
• Servikal nekrotik nodların çevresinde mukozal primer kitle; mediastinal nodlarda eşlik eden parankimal enfeksiyon odağı aranır.
• Merkezde gaz, bitişik fasyal aralıkta koleksiyon veya çevrede yaygın ödem süpüratif komplikasyonu destekler.

Normalde

Normal servikal nodlar kontrastlı görüntülerde homojen yumuşak doku yapıtısı gösterir ve belirgin bir hilus ya da merkezde sıvı yoğunluklu alan içermez; bu özellikleri nodülün patolojik olup olmadığını ayırt etmede referans alınır. Lenf nodu çevresindeki infiltrasyonu değerlendir; bu bulgu servikal nekrotik lenfadenopatilerin ayırıcı tanısında anlamlı bir öngördürücüdür.

Ayırıcı tanı

Skuamöz hücreli karsinom metastazı

düzensiz veya eksantrik nekroz, primer tümörle uyumlu drenaj istasyonu ve kapsül dışı uzanım eşlik edebilir.

Tüberküloz lenfadeniti

birden fazla istasyonda santral düşük atenüasyonlu, periferik kontrastlanan nodlar ve bazen nodal konglomeralar oluşturur.

Süpüratif bakteriyel lenfadenit

nod çevresinde ödem, belirgin inflamasyon ve sıvılaşmış apse boşluğu öne çıkar.

Lenfoma da nekrotik lenfadenopatiler arasında yer alabilir ve ayırıcı tanıda değerlendirilmelidir.

Kistik boyun lezyonu

düzgün sıvı içerik ve nodal doku kalıntısının yokluğu basit kisti düşündürür; erişkinde mural bileşen metastazı akla getirir.

Tuzaklar

• Halka tarzı kontrastlanmayı yalnızca tüberküloza özgü sayma; metastaz ve bakteriyel apse de benzer görünüm oluşturabilir.
• Nekrotik merkezi damar lümeniyle karıştırma; merkezde kontrastlanmama ve nodu çevreleyen yumuşak doku halkası nodal yapıyı gösterir.
• Nekrotik nod yanında yağ planı kaybı hem enfeksiyon hem tümör uzanımıyla oluşabilir; primer odak ve diğer istasyonların dağılımı belirleyicidir.

Kendini dene

1. Kontrastlı BT'de büyümüş nodun merkezi sıvı atenüasyonlu, çevresi kontrastlanan ve aynı bölgede mukozal kitle bulunan hastada en olası neden nedir?

   • Nodal metastaz
   • Basit lenfosel
   • Reaktif hiperplazi
   • Lipom
   Cevabı göster

   Nodal metastaz. Primer mukozal kitleyle uyumlu drenaj istasyonundaki nekrotik nod metastazı destekler. Lenfosel sıvı koleksiyonudur ve çoğunlukla cerrahi yatakla ilişkilidir; reaktif nod homojen kalır; lipom yağ atenüasyonundadır.

2. Nekrotik nodların çevresinde yaygın inflamasyon ve komşu derin boyun aralığında koleksiyon görülüyor. En uygun morfolojik tanım hangisidir?

   • Süpüratif lenfadenit
   • Homojen lenfoma
   • Yağlı hilus
   • Damar anevrizması
   Cevabı göster

   Süpüratif lenfadenit. Nodal sıvılaşma, çevre inflamasyonu ve bitişik koleksiyon süpüratif yayılımı destekler. Homojen lenfoma düşük atenüasyonlu merkez bekletmez; yağlı hilus nodun fizyolojik iç bileşenidir; anevrizma kontrast dolan damar lümeninin genişlemesidir.

İlgili konular

• Lenf nodu metastazı
• Reaktif lenfadenopati

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Differentiating Crohn’s disease from intestinal tuberculosispmc.ncbi.nlm.nih.gov
2. Isolated pancreatic tail and splenic hilum tuberculosis: a rare case reportpmc.ncbi.nlm.nih.gov
3. Pneumoperitoneum Secondary to Necrotic Intra-abdominal Lymph Nodepmc.ncbi.nlm.nih.gov
4. Unraveling an Unusual Presentation of Parotid Malignancy: A Case Reportpmc.ncbi.nlm.nih.gov
5. Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Reviewpmc.ncbi.nlm.nih.gov
6. Differentiating Crohn's disease from intestinal tuberculosis.pubmed.ncbi.nlm.nih.gov
7. Mesothelial inclusion cyst: a rare occurrence.pubmed.ncbi.nlm.nih.gov
8. Computed tomography in predicting smear-negative pulmonary tuberculosis in AIDS patients.pubmed.ncbi.nlm.nih.gov
9. Ancient Schwannoma: Cervical Sympathetic Chain with Review of Literature.pubmed.ncbi.nlm.nih.gov
10. Pneumoperitoneum Secondary to Necrotic Intra-abdominal Lymph Node.pubmed.ncbi.nlm.nih.gov
11. Fibrosing Mediastinitis Presenting With Superior Vena Cava Syndrome.pubmed.ncbi.nlm.nih.gov
12. Extent of neck dissection after transoral robotic surgical resection of oropharyngeal squamous cell carcinoma: Report of a case and potential indications for inclusion of level I in a selective neck dissection.pubmed.ncbi.nlm.nih.gov
13. Testicular Torsion in the Undescended Testis of a Four-Year-Old: A Delayed Diagnosis.pubmed.ncbi.nlm.nih.gov
14. Contrast-enhanced ¹⁸F-FDG-PET/CT for the assessment of necrotic lymph node metastases.pubmed.ncbi.nlm.nih.gov
15. Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings.pubmed.ncbi.nlm.nih.gov
16. 18 F-FDG PET/CT to differentiate malignant necrotic lymph node from benign cystic lesions in the neck.pubmed.ncbi.nlm.nih.gov
17. A Challenging Case of the Forgotten Abdominal Tuberculosis in the Developed World.pubmed.ncbi.nlm.nih.gov
18. Tuberculosis presenting as isolated bronchonodal fistula in a patient with systemic lupus erythematosus: Case report.pubmed.ncbi.nlm.nih.gov
19. Prediction of treatment response in head and neck carcinomas using IVIM-DWI: Evaluation of lymph node metastasis.pubmed.ncbi.nlm.nih.gov
20. Correlation of the Diagnostic Accuracy of Dual Energy Computed Tomography and Positron Emission Tomography/Computed Tomography in Mediastinal Lymph Node Staging in Lung Cancer: A Systematic Review.pubmed.ncbi.nlm.nih.gov
21. Tuberculosis meningoencephalitis mimicking lung cancer with metastasis: a case report.pubmed.ncbi.nlm.nih.gov
22. Nodal metastasis from an occult duodenal gastrinoma amid an overlap of xanthogranulomatous and type 1 autoimmune pancreatitis: A case report.pubmed.ncbi.nlm.nih.gov
23. Lymphadenopathy in Concurrent Head and Neck Malignancies.pubmed.ncbi.nlm.nih.gov
24. A Case of Necrotizing Lymphadenitis From Streptococcus pyogenes.pubmed.ncbi.nlm.nih.gov
25. Lemierre's Syndrome Complicated by Common Carotid Artery Pseudoaneurysm with Sentinel Bleed - A Case Report.pubmed.ncbi.nlm.nih.gov
26. Multiparametric MRI Assessment of Cervical Lymphadenopathy: Combined Diagnostic Performance of Morphological Features and Apparent Diffusion Coefficient.pubmed.ncbi.nlm.nih.gov
27. Diagnostic Algorithm Using Multimodal Imaging for the Differential Diagnosis of Intra-Cardiac Masses.pubmed.ncbi.nlm.nih.gov
28. Evidence-based guideline diagnosis, treatment, prevention and aftercare of oropharyngeal and hypopharyngeal carcinoma.pubmed.ncbi.nlm.nih.gov
29. A Case Series of Oral Cancer: An Enigma to Diagnosing Clinicians.pubmed.ncbi.nlm.nih.gov
30. Hidden in plain sight: Extrapulmonary manifestations of tuberculosis in Asia.pubmed.ncbi.nlm.nih.gov
31. Spectrum of Neuroimaging Findings in CNS Lymphoproliferative Disorders.pubmed.ncbi.nlm.nih.gov
32. Imaging for Pediatric Head and Neck Emergencies: Critical Insights.pubmed.ncbi.nlm.nih.gov
33. The Many Faces of the Angry Peritoneum.pubmed.ncbi.nlm.nih.gov
34. Bilateral ovarian metastases from gastric signet-ring cell carcinoma in an 18-year-old: a case report and narrative review.pubmed.ncbi.nlm.nih.gov
35. Spectral CT and Photon-counting Detector CT: Principles and Applications in Neuroradiology.pubmed.ncbi.nlm.nih.gov
36. Tuberculosis-Associated Renal Amyloidosis Presenting as Nephrotic Syndrome: A Case Report From Ethiopia.pubmed.ncbi.nlm.nih.gov
37. Congenital pulmonary airway malformation mimicking lung cancer in adults: a pitfall in oncologic diagnosis.pubmed.ncbi.nlm.nih.gov
38. Necrotizing (Abscessing) Lymphadenopathy and the Diagnostic Value of Contrast-Enhanced Ultrasound (CEUS): A Review with Clinical Vignettes.pubmed.ncbi.nlm.nih.gov
39. Case Report: Multimodality imaging features and serial metabolic changes on ¹⁸ F-FDG PET/CT in a dog with granulomatous hepatitis.pubmed.ncbi.nlm.nih.gov
40. Central Nervous System Tuberculoma in Qatar: Clinical, Radiological, and Pathological Insights From a Rare Case With Literature Review.pubmed.ncbi.nlm.nih.gov
41. Application and Development of Spectral CT in Target Delineation for Lung Cancer Radiotherapy.pubmed.ncbi.nlm.nih.gov
42. The diagnostic efficacy of venous-phase spectral CT combined with Node-RADS for differentiating enlarged lymph nodes in common solid tumors: a preliminary exploratory study.pubmed.ncbi.nlm.nih.gov
43. Metastatic adenocarcinoma centered in the male urethra with intestinal differentiation and uncertain accessory-gland origin presenting as urethral stricture: a case report.pubmed.ncbi.nlm.nih.gov
44. Non-Hodgkin Lymphoma and Tuberculosis Coexisting in the Same Cervical Lymph Node: A Case Report.pubmed.ncbi.nlm.nih.gov
45. Disseminated Sphingomonas paucimobilis Infection Mimicking Tuberculosis in a Patient With Type 3c Diabetes: Case Report.pubmed.ncbi.nlm.nih.gov
46. An Uncommon Presentation of a Common Disease: Hoarseness of Voice in a Young Patient With Tuberculosis.pubmed.ncbi.nlm.nih.gov
47. Imaging-detected extranodal extension in head and neck cancer: clinical implications, diagnostic criteria, and the potential of photon-counting detector CT.pubmed.ncbi.nlm.nih.gov
48. Threshold Validity of N3 Criteria in Nasopharyngeal Carcinoma: A Narrative Methodological Review of Pragmatic Cutoffs and Biologically Defensible Risk Boundaries.pubmed.ncbi.nlm.nih.gov
49. Case Report: Spectral CT characterization of giant esophageal schwannoma with reactive lymphoid hyperplasia mimicking lymphoproliferative disease.pubmed.ncbi.nlm.nih.gov
50. Diffuse Large B-Cell Lymphoma Presenting as an Infiltrative Masticator Space Lesion Mimicking Inflammatory Disease: A Case Report.pubmed.ncbi.nlm.nih.gov
51. A Case of Cervical Necrotising Fasciitis Precipitated by Hypopharyngeal Squamous Cell Carcinoma.pubmed.ncbi.nlm.nih.gov
52. Imaging of acute musculoskeletal infections in children and their differential diagnoses.pubmed.ncbi.nlm.nih.gov
53. Acute and chronic complications of cesarean delivery: An update for the general radiologist.pubmed.ncbi.nlm.nih.gov
54. Pre-contrast computed tomography reveals distinct characteristics and anatomical distribution of presumably lymphomatous lymph nodes in canine multicentric lymphoma.pubmed.ncbi.nlm.nih.gov
55. Rosai-Dorfman disease presenting as isolated cervical lymphadenopathy in a young adult: A case report.pubmed.ncbi.nlm.nih.gov
56. Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma: A Single-Center Case Series of Five Patients.pubmed.ncbi.nlm.nih.gov
57. Fibromatosis Colli Presenting as a Left-Sided Cervical Mass: A Case Report.pubmed.ncbi.nlm.nih.gov
58. Cervical Lymph Node Metastasis Patterns and Diagnostic Accuracy of Preoperative Staging in Oral Squamous Cell Carcinoma.pubmed.ncbi.nlm.nih.gov
59. Endoscopic Total Thyroidectomy via a Single-Port Subclavian Approach Versus Open Surgery for Papillary Thyroid Carcinoma.pubmed.ncbi.nlm.nih.gov
60. Synchronous p16-Negative Oropharyngeal Squamous Cell Carcinoma and High-Grade Small-Cell Neuroendocrine Carcinoma of the Head and Neck: A Case Report.pubmed.ncbi.nlm.nih.gov
61. Risk-adapted neck dissection in salivary gland carcinoma: integrating occult nodal metastasis patterns with contemporary guidelines.pubmed.ncbi.nlm.nih.gov
62. Tumor Surface Necrosis on Laryngoscopy Predicts Prognosis in Hypopharyngeal Carcinoma.pubmed.ncbi.nlm.nih.gov
63. Fusing Radiomics and Ultrasonic Features: A Superior Nomogram for Diagnosing Cervical Tuberculous Lymphadenitis.pubmed.ncbi.nlm.nih.gov
64. A Rare Clinical Presentation of Multifocal Tuberculous Osteomyelitis of the Right Parietal and Left Calcaneal Bones in an 11-Year-Old Male: A Case Report.pubmed.ncbi.nlm.nih.gov
65. Primary cutaneous squamous cell carcinoma of the neck mimicking tuberculous lymphadenitis.pubmed.ncbi.nlm.nih.gov
66. Histoplasma-Associated Mediastinal Granulomatous Disease With Superimposed Viridans Group Streptococcal Suppurative Lymphadenitis Mimicking Malignancy: A Case Report.pubmed.ncbi.nlm.nih.gov
67. Nocardia brasiliensis infection causes skin abscesses around the eyes: A case-report and review of literature.pubmed.ncbi.nlm.nih.gov
68. Role of ¹⁸F-FDG PET/CT in the diagnosis and treatment response assessment of primary pulmonary lymphoma.pubmed.ncbi.nlm.nih.gov
69. MR Imaging of Anal Cancer.pubmed.ncbi.nlm.nih.gov
70. Anal and Perianal Masses: The Common, the Uncommon, and the Rare.pubmed.ncbi.nlm.nih.gov
71. Seeing Angiogenesis: Multiparametric Ultrasound as a Non-Invasive Window into the Vascularization Status of Cervical Lymph Nodes in Head and Neck Squamous Cell Carcinoma.pubmed.ncbi.nlm.nih.gov
72. Application of conventional and contrast-enhanced ultrasound in diagnosing cervical tuberculous lymphadenitis.pubmed.ncbi.nlm.nih.gov
73. Isolated Testicular Tuberculosis Mimicking a Testicular Tumor: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
74. Diagnostic Imaging of Extrapulmonary Tuberculosis Across Organ Systems.pubmed.ncbi.nlm.nih.gov
75. Intravascular Pulmonary Artery Tumour Mimicking Nodal Recurrence and Inadvertently Sampled by EBUS-TBNA: A Case Report.pubmed.ncbi.nlm.nih.gov
76. The first CT-based classification system for pulmonary actinomycosis: correlating imaging patterns with therapeutic strategies and prognosis in a highly misdiagnosed disease.pubmed.ncbi.nlm.nih.gov
77. CLEC3B (tetranectin) expression is associated with vascular localization and tumor aggressiveness in breast cancer.pubmed.ncbi.nlm.nih.gov
78. Technique-Driven and Patient-Specific Variations in Complications of Mastectomy with Immediate Breast Reconstruction: An Evidence-Based Review.pubmed.ncbi.nlm.nih.gov
79. Multiparametric Abdominal Ultrasound as a Source of Imaging Biomarkers in Predictive and Personalized Medicine: A Narrative Review.pubmed.ncbi.nlm.nih.gov
80. Pre-treatment and post-treatment nasopharyngeal carcinoma imaging: imaging updates, pearls and pitfalls.pubmed.ncbi.nlm.nih.gov
81. Stiffness and Tissue Viscosity in a Cerebral Neoplasm Measured by Preoperative Multifrequency Magnetic Resonance Elastography (MRE) Guide the Differential Diagnosis of Brain Tumors by Ruling Out Glioma.pubmed.ncbi.nlm.nih.gov
82. Renal Medullary Carcinoma: Utility of [¹⁸F]FDG PET/CT in Evaluating Extent of Disease and Impact on Treatment Management.pubmed.ncbi.nlm.nih.gov
83. Migratory Pulmonary Infiltrates Mimicking Malignancy, Tuberculosis, and Sarcoidosis in an Apparently Immunocompetent Adult: A Case of Tissue-Proven Invasive Fungal Disease Due to a Non-<i>marneffei</i><i>Penicillium</i> Species.pubmed.ncbi.nlm.nih.gov
84. Pseudoprogression During Enfortumab Vedotin Plus Pembrolizumab Therapy in Muscle-Invasive Bladder Cancer Achieving Pathological Complete Response: A Case Report.pubmed.ncbi.nlm.nih.gov
85. Ten-year recurrence-free survival in stage IV perforated appendiceal mucinous adenocarcinoma with high-risk features: a case report.pubmed.ncbi.nlm.nih.gov
86. Artificial intelligence for rapid on-site evaluation of lymph node fine-needle aspiration: improving diagnostic efficiency and accuracy.pubmed.ncbi.nlm.nih.gov
87. Case Report: Eschar-like subcutaneous lesion in disseminated melioidosis revealing anti-interferon-γ autoantibody-associated adult-onset immunodeficiency and a review of the literature.pubmed.ncbi.nlm.nih.gov
88. Diagnostic imaging and emerging image-guided neurointervention in brain tumors: a narrative review.pubmed.ncbi.nlm.nih.gov
89. Pediatric pulmonary tuberculosis masquerading as chest neoplasms.pubmed.ncbi.nlm.nih.gov
90. Metastatic malignant phyllodes tumor of the breast with rapid progression and subsequent response to immunotherapy: a case report.pubmed.ncbi.nlm.nih.gov
91. Radiological Patterns of Abdominal Tuberculosis With Microbiological Confirmation: A Multi-Modal Prospective Analysis.pubmed.ncbi.nlm.nih.gov
92. Tuberculosis presenting with necrotic retroperitoneal lymphadenopathy in an immunocompetent patient: A case report and literature review.pubmed.ncbi.nlm.nih.gov
93. Tuberculous Peripancreatic Lymphadenitis Presenting as Obstructive Jaundice Due to Extrinsic Common Bile Duct Compression: A Case Report.pubmed.ncbi.nlm.nih.gov
94. Primary Aggressive Oral Lymphomas (PAOL): A Narrative Review of Diagnosis, Molecular Features, Therapeutic Approaches, and the Integrated Role of Dentists and Hematologists.pubmed.ncbi.nlm.nih.gov
95. Advancing Cancer Research: Current Knowledge on Cutaneous Neoplasia.pubmed.ncbi.nlm.nih.gov
96. Comprehensive review of post-treatment imaging in head and neck cancers: from expected to unexpected and beyond.pubmed.ncbi.nlm.nih.gov
97. PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology.pubmed.ncbi.nlm.nih.gov
98. Cancer of the oral cavity and oropharynx.pubmed.ncbi.nlm.nih.gov
99. Pathological Findings in COVID-19 and Non-COVID-19 Vaccine-Associated Lymphadenopathy: A Systematic Review.pubmed.ncbi.nlm.nih.gov
100. Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.pubmed.ncbi.nlm.nih.gov
101. HPV-associated Oropharyngeal Squamous Cell Carcinoma: An Imaging Framework for AJCC Version 9 TNM Staging.pubmed.ncbi.nlm.nih.gov
102. Factors Influencing Mandibular Invasion, Lymph Node Metastasis and Extracapsular Spread in Squamous Cell Carcinoma of the Oral Cavity.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.