Reactive vs malignant lymph nodes (ultrasound features)

A number of sonographic features are helpful in distinguishing reactive versus malignant lymph nodes.

Grey scale features

Features that favor reactive/infective nodes over malignancy include:

  • nodal matting
  • surrounding soft tissue edema
Doppler features

Doppler examination is particularly useful in helping distinguish reactive nodes from metastatic disease 1. Reactive nodes (including those in tuberculous lymphadenitis) demonstrate:

  • prominent hilar vascularity

Conversely features that favor malignancy includes:

  • peripheral/capsular vascularity
  • avascular areas
  • displacement of vessels
  • the aberrant course of hilar vessels
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Article information

rID: 9654
Section: Approach
Synonyms or Alternate Spellings:
  • Malignant vs reactive lymph nodes - ultrasound features
  • Ultrasound features helpful in distinguishing malignant vs reactive lymph nodes
  • Ultrasound features helpful in distinguishing reactive and malignant lymph nodes

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