Metastatic cervical lymphadenopathy from nasopharyngeal carcinoma

Multiple markedly enlarged bilateral upper and lower cervical specific lymph nodes with oblong and rounded shapes (L/T<2), heterogeneously hypoechoic, and the normal echogenic hila are absent.

They show disorganized intranodal vascularity, some of them show Intranodal necrosis: cystic (hypoechoic) or coagulation necrosis (echogenic, mimicking hilum but not continuous with surrounding fat).

The salient abnormality in the study is a large poorly defined soft tissue mass lesion implicating the left nasopharynx, obliterating the left fossa of Rosenmuller. The mass is eliciting mild heterogeneous post-contrast enhancement with the following relations: 

• anteriorly the mass is protruding into the posterior left nasal cavity
• posteriorly the mass is seen abutting the left prevertebral muscles
• laterally the mass shows extension to the parapharyngeal space
• superiorly the mass abuts the clivus and floor of the sphenoid, however, there is no definite evidence of overt extension. No evidence of intracranial extension.
• inferiorly, the mass abuts the oropharynx

Multiple enlarged bilateral upper and lower cervical lymph nodes are noted involving many groups (especially level 2), showing vivid heterogeneous enhancement, and some of them show necrotic changes with the largest necrotic one on the right.

The axial image revealed a heterogeneous soft tissue mass of the left nasopharynx.

The coronal image revealed multiple multiple cervical lymph nodes (arrows) with a large necrotic lymph node on the right side (red arrow).