The CT and ultrasound appearances of these metastatic nodes are different in appearance from the typical of metastatic nodes in the neck from the likes of a nasopharyngeal malignancy, lung or gastrointestinal tract malignancy.  These are typical of from a papillary thyroid primary.

Note the tiny tumor in relation to the large volume metastatic lymph node disease.  I have observed this several times with papillary carcinoma of the thyroid.

This patient falls into the most common group to suffer from this disease a female in the 3rd or 4th decade of life.