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Case of the Month

August 2019

Patient Data: Three patients with abnormal lymph nodes examined for SONOZORG a primary care ultrasound facility. Which patients would you biopsy and which one not

Clinical Info: Palpable lymph nodes in the axilla groin and neck


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Three patients two adults and one boy with abnormal lymph nodes. Which ones would you refer for a biopsy and which one not


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The first patient was an adult with a large axillary lymph node


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The node is oval but without a hilum


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The node is vascularized with multiple peripheral vessels


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There are other but smaller and round lymph nodes


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There are other but smaller and round lymph nodes


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Last image of the two nodes together. We decided to refer the patient for biopsy because we thought the nodes were suspicious for malignancy. It proved to be a T cell lymphoma


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The second patient is also an adult with a large round node in the groin


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The node is vascularized


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And there are smaller round nodes. We also decided to refer this patient for biopsy and this too proved to be a T cell lymphoma


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The third patient is a child with lymph nodes in the neck


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The node was oval


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There were other oval but small nodes


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The nodes are vascularized from one hilum. Because we thought the node could be reactive we decided not to refer the patient but wait and check again to see if the nodes changed over time. Children often have reactive lymph nodes. After a month the nodes returned to normal.

The first two patient proved to have a T cell lymphoma. `Beware of round nodes, nodes without or a compressed hilum and multiple vessel poles. The third patient was a child with benign reactive lymph nodes in the neck that returned to normal after a month.

For more examples off pathological lymph nodes in the axilla groin and neck see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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