US is ideal imaging modality for initial assessment of enlarged lymph nodes

Unilateral or bilateral

Reactive adenopathy: Absence of intranodal necrosis

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  Hypoechoic cortex compared with adjacent muscle ± cortical hypertrophy

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  Preserved hilar architecture usually

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  Oval in shape

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  Color Doppler: Hilar vascularity

Suppurative adenopathy: Loss of fatty hilum and cortical hypertrophy

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  Central fluid; surrounding inflammation resulting in blurring of margins

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  Complicated by nodal matting and abscess

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  Color Doppler: Peripheral increase in vascularity

Metastatic node

Tuberculosis

Non-Hodgkin lymphoma

Reactive adenopathy: Any age, most common in pediatric age group

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  Firm, sometimes fluctuant, freely mobile subcutaneous nodal masses, associated with viral infection

Suppurative adenopathy: Any age, upper respiratory tract/odontogenic/salivary gland bacterial infections

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  Tender, warm neck mass, fever, ↑ white blood cells

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  Pus on aspiration

Map out cervical nodes by level

Rule out abnormal morphology, such as necrosis or microcalcification

Look for surrounding cellulitis or abscess