It’s Not a Cervical Lymph Node, It’s a Vein

It’s Not a Cervical Lymph Node, It’s a Vein


Edward J. Escott, MD and Barton F. Branstetter, MD

1 From the Departments of Radiology (E.J.E., B.F.B.) and Otolaryngology (B.F.B.), University of Pittsburgh Medical Center, 200 Lothrop St, D-132, Pittsburgh, PA 15213-2582. Received October 20, 2005; revision requested January 17, 2006 and received March 7; accepted March 8. All authors have no financial relationships to disclose.

The anatomy and imaging appearances of the veins of the head and neck can vary considerably, and normal veins may mimic disease processes at computed tomography (CT) and magnetic resonance (MR) imaging. On unenhanced CT scans, aberrant veins may be difficult to differentiate from lymph nodes or other pathologic conditions. Even at contrast material–enhanced CT, differences in venous enhancement or the mixing of opacified with nonopacified blood can lead to confusion, particularly if the vein is focally dilated. Similarly, the size and signal intensity of head and neck veins may vary at MR imaging due to slow or turbulent flow or variable enhancement, resulting in misdiagnosis. A thorough understanding of the normal venous anatomy and common variants is necessary to properly differentiate an unopacified or focally dilated vein from lymphadenopathy or some other disease entity and can help the radiologist avoid the erroneous interpretation of findings.