Ninety patients, found to have lymph nodes in the hepato-duodenal ligament (HDL) on ultrasound ... called hepatic nodes and drain mainly the hepato-biliary.
1990, The British Journal of Radiology, 63, 26-30
Ultrasound examination of lymph nodes in the hepato duodenal ligament By *K. Lyttkens, MD, L. Forsberg, MD, PhD and E. Hederstrom, MD, PhD Department of Diagnostic Radiology, University Hospital, S-221 85 Lund, Sweden (Received May 1989 and in revised form August 1989)
Abstract. Ninety patients, found to have lymph nodes in the hepato-duodenal ligament (HDL) on ultrasound examination were reviewed over a one-year period in order to define the diseases in which such nodes can be found. The patients were divided into four main groups: benign liver disease (« = 31), malignant disease (« = 26), disease of the gallbladder or the biliary tree («= 14) and a group with various benign, most inflammatory diseases (n = 19). In 40% of the patients (36/90), the lymph nodes in the HDL were the only sign of disease on ultrasound examination, and the majority of those were in the benign group.
Patients with abnormal liver function tests or upper abdominal pain are often examined initially with ultrasound. A changed echo pattern of the liver with fatty infiltration can usually be detected (Taylor et al, 1976; Foster et al, 1980), whereas to diagnose mild cirrhosis without fatty infiltration and chronic active hepatitis and related diseases is often difficult or impossible (Dewbury & Clark, 1979). The finding of abnormal lymph nodes in the hepato-duodenal ligament (HDL) might, however, indicate the presence of liver disease and detection of nodes in the HDL by ultrasound is feasible (Forsberg & Hederstrom, 1985; Forsberg et al, 1987). The nodes surrounding the hepatic artery ventral to the portal vein are generally those observed, but nodes can also be seen dorsal to the portal vein. Nodes in the HDL in chronic active hepatitis have been reported on computed tomography (CT) (Gore et al, 1988). Lymph nodes in the HDL can be seen in patients with benign as well as malignant diseases (Baker et al, 1987; Hederstrom & Forsberg, 1987): in anatomical atlases they are called hepatic nodes and drain mainly the hepato-biliary system. In this study, however, lymph nodes were noted in patients with diseases of other organs as well, indicating lymph drainage to the nodes in the HDL, directly or indirectly. The aim of this review was to define those diseases in which nodes in the HDL can be detected by ultrasound. Material and methods The study covered 90 consecutive patients, 63 female and 27 male, with a mean age of 56 years (range 4-91 years), examined over a one-year period, in whom nodes (>0.5cm) were observed in the HDL on ultrasound examination. All patients were examined with dynamic ultrasound using 3.5 MHz and 5 MHz mechanic sector scan transducers and all the examinations were performed by radiologists with extensive experience in ultrasound. Most patients had been fasting for 4 to 12 h before the examination. The *Author for correspondence. 26
echogenicity and the homogeneity of the liver parenchyma and the size and echogenicity of the lymph nodes in the HDL were registered. The nodes were sometimes flattened or oval in shape, in which case the largest measurements were noted. Measured in retrospect, the nodes were subdivided into four groups according to size (Table I). Follow-up of 6 months (deceased patients) to 3 years later was made by studying case records. Histopathological diagnosis was available from autopsy in six cases, and from biopsy or surgery in 50 cases. In the remaining 34 cases the final diagnosis was obtained from clinical findings, including liver function tests (serum bilirubin, alkaline phosphatase, aminotransferase and y-glutamyltransferase) and radiological examinations. The patients were divided into four main groups depending on diagnosis: benign liver disease (« = 31), malignant disease (n = 26), disease of the gallbladder or the biliary tree (n— 14) and a group of miscellaneous diseases («= 19). A patient who had a gallstone or had had a cholecystectomy was classified as having gallbladder disease, since we noted that the nodes in the HDL seen in patients with cholecystitis do not seem to disappear after cholecystectomy. Malignant disease overrode the diagnosis of benign disease. Results Benign liver disease This was found in 31 patients (Table II). A histological diagnosis was available for 25 of these and the final diagnosis was established from clinical findings in six cases. Table I. Lymph nodes in the hepato-duodenal ligament Size of node (cm)
1.0 1.5 2.0
Group
Size of node (cm)
