Skeletal structures that clinically simulate lymph nodes: encounters during fine-needle aspiration

Area of Science:

• Medical Diagnostics
• Skeletal Anatomy
• Head and Neck Surgery

Background:

• Lymphadenopathy is a common clinical finding, often evaluated with fine-needle aspiration (FNA).
• Bony structures in the neck can mimic lymphadenopathy, leading to diagnostic challenges.

Purpose of the Study:

• To report cases where cervical spine or cervical rib anomalies were misdiagnosed as lymphadenopathy.
• To highlight the importance of accurate differential diagnosis in suspected lymphadenopathy.

Main Methods:

• Retrospective review of eight patients with suspected lymphadenopathy.
• Clinical examination, fine-needle aspiration (FNA), and radiographic imaging (including cervical spine and chest X-rays).

Main Results:

• Eight patients presented with pseudo-lymphadenopathy due to cervical spine or cervical rib abnormalities.
• FNA revealed normal soft tissues; bone contact during needle insertion indicated bony etiology in cervical cases.
• Radiographs confirmed cervical ribs in two patients with supraclavicular pseudo-lymphadenopathy.
• Follow-up showed no development of true lymphadenopathy in any patient.

Conclusions:

• Cervical spine and cervical rib anomalies can be mistaken for lymphadenopathy, necessitating careful clinical and radiological assessment.
• Fine-needle aspiration can be misleading if bony structures are not recognized.
• Accurate diagnosis prevents unnecessary invasive procedures and ensures appropriate patient management.