Cervical region — Reference values: Cervical lymph node — short axis, Short-axis / long-axis ratio, Suspicious node in thyroid cancer context, Normal parathyroid gland.
Brazil: according to the Brazilian College of Radiology scope standard, cervical region includes central and lateral cervical lymph nodes, thyroid bed only after total thyroidectomy, parathyroid beds and main cervical muscle groups. Thyroid, salivary glands and cervical vessels have separate examinations when requested.
Measurements and reference values
Measurement
Usual value
Note
Cervical lymph node — short axis
≤8–10 with benign morphology mm
Size alone is weak: use together with shape, fatty hilum, cortex, necrosis, calcifications, vascularity and clinical context.Green — practical benign consensus: ≤8 mm, oval, preserved hilum, no suspicious signsYellow — borderline or divergent: 8–10 mm or >10 mm with reactive morphologyRed — abnormal/suspicious: >15 mm or any size with necrosis, calcifications, associated absent hilum, peripheral vascularity or growthSource: Ahuja & Ying AJR 2005 / ATA 2015 / AIUM head and neck
Short-axis / long-axis ratio
<0,5
An oval node favors benignity; rounding increases suspicion, especially when combined with loss of hilum or peripheral vascularity.Green: <0.5 and preserved hilumYellow: ≈0.5 in isolationRed: >0.5 with suspicious signsSource: Ahuja & Ying AJR 2005 / thyroid cancer neck ultrasound reviews
Suspicious node in thyroid cancer context
≥8–10 mm in the smallest axis
The American Thyroid Association recommends fine-needle aspiration of a suspicious lymph node from 8–10 mm in the smallest axis when the result changes management.Yellow — smaller than 8 mm: may be follow-up if it does not change managementRed — suspicious ≥8–10 mm: consider fine-needle aspiration if clinically relevantSource: ATA 2015 Recommendation 32
Normal parathyroid gland
usually not visible
When an enlarged parathyroid gland is seen, document location, three measurements, relationship with the thyroid and Doppler if requested.Green: not identified and no focal lesionYellow: compatible hypoechoic lesion, but without laboratory contextRed: compatible lesion in hyperparathyroidism or documented growthSource: AIUM head and neck practice parameter
Focal cervical mass
measure in three axes
Describe compartment, side, relationship to skin, muscle, thyroid, salivary glands and vessels; Doppler only when indicated/requested.Source: ACR-AIUM-SPR-SRU head and neck / ACR Appropriateness Criteria
Classifications and calculators
Quick calculator — cervical lymph node
Color
Interpretation
Practical criteria
Green
Benign morphology
Short axis ≤8 mm, oval, preserved fatty hilum, thin cortex and hilar or absent vascularity.
Yellow
Gray zone
Short axis 8–10 mm, isolated rounding, poorly seen hilum, reactive enlargement or disagreement between size and morphology.
Red
Suspicious/abnormal
Intranodal necrosis/cyst, calcifications, peripheral or chaotic vascularity, associated absent hilum, irregular margins, conglomerate or growth.
The calculator is assistive. Painful/inflammatory node, age, known cancer, previous thyroidectomy and laterality change the weight of findings.
Source: Ahuja & Ying AJR 2005 / ATA 2015 / AIUM head and neck
Cervical region — examination scope in Brazil
Structure
How to handle in the report
Practical color
Central and lateral cervical lymph nodes
Included; describe location, size and morphology when seen or abnormal.
Green if benign morphology
Thyroid bed after total thyroidectomy
Included only in this context; assess residual tissue, local recurrence and suspicious lymph nodes.
Green if no focal lesion
Parathyroid beds
Assess; report parathyroid gland or muscle group mainly when detectable pathology is present.
Yellow if the finding depends on laboratory tests
Thyroid and salivary glands
In the Brazilian standard, they have separate codes/exams; mention if assessed by specific request or relevant finding.
Yellow because of scope
Doppler and cervical vessels
Doppler is not automatically part of the cervical region; carotid and jugular vessels require their own request/code.
Yellow because of scope
This table avoids mixing cervical region with thyroid, salivary glands or vascular Doppler when the request does not include those items.
Source: Colégio Brasileiro de Radiologia — Normatização de ultrassonografia
Cervical mass or cyst — priority signs
Color
Finding
Communication approach
Green
Typical benign superficial finding, small, without vascular solid component and without documented growth.
Describe and correlate with physical examination.
Yellow
Probable congenital cyst, inflammatory process or indeterminate mass without aggressive signs.
Suggest clinical correlation and cross-sectional imaging/follow-up according to persistence.
Red
Persistent mass in an adult, cystic mass in an adult, vascular solid component, invasion of planes, abscess or pulsatile mass.
Communicate as suspicious/urgent according to context; consider CT, MRI or specialist evaluation.
Ultrasound is useful, but persistent adult neck masses often require specialist clinical evaluation and/or cross-sectional imaging.