Is an elevated left level II lymph node measuring 1.8 cm in length and 0.7 cm in axis diameter concerning?

Evaluation of an Elevated Left Level II Lymph Node

A left level II lymph node measuring 1.8 cm in length and 0.7 cm in axis (short axis) diameter is not concerning and does not require further evaluation or intervention. This finding is considered within normal limits according to current guidelines.

Understanding Lymph Node Assessment

When evaluating lymph nodes, the short-axis diameter is the most important measurement for determining abnormality:

• Lymph nodes are generally considered abnormal when their short-axis diameter exceeds 1.0 cm 1
• In the head and neck region (including level II), nodes with short-axis diameter ≤1.0 cm are considered normal 2
• Your lymph node has a short-axis diameter of 0.7 cm, which falls within normal limits

Size Criteria by Anatomical Location

Different guidelines provide consistent criteria for lymph node assessment:

• Mediastinal lymph nodes: considered abnormal when >1.0 cm in short axis 1
• Cervical lymph nodes (including level II): considered abnormal when >1.0 cm in short axis 2
• Abdominal/pelvic lymph nodes: considered abnormal when >1.0 cm in short axis 1

Clinical Significance

The short-axis measurement of 0.7 cm in your case is well below the threshold for concern:

• According to the ACR Appropriateness Criteria, lymph nodes are considered abnormal only when exceeding established size thresholds 1
• The long-axis measurement (1.8 cm) is less clinically significant than the short-axis measurement for determining abnormality
• Normal lymph nodes often have an oval shape with a long axis that may exceed 1.5 cm while maintaining a normal short axis

Additional Considerations

While size is the primary criterion, other features that would raise concern (but are not mentioned in your case) include:

• Rounded shape (loss of normal oval configuration)
• Loss of fatty hilum
• Heterogeneous internal architecture
• Central necrosis
• Abnormal enhancement patterns

When Further Evaluation Would Be Warranted

Further evaluation would only be necessary if:

1. The short-axis diameter exceeded 1.0 cm
2. There were suspicious morphological features
3. There was a known history of malignancy
4. There were clinical symptoms suggesting pathology

Conclusion

Based on current guidelines and the provided measurements, this left level II lymph node with a short-axis diameter of 0.7 cm is within normal limits and does not require additional evaluation or follow-up.