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US Diagnostic Scenario - 4 month hx of painless lump right lateral neck

Patient presents with 4 month history of a painless lump on their right lateral neck. On exam, there is a palpable firm and non motile mass with subtle visible prominence of the overlying soft tissue about 2 cm inferior to the styloid process.

US report is as follows:

EXAMINATION: Superficial ultrasound of the neck.

CLINICAL INDICATION: Palpable lump in the neck.

COMPARISON: None

FINDINGS: A dedicated superficial ultrasound of the area of clinical concern reveals morphologically normal right level IIb lymph nodes measuring 0.9 x 0.5 x 0.2 cm in the area of the palpable abnormality and 1.2 x 0.7 x 0.9 cm anterior to the area of the palpable lump. There is no hyperemia, mass or abnormal fluid collection.

IMPRESSION: Normal-appearing right level IIb cervical chain lymph nodes measuring 0.9 and 1.2 cm at the area of clinical concern which do not meet criteria for lymphadenopathy. Mild prominence of the lymph nodes may be reactive. Follow-up with repeat ultrasound in 4-6 weeks can be recommended if clinically indicated.

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My clinical interpretation of this:

If the lymph nodes are completely normal in size (in fact the one anterior to the lump is bigger than the one in the area of the lump—but both are normal anyway), this rules out lymphadenopathy as the cause of the lump.

“There is no hyperemia, mass or abnormal fluid collection,” but there is still a lump that is not present on the contralateral side. All the US does is rule out lymphadenopathy as the cause of the lump, and further imaging would be necessary to identify it.

Would that be a reasonable interpretation? Why would there be a lump at all if the nodes are totally normal in size and there are no other findings that explain it?

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source https://www.reddit.com/r/Radiology/comments/hfvybj/us_diagnostic_scenario_4_month_hx_of_painless/

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