High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children.
OBJECTIVE
To assess the frequency of high-resolution and color Doppler sonographic findings in the most common diseases of childhood manifested with cervical lymphadenopathy at initial presentation.


METHODS
High-resolution and color Doppler US were performed in 103 and 43 children respectively, with cervical lymphadenopathy at initial presentation. Sonomorphology and intranodal vascularity were assessed. Final diagnoses, based on biopsy or clinical and sonographic follow-up, included: Reactive hyperplasia (n=34), infectious mononucleosis (n=20), lymphoma (n=11), bacterial (n=28), tuberculous (n=5) and cat-scratch disease (CSD, n=5) lymphadenites.


RESULTS
Round shape (L/S<2) was common both in lymphoma (78%), infectious mononucleosis (85%) and bacterial lymphadenitis (73%) while 91% of reactive nodes had L/S>2. Wide hilum conforming to nodal shape characterized reactive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). Central irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On color Doppler US, hyperplastic nodes more frequently exhibited a solitary hilar vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascular patterns.


CONCLUSIONS
Although individual sonographic signs are not specific, the categorization and combination of findings might be highly suggestive of diagnosis of the underlying disease presenting with cervical lymphadenopathy.
Papakonstantinou
O
O
Department of Radiology, Medical School, University of Crete, Heraklion, Crete, Greece.
Bakantaki
A
A
Paspalaki
P
P
Charoulakis
N
N
Gourtsoyiannis
N
N
D000293:Adolescent; D001424:Bacterial Infections / Q000000981:diagnostic imaging; D002372:Cat-Scratch Disease / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007244:Infectious Mononucleosis / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging*; D008223:Lymphoma / Q000000981:diagnostic imaging; D009333:Neck; D019310:Pseudolymphoma / Q000000981:diagnostic imaging; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color