title: The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children.
abstract: BACKGROUND
  Nontuberculous mycobacteria (NTM) are a common cause of chronic cervicofacial lymphadenitis in young children. The differential diagnosis includes other infections, lymphoepithelial cysts and malignancies.
  
  
  OBJECTIVE
  To assess the sonographic findings of NTM cervicofacial lymphadenitis in children.
  
  
  METHODS
  We analysed the sonograms of cervicofacial lymph nodes of 145 children with microbiologically proven NTM lymphadenitis.
  
  
  RESULTS
  The size of the involved lymph nodes ranged from 1.9 cm to 4.4 cm. Most of the NTM patients (85%) presented in a stage of lymph node fluctuation with violaceous skin discoloration. On sonography, marked decreased echogenicity was seen in all cases. In 133 of the patients (92%) liquefaction with intranodal cystic necrosis, nodal matting and adjacent soft-tissue oedema were present. 66 children received antibiotic treatment, and the other children underwent surgical excision of the involved lymph nodes. In 69% of the patients successfully treated with antibiotics, multiple intranodal calcifications were present on sonography after 1 year.
  
  
  CONCLUSIONS
  Sonographic findings can provide additional diagnostic clues for NTM lymphadenitis in childhood. A marked decrease of echogenicity in the early stages, with intranodal liquefaction in the advanced stages, are universal features, albeit not entirely specific. Multiple intranodal calcifications are rather characteristic of end-stage mycobacterial infection.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.a.lindeboom@amc.uva.nl
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Lindeboom
authors.forename: Anne M J B
authors.initials: AM
authors.lastname: Smets
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: Rick R
authors.initials: RR
authors.lastname: van Rijn
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D009164:Mycobacterium Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology; D009333:Neck; D009426:Netherlands / Q000453:epidemiology; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents