title: Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children.
abstract: Mesenteric lymphadenitis (ML) is considered as one of the most common alternative diagnosis in a child with suspected acute appendicitis (AA). In this retrospective study, patients diagnosed with ML (n = 99) were compared in terms of demographic, clinical, and laboratory findings to patients diagnosed with AA (n = 102). This comparison was applied for both lymph nodes smaller and larger than 10 mm. When compared to patients with AA, patients with ML had significantly longer duration of symptoms prior to emergency department (ED) presentation (2.4 ± 2.6 vs 1.4 ± 1.4 days, P = 0.002) and multiple ED presentations (1.3 ± 0.7 vs 1.05 ± 0.3, P < 0.001) and had longer duration of stay in the ED (9.2 ± 5.9 vs 5.2 ± 4 h, P < 0.001), respectively. They also had significantly lower WBC (10.16 ± 4.7 × 103/dl vs 15.8 ± 4.4 × 103/dl, P < 0.001) with lymphocyte predominance (24.6 ± 14 vs 13 ± 8.7%, P < 0.001) and lower CRP levels (0.48 vs 1.6 mg/dl). Migration of pain (28 vs 7%), vomiting (62 vs 34%), and classic abdominal findings of AA (72 vs 20%) were all significantly more common for children with AA. When comparing lymph node size, no significant difference was found between those presenting with small and large nodes.
  
  
  CONCLUSIONS
  This study highlights multiple clinical and laboratory findings that differentiate ML and AA. Moreover, the absence of any difference with regard to the lymph nodes size might suggest that lymph nodes enlargement is a non-specific finding. What is Known : • Mesenteric lymphadenitis is a very common diagnosis in children with suspected acute appendicitis. • Despite its prevalence, only few studies addressed the clinical characteristics of this clinical entity and their comparison with acute appendicitis. What is New: • Mesenteric lymphadenitis and acute appendicitis could be differentiated by multiple clinical and laboratory parameters. • No significant difference was found between those presenting with small and large lymph nodes.
authors.affiliation: Department of Pediatrics, Hadassah Medical Center, Ein Kerem, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel. itaigross@gmail.com.
authors.forename: Itai
authors.initials: I
authors.lastname: Gross
authors.affiliation: Department of Pediatrics, Hadassah Medical Center, Ein Kerem, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Siedner-Weintraub
authors.affiliation: Faculty of Medicine, Hebrew University, Ein Kerem, Jerusalem, Israel.
authors.forename: Shir
authors.initials: S
authors.lastname: Stibbe
authors.affiliation: Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Rekhtman
authors.affiliation: Department of General Surgery, Hadassah and Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weiss
authors.affiliation: Medical Imaging, Hadassah and Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovsky
authors.affiliation: Pediatric Surgery, Hadassah and Hebrew University Hospital, Jerusalem, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Arbell
authors.affiliation: Department of Pediatric Emergency Medicine, Hadassah Medical Center, Jerusalem, Israel.
authors.forename: Saar
authors.initials: S
authors.lastname: Hashavya
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008640:Mesenteric Lymphadenitis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D063189:Symptom Assessment; D014463:Ultrasonography
keywords: Abdominal pain; Acute appendicitis; Lymph nodes; Mesenteric lymphadenitis