Regional lymphadenopathy in cat-scratch disease: ultrasonographic findings

Background. Cat-scratch disease (CSD) is considered to be an emerging disea se worldwide and is caused by Bartonella henselae, a gram-negative bacteriu m introduced by a scratch or bite of a cat. The most common clinical manife station is regional lymphadenopathy, but clinical recognition may be diffic ult, as atypical manifestations may occur. The diagnosis is confirmed with serologic testing and histology is rarely needed. This paper is based on ou r experience with the use of ultrasonography in the diagnosis of CSD. Objective. The aim of this study was to describe the sonographic and color Doppler appearances of regional lymphadenopathy in CSD, as this has not wid ely reported in the literature. Materials and methods. Forty-seven patients (average 9.4 years) were includ ed who all had serologically and/or histologically proven CSD and had been studied using US early in the clinical course. All had a positive history o f exposure to cats and exhibited regional lymphadenopathy. Results. US showed large hypoechoic adenopathy with some transmission enhan cement and high vascularization on color-flow Doppler imaging. In 30 patien ts, abdominal US was also performed and splenic and/or hepatic granulomata were found in 10. Conclusions. In our experience, sonography and especially color-Doppler and power-Doppler sonography was helpful in the diagnosis of CSD. We believe i t should be used in the initial study of children with regional lymphadenop athy, and serologic testing should be performed when CSD is suspected.