High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children

Purpose: To assess the frequency of high-resolution and color Doppler sonog raphic findings in the most common diseases of childhood manifested with ce rvical lymphadenopathy at initial presentation. Material and Methods: High-resolution and color Doppler US were performed i n 103 and 43 children respectively, with cervical lymphadenopathy at initia l presentation. Sonomorphology and intranodal vascularity were assessed. Fi nal diagnoses, based on biopsy or clinical and sonographic follow-up, inclu ded: 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 react ive hyperplasia (94%) and infectious mononucleosis whereas absent or narrow hilum was frequent in lymphoma (100%) and bacterial lymphadenitis (60%). C entral irregular hyperechogenic areas, blurred margins and central necrosis were most frequent in bacterial, tuberculous and CSD lymphadenites. On col or Doppler US, hyperplastic nodes more frequently exhibited a solitary hila r vessel (48%), whereas infectious mononucleosis nodes had a central radial pattern (75%). Bacterial lymphadenitis presented with a variety of vascula r patterns. Conclusion: Although individual sonographic signs are not specific, the cat egorization and combination of findings might be highly suggestive of diagn osis of the underlying disease presenting with cervical lymphadenopathy.