Color Doppler pseudolymphomatous manifestations of the cat scratch disease

Cat Scratch Disease (CSD) is an infectious illness, caused by the Bartonella henselae bacterium. Besides the common infective symptoms, swelling in the axillary and cervical region is very common and is usually evaluated by Color Doppler US (CDUS) (among other diagnostic methods). The aim of this work is to present ultrasound findings of the Cat Scratch Disease. During 2002 and 2003, we followed four patients (three male and one female) by CDUS, with different manifestations of the disease. The average age of the patients was 12. In all four cases, the local and generalized lymphadenopathy was found, and in two cases we found multiple focal hepatolienal lesions as well. The enlarged lymph nodes were found, with heterogeneous echogenicity of the cortex, and increased number of the hiluses, disturbed vascular structure and non specific hemodynamic. Hepatolienal lesions were hypoechogenic, round, unclear outline, and poorly vascularised. CDUS has proved to be a very sensitive imaging method in detection of pathomorphologic and hemodynamic changes of superficial lymph nodes and focal lesions of visceral organs in CSD. Opposite to the high sensitivity, its specificity is much lower, because of similar findings in lymphoma, TB lymphadenopathy and multiple visceral abscesses. Detailed anamnesis, clinical findings, with laboratory and specific serological tests (IgG, IgM), US characteristics, sometimes percutaneous aspiration biopsy as well, are crucial in determination of etiology of the disease.