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Ultrasonographic findings of Kikuchi cervical lymphadenopathy in children
Ji Young Kim1, Hyunju Lee2, Bo La Yun1
1Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Insights
Ultrasonography reveals common findings in pediatric Kikuchi cervical lymphadenopathy, including multiple, unilateral, conglomerated lymph nodes with perinodal fat swelling and even size distribution.
Area of Science:
- Pediatric Radiology
- Lymphadenopathy Imaging
- Rheumatology
Background:
- Kikuchi disease, a rare benign lymphadenopathy, primarily affects young adults but can occur in children.
- Accurate ultrasonographic (USG) characterization is crucial for diagnosing Kikuchi cervical lymphadenopathy in pediatric patients.
- Understanding typical imaging findings aids in differentiating Kikuchi disease from other causes of cervical lymphadenopathy.
Purpose of the Study:
- To analyze and document the ultrasonographic (USG) findings associated with Kikuchi cervical lymphadenopathy in a pediatric cohort.
- To identify characteristic USG features that can aid in the diagnosis of Kikuchi disease in children.
- To correlate clinical and laboratory findings with USG observations in pediatric Kikuchi lymphadenopathy.
Main Methods:
- Retrospective review of clinical and USG findings in 84 pediatric patients diagnosed with Kikuchi disease (April 2007-September 2016).
- Analysis of clinical symptoms (tenderness, fever) and laboratory data (WBC, ESR, CRP).
- Detailed USG evaluation including lymph node location, size, perinodal fat swelling, echogenic hilum, and nodal distribution.
Main Results:
- 58% of patients presented with localized cervical lymphadenopathy tenderness; 66% had fever.
- Leukopenia was observed in 73% of patients with available lab results; elevated ESR and CRP were less common.
- USG commonly showed unilateral involvement (86%), particularly in the posterior triangle (level V), with conglomerated nodes (68%), preserved echogenic hilum (98%), and perinodal fat swelling (65%).
Conclusions:
- Common ultrasonographic findings in pediatric Kikuchi cervical lymphadenopathy include multiple, conglomerated, unilateral cervical lymph nodes.
- Perinodal fat swelling and an even size distribution of affected lymph nodes are characteristic USG features.
- These USG findings can assist in the diagnosis of Kikuchi disease in children.
Purpose:
The purpose of this study was to analyze the ultrasonographic (USG) findings of Kikuchi cervical lymphadenopathy in pediatric patients.
Methods:
Between April 2007 and September 2016, 84 children (42 male and 42 female; mean±standard deviation age, 12.9±3.2 years; range, 5 to 18 years) confirmed with Kikuchi disease were enrolled. Clinical findings and USG findings of Kikuchi cervical lymphadenopathy were retrospectively reviewed. Localized symptoms, systemic symptoms, and laboratory findings including the white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were analyzed. An analysis of the USG findings included evaluation of the location, size, and presence of intranodal abscess; intranodal calcification; perinodal fat swelling; localized fluid collection; and loss of nodal echogenic hilum.
Results:
Among the patients, 49 (58%) showed localized tenderness at the cervical lymphadenopathy. Fever was present in 55 (66%), while 27 (32%) had prolonged fever. Of 74 with lab results, 54 (73%) had leukopenia but none had leukocytosis. Among the same 74, there was a high ESR (>50 mm/hr) in 10 (14%) and a high CRP level (>5 mg/dL) in seven (9%). The USG findings of most of the patients (n=72, 86%) showed unilateral neck involvement, especially in the left side neck (45 of 72, 63%). The most common site of Kikuchi lymphadenopathy involvement was the area at cervical lymph node level V, at the posterior triangle (n=77, 92%). Conglomerated nodal distribution (n=57, 68%), preserved central nodal echogenic hilum (n=84, 98%), and perinodal fat swelling (n=55, 65%) were common USG findings in the children with Kikuchi. In addition, multiple cervical lymph nodes showed a relatively even size distribution (n=73, 87%).
Conclusion:
The common USG findings of Kikuchi disease in the pediatric population of our study were multiple conglomerated unilateral cervical lymphadenopathy showing perinodal fat swelling and even size distribution.
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