Ultrasound evaluation of pediatric lymphadenopathies: diagnostic patterns and pitfalls

Palpable lymph nodes are among the most common indications for ultrasound evaluation in the pediatric population. Ultrasound provides valuable insight into nodal composition by assessing greyscale morphology, color Doppler vascularity, and vascular resistance, with emerging techniques such as elastography and contrast-enhanced ultrasound offering additional diagnostic potential. Although certain sonographic features may suggest a benign or malignant etiology, imaging overlap often exists posing diagnostic challenges. This review provides an overview of the sonographic appearance of the most common pediatric lymphadenopathies, including reactive hyperplasia, bacterial and viral lymphadenitis, necrotizing and granulomatous lymphadenitis, malignant and atypical entities. Characteristic and non-specific imaging features are discussed, along with practical approaches to interpretation and current strategies for diagnosis and management.