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Visualization of enlarged mesenteric lymph nodes at US examination. Clinical significance
C J Sivit1, K D Newman, R S Chandra
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010.
Insights
Enlarged mesenteric lymph nodes in children with abdominal pain are nonspecific. Ultrasound can help diagnose conditions like appendicitis, but findings are often non-specific.
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Gastroenterology
Background:
- Mesenteric lymphadenopathy is a common finding in pediatric abdominal imaging.
- The clinical significance of enlarged mesenteric lymph nodes in children with acute abdominal pain requires further investigation.
Purpose of the Study:
- To identify conditions associated with enlarged mesenteric lymph nodes in children presenting with acute abdominal pain.
- To evaluate the diagnostic utility of ultrasound (US) in detecting abnormalities related to mesenteric lymphadenopathy.
Main Methods:
- A cohort of 250 children with acute abdominal pain underwent ultrasound to assess for enlarged mesenteric lymph nodes (anteroposterior diameter > 4 mm).
- A control group of 50 asymptomatic children was included for comparison.
- Ultrasound findings were correlated with clinical diagnoses and, in some cases, histopathologic examination.
Main Results:
- Enlarged mesenteric lymph nodes were identified in 14% of symptomatic children and 4% of asymptomatic children.
- A specific diagnosis was established in 46% of symptomatic children with lymphadenopathy, with acute appendicitis being the most frequent.
- Ultrasound correctly suggested the primary diagnosis in 75% of cases where a definitive diagnosis was made. Histopathology revealed non-specific inflammatory changes.
Conclusions:
- Enlarged mesenteric lymph nodes in children with acute abdominal pain represent a nonspecific imaging finding.
- Mesenteric lymphadenopathy is associated with diverse medical and surgical conditions and can be present in asymptomatic children.
- Sonography plays a valuable role in establishing the primary diagnosis in pediatric patients with acute abdominal pain and mesenteric lymphadenopathy.
Purpose:
To identify conditions associated with enlarged mesenteric lymph nodes in children with acute abdominal pain and determine the ability of US to detect associated abnormalities.
Methods:
Two hundred and fifty children with acute abdominal pain were evaluated for the presence of enlarged mesenteric lymph nodes (AP diameter > 4 mm). Additionally, a reference group of 50 asymptomatic children was also studied for the presence of enlarged mesenteric lymph nodes.
Results:
Enlarged mesenteric lymph nodes were noted in 35 (14%) symptomatic children and two (4%) asymptomatic children. A specific diagnosis was established in 16/35 (46%) symptomatic children with mesenteric lymphadenopathy. Acute appendicitis was the most common diagnosis. The discharge diagnosis in the remaining 19 children was abdominal pain or gastroenteritis of unknown origin. US suggested the correct diagnosis in 12/16 (75%) children in whom a definite diagnosis was established. Histopathologic examination of enlarged mesenteric lymph nodes in three patients demonstrated non-specific inflammatory changes.
Conclusion:
Enlarged mesenteric lymph nodes in children with acute abdominal pain represents a nonspecific finding. Mesenteric lymphadenopathy is associated with a variety of medical and surgical conditions in symptomatic children and is occasionally seen in asymptomatic children. Sonography is useful in establishing a primary diagnosis in these children.