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Evaluation of abdominal lymphadenopathy in children by ultrasonography
M Watanabe1, E Ishii, Y Hirowatari
1Division of Pediatrics, Saga Prefectural Hospital Koseikan, Saga, Japan.
Insights
Enlarged abdominal lymph nodes (LNs) in children with acute gastroenteritis or abdominal pain may show increased size and tenderness. Ultrasonography (US) is key for diagnosing underlying conditions, as LN enlargement alone lacks specificity.
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Lymph Node Evaluation
Background:
- Enlarged abdominal lymph nodes (LNs) in children can present diagnostic uncertainty.
- Distinguishing normal from abnormal lymphadenopathy is crucial for pediatric care.
Purpose of the Study:
- To compare abdominal lymph node characteristics via ultrasonography (US) in healthy children versus those with acute abdominal pain or gastroenteritis.
- To assess the diagnostic utility of US in evaluating pediatric abdominal lymphadenopathy.
Main Methods:
- Comparative ultrasonography (US) study of 122 asymptomatic children and 44 with acute abdominal pain, plus 27 with acute gastroenteritis.
- Evaluation of lymph node number, size, shape, and tenderness by age group (0-15 years).
Main Results:
- Lymph nodes were common in asymptomatic children, with larger and rounder nodes in older children.
- Children with acute gastroenteritis had the largest lymph nodes, followed by those with abdominal pain.
- Tenderness and round shape of lymph nodes were significantly increased in children with acute abdominal pain or gastroenteritis.
Conclusions:
- Increased size and tenderness of abdominal lymph nodes (LNs) are observed in children with acute gastroenteritis and abdominal pain.
- Ultrasonography (US) findings of lymphadenopathy in children lack specificity for acute abdominal pain.
- Diagnosing organic pathology using US is essential, irrespective of lymphadenopathy presence in pediatric abdominal conditions.
Background:
There may be uncertainty as to whether enlarged abdominal lymph nodes (LNs) in children are normal or abnormal.
Objective:
To compare, by ultrasonography (US), enlarged abdominal LNs in healthy children with those in children with acute abdominal pain or acute gastroenteritis.
Materials And Methods:
One hundred and twenty-two asymptomatic children were selected by questionnaire and compared with 44 children with acute abdominal pain of unknown origin and 27 children with acute gastroenteritis. The number of LNs, their location, their shape and the presence of tenderness as detected by finger compression of each LN were evaluated. The children were divided into four groups according to age: 0-2, 3-6, 7-10, and 11-15 years.
Results:
LNs were detected in the ileo-caecal and/or para-aortic areas in almost all of the asymptomatic children. The number of large LNs ( > 10 mm) in the para-aortic areas was higher in the older children (>/= 7 years of age) than in the younger children ( /= 2.0) was increased in the older children. The number of LNs was not increased in the children with acute abdominal pain. The size of the LNs was largest in the children with acute gastroenteritis, followed by the children with acute abdominal pain and the asymptomatic children (P < 0.001). Although the shape of the LNs was no different among the three groups of children, the frequency of round-shaped LNs (ratio of long- to short-axis diameter < 2.0) was greater in the older children with acute abdominal pain or acute gastroenteritis than in the asymptomatic children (P < 0.01). The number of LNs with tenderness detected by finger compression was significantly greater in the children with acute abdominal pain and acute gastroenteritis than in the asymptomatic children (P < 0.0001).
Conclusion:
The number of large and round-shaped LNs with tenderness tended to be increased in the children with acute gastroenteritis and acute abdominal pain. There is no clear specificity of LN enlargement in the children with acute abdominal pain, and the main challenge is to diagnose or estimate the organic pathology by US, regardless of the presence of lymphadenopathy.