Lymph Nodes In Children Research Articles

FDG uptake in cervical lymph nodes in children without head and neck cancer.

Reactive cervical lymphadenopathy is common in children and may demonstrate increased 18F-fluoro-deoxyglucose (18F-FDG) uptake on positron emission tomography/computed tomography (PET/CT). We sought to evaluate the frequency and significance of 18F-FDG uptake by neck lymph nodes in children with no history of head and neck cancer. The charts of 244 patients (114 female, mean age: 10.4years) with a variety of tumors such as lymphoma and post-transplant lymphoproliferative diseases (PTLD), but no head and neck cancers, who had undergone 18F-FDG PET/CT were reviewed retrospectively. Using the maximum standardized uptake value (SUVmax), increased 18F-FDG uptake by neck lymph nodes was recorded and compared with the final diagnosis based on follow-up studies or biopsy results. Neck lymph node uptake was identified in 70/244 (28.6%) of the patients. In 38 patients, the lymph nodes were benign. In eight patients, the lymph nodes were malignant (seven PTLD and one lymphoma). In 24 patients, we were not able to confirm the final diagnosis. Seven out of the eight malignant lymph nodes were positive for PTLD. The mean SUVmax was significantly higher in malignant lesions (4.2) compared with benign lesions (2.1) (P=0.00049). 18F-FDG uptake in neck lymph nodes is common in children and is frequently due to reactive lymph nodes, especially when the SUVmax is <3.2. The frequency of malignant cervical lymph nodes is higher in PTLD patients compared with other groups.

Изменения ультразвуковых параметров мезентериальных и шейных лимфатических узлов у детей с увеличением относительных размеров селезенки

Изменения ультразвуковых параметров мезентериальных и шейных лимфатических узлов у детей с увеличением относительных размеров селезенки

Editorial Comment on: D. Schreiber-Dietrich, M. Pohl, X.W. Cui, B. Braden, C.F. Dietrich, L. Chiorean Perihepatic lymphadenopathy in children with chronic viral hepatitis

The article entitled Perihepatic lymphadenopathy in children with chronic viral hepatitis(1) is an original paper of high clinical relevance – viral hepatitis B and C are the main causes of chronic hepatitis and liver cirrhosis in children. Based on ultrasound findings, the authors assessed the presence of the perihepatic lymph nodes and their morphology in 49 children with chronic viral hepatitis B and C (38 and 11 children, respectively). The authors hoped that this investigation would help establish a new, non-invasive marker enabling screening examinations to be conducted in children with chronic viral hepatitis. In adults, a correlation was found between the activity of hepatitis and the morphology of the lymph nodes in a US examination, but such a correlation has, until now, not been reported in children(2–4). The results of the study have a clinically significant aspect – the loops of the hepatoduodenal ligament are relatively readily available in a transabdominal examination, and ultrasonography is an inexpensive and safe method to be conducted in children. The authors assumed that the lymph nodes with the size of over 14 mm in the long axis were pathologically enlarged. In a US examination, such nodes were visualized in 70% of children with viral hepatitis and in 11% of healthy children. Based on the studies conducted, it was concluded that the general volume of the perihepatic lymph nodes is greater in children with chronic hepatitis in a statistically significant way (p < 0.05), compared to healthy children: 1.0 ± 1.2 mL (0.1–5.4 mL) vs 0.1 ± 0.1 mL (0.0–0.4 mL). Ultrasonography demonstrated a moderate level of sensitivity (70%) and NPV (75%), and considerable specificity (89%) and PPV (86%) in detecting enlarged perihepatic lymph nodes in children with chronic viral hepatitis. Enlarged lymph nodes of the hepatoduodenal ligament were present in patients with both chronic hepatitis B and C. There were no significant differences in the sensitivity and specificity levels of ultrasonography between the two types of hepatitis (hepatitis B: sensitivity 69%, specificity 89%; hepatitis C: sensitivity 70%, specificity 89%), but the method was characterized by superior accuracy in confirming hepatitis B (PPV 83%) compared to hepatitis C (PPV merely 58%). However, ruling out chronic viral hepatitis based on US findings was much more accurate in children with hepatitis C than in children with hepatitis B (NPV 93% vs 79%). The article summarized above is a very good example of research methodology, particularly for young scientists. The design is exemplary: the study is prospective, randomized; the inclusion and exclusion criteria are clearly specified. The methods involve the principles of so-called good clinical practice. The accurate assessment of the repeatability of size and volume measurements in a US examination must be emphasized. The evidence for a high repeatability of the measurements is an additional argument for including the perihepatic lymph node assessment into everyday clinical practice involving the treatment of children with chronic viral hepatitis B and C. In the Discussion, the authors prove how innovative their results are and indicate the path for further research – the possibility of monitoring the therapy of chronic viral hepatitis using size measurements of the perihepatic lymph nodes. Moreover, the authors also mention other methods enabling perihepatic lymph node imaging, such as CT and MRI. However, the argument concerning limited possibilities of the lymph node reconstruction in the age of multi-slice CT seems unconvincing. Furthermore, the methods of conducting US examinations applied by the authors seem lacking: the authors used a 3.5 MHz transducer in all patients irrespective of their age (1–17). Yet our experience and literature guidelines suggest that probes of higher frequency should be used for the assessment of visceral lymph nodes in younger children. The results of the measurements of the size and volume of the perihepatic lymph nodes in children with chronic viral hepatitis also raise questions regarding their accurate assessment (configuration of the hilum, blood supply and direction of flow) as well as a possible relationship of these features with the activity of the disease. Further investigations should continue the issues started in this article.

Can ultrasound elastography be used as a new technique in the differentiation of undescended testes and reactive lymph nodes in children?

To determine the diagnostic performance of ultrasound elastography in the differentiation of reactive lymph nodes and undescended testes in children. Seventy-two undescended testes and 34 reactive lymph nodes were prospectively examined with the elastography technique. Four elastographic patterns were used for classification based on the distribution of the blue area. The strain ratios and elasticity patterns of the undescended testes and reactive lymph nodes were evaluated independently by two radiologists. Interobserver agreement and diagnostic performance were analysed. Thirty of the 34 reactive lymph nodes were classified as exhibiting high-strain elastographic patterns (considered Type 1 or Type 2, with blue areas in ˂50% of the tissue) by both observers; in contrast, 67 and 71 of 72 undescended testes were classified as exhibiting low-strain elastographic patterns (considered Type 3 or Type 4, with blue areas in >50% of tissue) by radiologists 1 and 2, respectively. The respective mean strain ratios measured by the two radiologists were 0.60±0.03 and 0.62±0.02 for the reactive lymph nodes and 0.25±0.08 and 0.25±0.09 for the undescended testes. There were significant differences in the elasticity patterns and strain ratios between the reactive lymph nodes and the undescended testes (p<0.001). The interobserver agreement was excellent for the four elasticity patterns with a weighted kappa coefficient of 0.872. The concordance of the strain ratios between the observers was excellent in the present study (intra-class correlation score: 0.988). In the majority of cases, conventional two-dimensional ultrasound could be used to differentiate undescended testes from reactive lymph nodes with acceptable accuracy. Although the incremental value of elastography is limited, this technique might have a role in some specific cases.

English

Mesenteric Lymph nodes are frequently visualized by sonography in pediatric patients. The purpose of this study was to evaluate the incidence of the appearance of enlarged mesenteric nodes, in pediatric patients who were referred for abdominal pain of various causes. METHODS: Of the 500 patients who were referred for abdominal pain of various causes, the presence of enlarged nodes, their location, size and other sonological findings were recorded. The patients were divided into two groups. One is those with abdominal pain, due to an acute abdominal condition and those without an acute abdominal condition. The study was carried out in a one year period of March 2010, to March 2011. RESULTS: Enlarged lymph nodes > 5 mm were detected in 25 % of the asymptomatic patients and 27.2% of the patients presenting with abdominal pain. On the basis of this study, mesenteric lymphadenitis should be used for the specific inflammation of the nodes in the appropriate clinical setting. Our study also showed that the 90% of the lymph nodes were seen in the right lower quadrant followed by the left lower quadrant and in the peri-aortic region. Another observation that was made was that - the incidence of enlarged lymph nodes increase with age with the peak incidence at around 5 years and decrease thereafter. CONCLUSION: Enlarged lymph nodes are frequently seen in pediatric patients who are referred for abdominal pain. Mesenteric lymph nodes more than 5mm on their long axis in children presenting with abdominal pain represent Mesenteric Lymphadenitis. INTRODUCTION: Abdominal pain is a frequent symptom in pediatric patients presenting to the outpatient department and causality. Sonography of the abdomen was performed routinely to investigate the cause of pain. The detection of enlarged lymph nodes without any other abnormality is termed mesenteric lymphadenitis, meaning inflammatory process of abdominal lymph nodes. Radiologically the term mesenteric lymphadenitis is used to describe lymph nodes > 5 mm. This retrospective study was performed to evaluate the incidence of mesenteric lymphadenitis as a cause of abdominal pain. As per the study by Sivit CJ, Newman KD, Chandra RS mesenteric lymph nodes were detected in 14% of symptomatic children, but enlarged mesenteric lymph nodes in children with acute pain represents a non-specific finding. The purpose of this study was to explore the prevalence and specific location of the enlarged nodes, and their gender distribution, and associated findings like ascites. MATERIALS AND METHODS: Our study group included 500 successive pediatric patients who were referred for abdominal sonography with abdominal pain. Two experienced radiologists performed all the examinations. Scanning was performed using GE Voluson 730 and Siemens SONOLINE G50Ultrasound machines. The transducers used were convex3.75 MHz and Linear 7.5MHz probes. Scanning of the right and left lower abdominal quadrants and para aortic region were performed with the linear probes routinely. Lymph nodes of size >5mm were documented for further study.

Correlation Between Preoperative Staging Computerized Tomography and Pathological Findings After Nodal Sampling in Children with Wilms Tumor

Guidelines for staging Wilms tumor mandate regional lymph node sampling at nephrectomy. However, the usefulness of preoperative computerized tomography in staging lymph nodes has not been rigorously investigated. Thus, we correlated preoperative computerized tomography and pathological lymph node findings to establish a radiological criterion for pathological lymph node enlargement. We reviewed the medical records of children with Wilms tumor at our institution who underwent pre-chemotherapy surgery with lymph node sampling and had preoperative computerized tomography with contrast medium available for interpretation. Computerized tomography was independently reviewed by 2 radiologists blinded to the pathological findings. We collected data on the diameter of the largest regional lymph node identified and this measurement was correlated with the pathological results. A total of 52 children (25 male, 27 female) with a median age of 3.1 years (range 0.4 to 9.6) were identified. The median largest regional lymph node diameter was 6 mm (range 2 to 15). Of the children 10 (19.2%) had metastatic involvement of sampled lymph nodes. A radiological cutoff of 7 mm for lymph node positivity corresponded to a negative predictive value of 89.0%, a sensitivity of 70.0% and a specificity of 57.1%. A ROC curve was constructed with these data describing the prognostic ability of the diameter of the largest regional lymph node on preoperative computerized tomography to determine lymph node positivity in Wilms tumor, which revealed an AUC of 0.67 (95% CI 0.48-0.87, p = 0.09). By defining a radiological size cutoff for suspicious lymph nodes, preoperative computerized tomography for staging lymph nodes in Wilms tumor demonstrates potential clinical usefulness through risk stratification for therapy and future study design.

Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography

ObjectiveTo study normal mediastinal and hilar lymph nodes on multi-detector chest computed tomography (CT).MethodsA cohort of 120 children aged 1–17 years underwent emergency CT, including the chest, after high-energy trauma. Axial 5-mm reconstructions were evaluated for lymph nodes at hilar and various mediastinal levels and the short-axis diameters were measured.ResultsAt least one lymph node was found in 115 (96%) children, with subcarinal (69%), lower paratracheal (64%) and hilar (60%) nodes being most common. Up to 10 years of age most lymph nodes were smaller than or equal to 7 mm. In older children lymph nodes measuring up to 10-mm-short-axis diameter were found. Lymph nodes were rare along the mammary vessels, at lower oesophageal and at prevascular and posterior mediastinal levels in children.ConclusionMediastinal and hilar lymph nodes are more common than previously thought, probably because of increased detection by modern multi-detector CT. Lymph node location and age have to be taken into account when evaluating lymph nodes in the paediatric chest. Key Points • The size and location of normal lymph nodes is of great diagnostic importance • There is little relevant published information related to pediatric chest computed tomography • We provide normative data concerning mediastinal and hilar lymph nodes in children • These normal values can help identify abnormal lymph nodes in children

Retropharyngeal Lymph Nodes in Children: A Common Imaging Finding and Potential Source of Misinterpretation

The retropharyngeal lymph nodes are the least well-described portion of the Waldeyer ring. Originally described as occurring in medial and lateral groups, reports have described only the presence of lateral nodes in children. We have seen cases of MRI sleep studies in children with obstructive sleep apnea (OSA) in which lateral and medial retropharyngeal lymph nodes are present and have been misinterpreted. Our purpose is to describe the frequency and appearance of retropharyngeal lymph nodes in children with and without OSA. Axial and sagittal T2-weighted MRI scans were reviewed in 150 children with OSA and 150 control subjects without OSA, who underwent imaging for other indications. The presence, size, and location of the retropharyngeal lymph nodes were evaluated. Retropharyngeal lymph nodes were evaluated for frequency of medial nodes, frequency of lateral nodes, size as indicated by the anterior-to-posterior diameter, laterality (bilateral or unilateral), and superior-to-inferior location compared with the cervical vertebral body level. Analyses were performed using the chi-square or Fisher's exact test (for categorical data) and generalized linear model or two-sample Wilcoxon's Mann-Whitney test (for continuous data). Lateral retropharyngeal lymph nodes were common in both children with OSA (137/150 [91.3%]) and children without OSA (146/150 [97.3%]). Medial retropharyngeal lymph nodes occurred not uncommonly in both children with OSA (32/150 [21.3%]) and those without OSA (26/150 [17.3%]). Lateral retropharyngeal lymph nodes were more commonly bilateral (95% CI, 88.4-97.4%; p < 0.0001) and located at the skull base (C1) or C1-C2 level (99%; p < 0.0001). Medial retropharyngeal lymph nodes were more commonly unilateral (95% CI, 71.9-84.6%; p < 0.0004) and located at the C2-C3 level (95% CI, 78.13-84.62%; p < 0.0001). There were no statistically significant differences in the proportion of medial or lateral retropharyngeal lymph nodes in the OSA group compared with the control group. Retropharyngeal lymph nodes are seen commonly in children in both lateral (95% CI, 91.3-97.3%) and medial (95% CI, 17.3-21.3%) locations. Media nodes are present more frequently than previously described. Such nodes occur almost equally frequently in populations with and without OSA. Retropharyngeal lymph nodes should be considered normal in children and not be interpreted as abnormal or misdiagnosed.

Cytomorphological patterns of M. bovis BCG and M. tuberculosis on fine needle aspiration biopsies: Does HIV make a difference?

To determine if fine needle aspiration (FNAB) of mycobacterial lymphadenopathy can differentiate infection with M. bovis BCG (BCG) from M. tuberculosis (TB) and whether HIV status affects discriminatory cytological features. A retrospective study of culture positive, fine needle aspiration biopsies of lymph nodes in children (<13 years) between 2003 and 2008. A total of 77 aspirates were available for evaluation with 67 (87%) patients having known HIV status. BCG occurred at a younger age (6 months), predominantly axillary lymph nodes (90%) compared with TB (5 years and 20% axillary lymph nodes). Amorphous necrosis was only seen in aspirates from TB lymph nodes, while in HIV negative children with TB, foamy macrophages were absent. On ZN staining there were more organisms in the BCG group and in HIV positive patients the organisms were present in both extra- and intracellular locations, whereas in the HIV negative patients the organisms were predominantly extracellular in location. Demographic and cytomorphologic features that can assist in distinguishing between the two mycobacterial species include: age of patient, location of the lymph node, and presence/absence of amorphous necrosis and foamy macrophages on FNAB. However the only reliable method to identify the mycobacterial species is by mycobacterial culture and/or PCR.

Discrimination Between Childhood Subacute Necrotizing Lymphadenitis and Nonspecific Cervical Lymph Hyperplasia for Earlier Diagnosis

Purpose :We conducted this research to make an earlier diagnosis and identify better treatment for Kikuchi-Fujimoto disease (KFD) by comparing clinical findings with nonspecifically enlarged cervical lymph nodes in children. Methods :Nineteen patients were diagnosed with KFD by tissue pathology from a fine needle aspiration biopsy and/or excisional biopsy and were compared with the clinical, radiological, and pathological findings of reactive hyperplasia. Results :The average onset age of onset for patients with KFD was 11.8 3.61 years, and the ± male to female ratio was 1:1.1, whereas patients with reactive hyperplasia were 11.8 5.96 years, ± and the male to female ratio was 1.7:1. Patients with KFD suffered more from fever than patients with reactive hyperplasia (68% vs. 13%, P=0.002). Patients with KFD showed perinodal infiltration (P=0.001) and necrosis on computed tomography, whereas patients with reactive hyperplasia did not show any of these findings. Ultrasonographic findings were similar between the two study groups. In contrast, the histopathological examinations of biopsied cervical lymph nodes were enormously helpful for distinguishing the findings of KFD from those of patients with reactive hyperplasia. Conclusion :We recommend a histopathological examination to distinguish KFD from reactive hyperplasia in children with significantly enlarged cervical lymph nodes. [Pediatr Allergy Respir Dis(Korea) 2011;21:326-333]

Diagnostic Accuracy of Doppler Ultrasonography in Differentiation between Malignant and Benign Cervical Lymphadenopathies in Pediatric Age Group

Cervical lymphadenopathy is a relatively common finding in pediatric age group and is caused by a wide spectrum of diseases from transient infections to malignancies especially lymphomas. The present study was aimed at evaluating the diagnostic performance of grey-scale ultrasonography, color Doppler ultrasonography and power Doppler ultrasonography in differentiation of reactively and metastatically enlarged cervical lymph nodes in pediatric age group. Fifty children with cervical lymphadenopathies were assessed by ultrasonographic methods. In each patient, the longest (L) and transverse (T) diameters, L/T ratio and presence or absence of the normal hilar pattern were checked by grey-scale ultrasonography. Spectral parameters (resistive and pulsatility indices) and vascular distribution pattern of nodes were recorded by color and power Doppler ultrasonography, respectively. Following the ultrasonographic evaluations, biopsy and/or clinical follow up was applied for six months, based on the clinical and paraclinical findings. Statistical analyses were performed by chi-square test, independent t-test and receiver operator characteristic curves. The mean age of patients was 12.42 +/- 2.42 years. Twenty eight patients (56%) had malignant enlargement of lymph nodes. The mean value of L/T ratio in malignant group was 1.70 +/- 0.22 and 2.40 +/- 0.38 in non-malignant nodes (p < 0.001). Sensitivity, specificity and accuracy of combined grey-scale and power Doppler ultrasonography were 70, 86 and 81%, respectively. Combination of grey-scale and power Doppler ultrasonography is recommended for the differentiation between the malignant and benign lymphadenopathies in children. Moreover, our findings revealed no diagnostic role of color Doppler ultrasonography in the selection of malignant cervical lymph nodes in children.

Atypical Spitzoid Melanocytic Tumors With Positive Sentinel Lymph Nodes in Children and Teenagers, and Comparison With Histologically Unambiguous and Lethal Melanomas

Children and teenagers with a positive sentinel lymph node (SLN) after a prior diagnosis of an atypical spitzoid melanocytic tumor (ASMT) are usually cared for clinically in the same way as patients with melanoma. Little is known about long-term follow-up of these individuals to determine whether this practice is appropriate. To learn more about the biology of these tumors we retrospectively reviewed the clinical and pathologic findings of children and teenagers (<18 y of age at the time of diagnosis) with an ASMT, positive SLN and follow-up of at least 3 years. Their findings were compared with histologically unambiguous melanomas of children or teenagers, who had a positive SLN or died of metastatic melanoma. Eleven individuals, 6 girls and 5 boys, with primary ASMT and positive SLN were identified. The primary tumors ranged in thickness from 2.1 to 12 mm (median, 4.6 mm; mean, 5 mm). The tumor mitotic rate ranged from 1 to 10 mitoses/mm (median, 3/mm, median, 3/mm). The positive SLNs included 6 nodes with intranodal melanocytic aggregates measuring <1 mm in greatest dimension, and 5 nodes, in which the size of the melanocyte deposits was >/=1 mm. All the patients with ASMT and positive SLN remained free of disease with a median follow-up of 47 months (mean, 61 mo, range: 36 to 132 mo). In contrast, 2 of 5 patients <18 years of age with a histologically unambiguous melanoma and a positive SLN died of metastatic melanoma. The overall disease-specific mortality rate for all patients <18 years of age diagnosed with melanoma was 12%. Our findings confirm that children and teenagers with ASMTs and positive SLNs have a less aggressive clinical course than those with histologically unambiguous melanoma.

Head and neck lymph nodes in children: the spectrum from normal to abnormal

Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.

Localized Abdominal Castleman Disease Masquerading as Malabsorption Syndrome

Castleman disease is a rare lymphoproliferative disorder of unclear etiology. It usually presents as localized enlarged lymph nodes in children. Surgical excision is curative in localized form. Clinical findings of malabsorption are rarely reported in the literature. Herein, we describe a 14-year-old girl who presented with anemia, failure to thrive, osteoporosis, zinc, and vitamin deficiency. She was diagnosed as localized mesenteric mixed type of Castleman disease. Her clinical findings improved after surgical excision of the mass.

Importance of Sonographic Detection of Enlarged Abdominal Lymph Nodes in Children

Abdominal lymph nodes are frequently visualized by sonography in the pediatric population. The term "mesenteric lymphadenitis" is frequently used in the radiologic literature to describe this finding, whereas in the pediatric literature, this term is reserved for specific inflammation of the lymph nodes. The purpose of this study was to compare by sonography the incidence of appearance of enlarged abdominal lymph nodes (EALNs) in healthy children compared with that in children with abdominal pain of various causes. In 200 patients referred for abdominal sonography for various indications, the presence of EALNs, their location, and size were registered. The patients were divided into 3 groups: those with abdominal pain due to an acute abdominal condition (group 1), those with abdominal pain without an acute abdominal condition (group 2), and asymptomatic patients (group 3). Enlarged abdominal lymph nodes greater than 5 mm were detected in 83.3% of group 1 patients, 73.8% of group 2 patients, and 64% of group 3 patients. A significant statistical difference was found between patients with abdominal pain and asymptomatic children only for lymph nodes of 10 mm and larger (P = .0117). No statistically significant difference was seen in the presence of lymph node clusters between the patients with abdominal pain and asymptomatic children. There was a tendency of increased EALN occurrence with age, peaking at 10 years, with a decrease later. Enlarged abdominal lymph nodes are frequently encountered in asymptomatic children and should not always be considered abnormal. Enlarged abdominal lymph nodes exceeding 10 mm in their shortest axis in children with abdominal pain may represent mesenteric lymphadenitis of various causes.

Mesenteric lymph nodes in children: what is normal?

Mesenteric lymph nodes in children: what is normal?

Fine needle aspiration cytology of enlarged lymph nodes in children and adolescents

Purpose:Palpable lymph nodes are common in the pediatric population, and most of them are either inflammatory or congenital. As the diagnostic evaluation, fine needle aspiration cytology (FNAC) is known to be more convenient and economical than tissue biopsy. We evaluated the usefulness of FNAC in children and adolescents. Methods:Four hundred and thirteen FNAC samples(M:F=1:1.15) were retrospectively analyzed in patients who were brought to Inha University Hospital, from August 1999 to August 2004. Results:The most common age group was 16-20 years of age(N=148, 35.8 percent). The cervical area was the most frequently involved site(N=310, 75 percent). Non-specific lymphadenitis was the most common(N=227, 54.9 percent), followed by the benign neoplasm(N=59, 14.2 percent). Malignant tumors were 18 cases(4.3 percent), and congenital diseases were found in 10 cases(2.4 percent). In inflammatory lesions, tuberculous lymphadenitis(N=22, 5.3 percent) was the most common with a histologic sensitivity of 90.9 percent. The peripheral blood and serologic studies were non-specific. Fifty nine percent(N=244) of lymphadenitis improved without specific management. Antibiotics were prescribed in 15.2 percent of lymphadenitis and lymphadenectomy was performed in 12.6 percent. Conclusion:Most of the enlarged lymph nodes in children and adolescents were benign. These results show FNAC is a safe, rapid and reliable diagnostic procedure for the appropriate differential diagnosis of enlarged lymph nodes in children and adolescents.

Treatment of Enlarged Lymph Nodes in Children and Adolescents

Purpose:Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided pre- emptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. Methods:We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. Results:CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade ≥II) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade ≥II) were the independent risk factors for positive CMV antigenemia. Conclusion:Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.

Mesenteric lymph nodes in children: what is normal?

Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and, in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. To evaluate the prevalence of enlarged MLN (short axis>or=5 mm) as detected by abdominal CT in children with a low likelihood for mesenteric lymphadenopathy. During a 14-month period, we identified all non-contrast abdominal CT examinations performed at a tertiary care pediatric hospital for evaluation of suspected or known renal stones. Two radiologists reviewed the examinations and recognized all enlarged MLN, measured the short-axis diameter, and noted the quadrant location. Sixty-one children were identified who met entry criteria; mean age was 10.7 years (range 1.1-17.3 years). Enlarged MLN were found in 33 (54%) of the 61 children; the largest enlarged MLN was most frequently in the right lower quadrant (RLQ) (29 of 33, 88%). Seventeen of the 61 children (28%) had three or more enlarged MLN; all were in the RLQ. The largest short-axis diameter measured was 10 mm. MLN with a short-axis diameter of >5-10 mm are commonly found on abdominal CT examination of children with a low likelihood for mesenteric lymphadenopathy and should be considered a non-specific finding. A short-axis diameter of 8 mm might better define the upper limit of normal mesenteric lymph node size in children.

Comparison of ultrasound with plain radiography and CT for the detection of mediastinal lymphadenopathy in children with tuberculosis

Lymphadenopathy, with or without parenchymal abnormality, is the radiological hallmark of primary tuberculosis (TB) in children. However, lymph node enlargement may pass undetected on plain chest radiographs. Ultrasonography provides complementary information to that obtained by radiographs. To assess the clinical value of US for the detection of mediastinal lymphadenopathy in children with a positive intradermal tuberculin test. Thirty-two children with a mean age of 6 years and a positive Mantoux test underwent chest radiography (frontal and lateral) and US (suprasternal and left parasternal access routes). Chest CT was performed at the discretion of the attending physician in six cases. Eleven children had clinical symptoms and 90% a recent contact with a person with active TB. In 90.5% of children with chest radiographic images compatible with TB, coincident findings in the mediastinal US study were found. By comparison, 66.7% of those with normal chest radiography had evidence of mediastinal lymphadenopathy on the US scan. In all cases but one, US and CT findings agreed. Mediastinal US is useful for the detection of enlarged lymph nodes in children with a positive tuberculin reaction and normal chest radiography.