Cervical ultrasound and computed tomography of Kawasaki disease: Comparison with lymphadenitis

Nozaki, Taiki; Morita, Yuka; Hasegawa, Daisuke; Makidono, Akari; Yoshimoto, Yuri; Starkey, Jay; Kusakawa, Isao; Manabe, Atsushi; Saida, Yukihisa

doi:10.1111/ped.13017

Cited by 21 publications

(14 citation statements)

References 19 publications

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“…Unilateral cervical lymphadenopathy is a characteristic clinical sign of KD but is seen in only 60% of patients [8][9][10][11] Often mistaken for suppurative lymphadenitis 12,13 Exclusion of other diseases with similar findings…”

Section: Cervical Lymphadenopathymentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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Kawasaki disease (KD) is a medium vessel vasculitis with predilection for coronary arteries. Due to lack of a reliable confirmatory laboratory test, the diagnosis of KD is based on a constellation of clinical findings that appear in a typical temporal sequence. These diagnostic criteria have been modified from time to time and the most recent guidelines have been proposed by the American Heart Association (AHA) in 2017. However, several children may have incomplete or atypical forms of KD and the diagnosis can often be difficult, especially in infants and young children. In this review, we have detailed the steps involved in arriving at a diagnosis of KD and also highlight the important role of echocardiography in diagnosis and management of children with KD.

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Section: Cervical Lymphadenopathymentioning

confidence: 99%

Diagnosis of Kawasaki disease

2017

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“…Early differentiation between KD with deep neck inflammation and DNI should be necessary for an appropriate treatment. In previous studies, children with KD who initially presented with only fever and cervical LAP showed high CRP, AST, and ALT levels and higher frequency of retropharyngeal inflammation on neck CT compared to children with infectious cervical LAP [7][8][9][10][11]. Most of clinical and laboratory findings were not signifi-cantly different between children with KD and those with retropharyngeal infection, with the exception of a higher frequency of neck pain and dysphagia in children with retropharyngeal infection compared to those with KD [4].…”

Section: Discussionmentioning

confidence: 83%

“…However, KD can manifest as only fever and cervical LAP or accompanying retropharyngeal inflammation [4][5][6][7][8]. Although infectious cervical LAP and DNI should be excluded in these patients due to their different treatment strategies, comparative studies between children with KD and accompanying retropharyngeal inflammation and those with DNIs are rare [4][5][6], compared to studies comparing children with KD and accompanying cervical LAP and those with infectious cervical LAP [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Deep Neck Inflammation: Probable Kawasaki Disease in Korean Children

Lim¹,

Lee²,

Han³

et al. 2020

Clin Exp Otorhinolaryngol

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Objectives. Deep neck infections (DNIs) can cause life-threatening complications, and prompt diagnosis and management are necessary. Kawasaki disease (KD) may be accompanied by deep neck inflammation; making it difficult to distinguish from DNIs. This study was performed to evaluate clinical features and outcomes of children with parapharyngeal and retropharyngeal inflammation.Methods. Medical records of the children diagnosed with parapharyngeal and retropharyngeal cellulitis or abscess using cervical computed tomography (CT) between 2013 and 2017 were retrospectively reviewed.Results. A total of 47 children were diagnosed with parapharyngeal and retropharyngeal inflammation. Eleven (23.4%) of them were eventually diagnosed with KD, and 36 (76.6%) were diagnosed with DNIs. There were no significantly different clinical and laboratory characteristics on admission between children diagnosed with KD and DNIs; however, significantly more children with KD were febrile for ≥3 days after admission compared to those with DNIs (P=0.009). Deep neck abscesses on CT were observed in 16 children with DNIs (44.4%) and in no child with KD (P=0.009). Among the 36 children with DNIs, 30 (83.3%) were cured with antibiotic therapy only.Conclusion. A quarter of children presenting with deep neck inflammation were diagnosed with KD. KD should be considered in children showing deep neck inflammation unresponsive to empirical antibiotic therapy after 3 days, especially in those presenting with deep neck cellulitis rather than deep neck abscess.

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“…Almost all cases were reported by pediatricians or otorhinolaryngologists, which we attribute to age-related and anatomic factors. All cases occurred in patients younger than 10 years of age, except for a single 14-year-old patient, and the average patient age was 4.8 years ( 7 - 36 ). To our knowledge, no similar reports have described cases in adults, who tend to visit adult primary care physicians such as internal medicine clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Some recent publications have discussed retrospective studies of neck CT findings in patients with KD, including many cases of KD with retropharyngeal edema. We identified 30 reports involving a total of 157 cases of KD with retropharyngeal edema ( 7 - 36 ). Almost all cases were reported by pediatricians or otorhinolaryngologists, which we attribute to age-related and anatomic factors.…”

Section: Discussionmentioning

confidence: 99%

Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess

et al. 2017

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Kawasaki disease (KD) is an acute, self-limited vasculitis of unknown etiology that occurs predominantly in young children (≤5 years of age). We herein report the case of an 18-year-old Japanese man with a history of incomplete KD during infancy; later, despite an initial diagnosis of retropharyngeal abscess, he was ultimately diagnosed with retropharyngeal edema associated with recurrent KD. Adult-onset or recurrent KD is an uncommon event, and retropharyngeal edema is a rare manifestation of this disease. Internists should be aware of the possibility of KD that mimics a retropharyngeal abscess, even in adult patients.

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Cervical ultrasound and computed tomography of Kawasaki disease: Comparison with lymphadenitis

Abstract: Ultrasound is mainly useful for excluding purulent lymphadenopathy while CT is a useful diagnostic tool for differentiating KD from CL, especially in patients with incomplete KD, who present with prominent cervical lymphadenopathy and other equivocal principal findings.

Cited by 21 publications

References 19 publications

Diagnosis of Kawasaki disease

Diagnosis of Kawasaki disease

Deep Neck Inflammation: Probable Kawasaki Disease in Korean Children

Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess

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