CT Analysis of Retropharyngeal Abnormality in Kawasaki Disease

Roh, Kyungmin; Lee, Sun Wha; Yoo, Jeong-Hyun

doi:10.3348/kjr.2011.12.6.700

Cited by 33 publications

(28 citation statements)

References 17 publications

(24 reference statements)

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“…Previous reports have compared NFKD with typical KD. 9, 10 Others have described radiologic features 11 and laboratory values 12 that could distinguish NFKD from BCL. Our KD Research Center’s extensive database afforded the unique opportunity to describe and compare NFKD, typical KD, and BCL from a single center.…”

mentioning

confidence: 99%

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

104

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Objective To identify characteristics differentiating the node-first presentation of Kawasaki disease (NFKD) from bacterial cervical lymphadenitis (BCL) and typical Kawasaki disease (KD). Study design From our prospectively collected database, we compared clinical, laboratory, and imaging characteristics of NFKD and BCL cohorts and performed multivariable logistic regression to identify variables that distinguish NFKD from BCL. We then compared outcomes of NFKD and patients with typical KD treated during the same period. Results Over 7 years, 57 patients were hospitalized for NFKD, 78 for BCL, and 287 for typical KD. Patients with NFKD were older and had more medical encounters and longer duration of illness prior to correct diagnosis than patients with BCL. Of patients with NFKD, 33% had an admission diagnosis of bacterial adenitis or abscess. Compared with patients with BCL, patients with NFKD had lower leukocyte (WBC), hemoglobin, and platelet counts and higher absolute band counts (ABC), C-reactive protein (CRP), alanine transaminase and γ-glutamyl transpeptidase levels, and erythrocyte sedimentation rates. In the multivariable analysis, smaller nodes, lower WBC, and higher ABC and CRP were independently associated with NFKD. Patients with NFKD had multiple enlarged solid nodes and comparable rates of retropharyngeal edema. Compared with patients with typical KD, patients with NFKD were older, had more severe inflammation, and had similar rates of coronary artery abnormalities and resistance to intravenous immune globulin. Conclusions High ABC and CRP values and multiple enlarged solid nodes in febrile patients with cervical adenopathy should prompt consideration of NFKD to prevent delayed diagnosis of KD. Retropharyngeal edema on radiography should not dissuade from the diagnosis of NFKD.

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mentioning

confidence: 99%

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Kanegaye

Cott

Tremoulet

et al. 2013

The Journal of Pediatrics

104

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“…Group A had greater thickness of RLD, greater scores of the RLD extent into the deep neck spaces, greater scores of the adjacent soft tissue changes than Group B. 19 Therefore, KD patients with retropharyngeal space changes have stronger inflammatory reactions than non-KD patients.…”

Section: Discussionmentioning

confidence: 98%

“…11 However, inflammation and edema were considered the main mechanism. 19 Increased microvascular permeability is an initial step of KD, and vascular endothelial growth factor might play a role in the vascular leakage. Increases in vascular leakage cause hypoalbuminemia and noncardiogenic edema.…”

Section: Discussionmentioning

confidence: 99%

Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child

Fang

Shyur

Peng

et al. 2014

Journal of Microbiology, Immunology and Infection

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We report a 3-year-old girl with Kawasaki disease who presented with retropharyngeal edema and shock syndrome. This is the first reported case in Taiwan. The patient initially presented with fever, cough, and pyuria followed by rapidly progressive enlarged bilateral cervical lymphadenopathy. On the third day of the fever, computed tomography for airway compression sign found widening of the retropharyngeal space mimicking a retropharyngeal abscess. Later, an endotracheal tube was inserted for respiratory distress. A skin rash over her trunk was also noted. On the fifth day of the fever, the clinical course progressed to hypotension and shock syndrome. Because of more swelling of bilateral neck lymph nodes, computed tomography was arranged again and revealed partial resolution of the edematous changes in the retropharyngeal space. Edema of the hands and feet, bilateral bulbar conjunctivitis, and fissured lips were subsequently found. The diagnosis of Kawasaki disease was confirmed on the eighth day of fever. There was no evidence of bacterial infection. She was administered intravenous immunoglobulin (2 mg/kg) and high dose aspirin (100 mg/kg/day). One day later, the fever subsided, and her blood pressure gradually became stable. Heart echocardiography on the Day 13 revealed dilated left coronary artery and mitral regurgitation. Follow-up echocardiography six months later showed normal coronary arteries. To date, the patient has not experienced any complications. This case illustrates that retropharyngeal edema and shock syndrome can be present in the same clinical course of Kawasaki disease. Clinicians and those who work in intensive care units should be aware of unusual presentations of Kawasaki disease to decrease rates of cardiovascular complications.

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“…No KD case was pathologically analyzed according to the database of our university hospital from 2000 to 2016. Previous reports on KD-associated pseudoabscesses suggested that such lesions could originate from systemic vasculitis of microvessels with the tissue edema and inflammation [3,4,10]. The aberrant activation of neutrophils, monocytes/macrophages, CD8 + cells, and IgA-producing plasma cells has been reported to involve the systemic vasculitis in KD patients [1].…”

Section: Discussionmentioning

confidence: 99%

“…The early-appearing manifestation often challenges us to differentiate KD and deep neck infections because the critical lesions may need urgent interventions. KD is suspected when a retropharyngeal abscess is assessed by computed tomography (CT) [3,4,5]. On the other hand, no aspirate samples have been reported that verify abscess formation or fluid collection at the site, even though contrast imaging has indicated ring-enhancing lesions [3].…”

Section: Introductionmentioning

confidence: 99%

Distinct Distribution of Immunocytes in a Retropharyngeal Lymphadenopathy Associated with Kawasaki Disease: A Case Study Compared with Tonsillitis

et al. 2017

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Objectives: Retropharyngeal lesions are often associated with Kawasaki disease (KD). A 4-year-old male first presented a peritonsillar and retropharyngeal abscess-like lesion. Surgical tonsillectomy was performed to avoid a risk of mediastinal abscess, but he fulfilled the diagnostic criteria of KD after the operation. This prompted us to perform a histological study on the KD tonsils. Methods: Thehistopathology of the KD tonsil specimens were compared with hypertrophic tonsils obtained from 4 patients with chronic tonsillitis unrelated to KD assessed by the immunostainings. Results: KD tonsils showed small lymphatic follicles and neutrophil infiltration in the peritonsillar muscle layer, with no evidence of vasculitis or abscess formation. The KD tonsils exclusively showed (1) predominant activated CD4⁺ T cells in the perifollicular interstitium, (2) sparse scattering of CD68⁺ monocytes/macrophages in the lymphatic follicles, and (3) polyclonal carcinoembryonic antigen-positive cells in the lymphatic follicles and venules with the high endothelial cells. Conclusions: The uniquely distributed immunocytes suggest the inflammatory process of KD involving the pathogen-associated molecules.

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CT Analysis of Retropharyngeal Abnormality in Kawasaki Disease

Cited by 33 publications

References 17 publications

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child

Distinct Distribution of Immunocytes in a Retropharyngeal Lymphadenopathy Associated with Kawasaki Disease: A Case Study Compared with Tonsillitis

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