Kikuchi Cervical Lymphadenitis in Children

Abstract

Objectives To investigate ultrasound (US) features of enlarged cervical lymph nodes (LNs) to differentiate between Kikuchi disease (KD) and other common types of infectious lymphadenitis in an East Asian pediatric patient population. Methods A total of 142 pediatric patients with KD and 45 patients with infectious lymphadenitis (suppurative lymphadenitis [n = 29], nontuberculous mycobacterial lymphadenitis [n = 9], and tuberculous lymphadenitis [n = 7]) were included. The clinical characteristics, laboratory results, and US features of LNs were reviewed. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used as a diagnostic accuracy measure. Results A multiple clustered adjacent pattern, bilaterality, an even size, posterior neck involvement, no enlargement, an elongated‐to‐ovoid shape, homogeneous hypoechogenicity, a well‐defined margin, presence of an echogenic fatty hilum, no intranodal gross necrosis, increased perinodal fat echogenicity, and no increased echogenicity of the adjacent sternocleidomastoid muscle were significant US features of the affected LNs to discriminate KD from infectious lymphadenitis (P < .05). Homogeneous hypoechogenicity in KD showed the highest AUC (0.930) as a single variable (95% confidence interval, 0.88–0.96). The AUCs were increased in 3 combination models with 2 US features: homogeneous echogenicity and 1 of 3 other US features (increased perinodal fat echogenicity, 0.935; number of affected LNs, 0.947; and LN shape, 0.949). Conclusions Homogeneous hypoechogenicity of LNs was a significant US feature with the highest diagnostic accuracy in differentiating KD from common infectious lymphadenitis on a univariate analysis. In the combination model, US features of an elongated‐to‐ovoid shape and homogeneous hypoechogenicity showed the highest diagnostic accuracy.

Analysis of bleeding after ultrasound-guided needle biopsy of benign cervical lymph nodes

“…In this study, tuberculous lymph nodes with a large nonenhancement range were more likely to bleed than those with punctate nonenhancement; all of these were intra-lymph node bleeding with no perilymph node bleeding associated with needle tract bleeding spilled into the abscess cavity along the needle tract after CNB. Most infectious cases in this study were of lymph node tuberculosis—a chronic infection that frequently causes adhesion between surrounding tissues and lymph nodes and poor palpation activity [ 20 ]. Bleeding after lymph node tuberculosis CNB primarily affects lymph nodes.…”

Case report: Kikuchi-Fujimoto disease: unveiling a case of recurrent fever and enlarged cervical lymph nodes in a young female patient with a literature review of the immune mechanism

“…KFD typically presents as an acute to subacute course, characterized by cervical lymph node inflammation and fever, and may involve the skin. Less common manifestations include weight loss, fatigue, night sweats, myalgia, arthralgia, elevated hepatic enzymes, and nervous system involvement, and approximately 15% of patients experience hepatomegaly or splenomegaly (8)(9)(10). Sometimes, it occurs in patients with systemic lupus erythematosus (SLE) and can be complicated by macrophage activation syndrome (MAS) (11).…”