Ultrasonographic findings of Kikuchi cervical lymphadenopathy in children

Abstract

PurposeThe purpose of this study was to analyze the ultrasonographic (USG) findings of Kikuchi cervical lymphadenopathy in pediatric patients.MethodsBetween April 2007 and September 2016, 84 children (42 male and 42 female; mean±standard deviation age, 12.9±3.2 years; range, 5 to 18 years) confirmed with Kikuchi disease were enrolled. Clinical findings and USG findings of Kikuchi cervical lymphadenopathy were retrospectively reviewed. Localized symptoms, systemic symptoms, and laboratory findings including the white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were analyzed. An analysis of the USG findings included evaluation of the location, size, and presence of intranodal abscess; intranodal calcification; perinodal fat swelling; localized fluid collection; and loss of nodal echogenic hilum.ResultsAmong the patients, 49 (58%) showed localized tenderness at the cervical lymphadenopathy. Fever was present in 55 (66%), while 27 (32%) had prolonged fever. Of 74 with lab results, 54 (73%) had leukopenia but none had leukocytosis. Among the same 74, there was a high ESR (>50 mm/hr) in 10 (14%) and a high CRP level (>5 mg/dL) in seven (9%). The USG findings of most of the patients (n=72, 86%) showed unilateral neck involvement, especially in the left side neck (45 of 72, 63%). The most common site of Kikuchi lymphadenopathy involvement was the area at cervical lymph node level V, at the posterior triangle (n=77, 92%). Conglomerated nodal distribution (n=57, 68%), preserved central nodal echogenic hilum (n=84, 98%), and perinodal fat swelling (n=55, 65%) were common USG findings in the children with Kikuchi. In addition, multiple cervical lymph nodes showed a relatively even size distribution (n=73, 87%).ConclusionThe common USG findings of Kikuchi disease in the pediatric population of our study were multiple conglomerated unilateral cervical lymphadenopathy showing perinodal fat swelling and even size distribution.

Acoustic radiation force impulse imaging of biopsy-proven Kikuchi disease: initial experiences for evaluating feasibility in pediatric patients

“…Several studies have reported unilateral neck involvement to be predominant in Kikuchi disease, occurring in up to 80% of cases [6,11]. Based on previous research, we assumed that patients had unilateral disease.…”

“…Another study of the sonographic features of Kikuchi disease found that conglomerated unilateral cervical lymphadenopathy with perinodal fat swelling and an even size distribution were common findings. In that study, the mean size of the LNs was 1.6 cm and the LNs were mainly located at levels II and V [9,11].…”

“…US is a non-invasive modality of evaluating cervical lymphadenopathy. Several previous reports have described the sonographic findings of Kikuchi disease, which include elongated or oval hypoechoic LNs with increased perinodal echogenicity, an echogenic hilum, and normal hilar flow [8-11]. These features are nonspecific, and are similar to those of other common causes of lymphadenopathy, such as reactive hyperplasia, tuberculous lymphadenitis, lymphoma, and metastasis [9,12-14].…”

Histiocytic Necrotizing Lymphadenitis Involving the Neck: Radiology-Pathology Correlation

“…The majority of cases have unilateral lymph node involvement, mostly in levels 2 and 5 [4][5][6]. Ultrasound typically demonstrates cervical lymphadenopathy in the form of lymph node clusters or conglomerates that may be accompanied by perinodal fat swelling [6]. On CT, the affected lymph nodes can display homogeneous contrast enhancement or with hypoattenuation areas that correspond to necrosis surrounding by cortical hyperenhancement, as demonstrated in this case [5,7,8].…”

“…Diagnostic imaging can be useful for evaluating the extent and nature of the lymphadenopathy in a patient with histiocytic necrotizing lymphadenitis. The majority of cases have unilateral lymph node involvement, mostly in levels 2 and 5 [4][5][6]. Ultrasound typically demonstrates cervical lymphadenopathy in the form of lymph node clusters or conglomerates that may be accompanied by perinodal fat swelling [6].…”