Ultrasonographic Evaluation of Suppurative Cervical Lymphadenitis in Children : Focusing on Abscess Formation.

Lee,  Min Hee; Lee,  Sun Wha; Kang,  Byung Chul

Journal of Korean Society of Medical Ultrasound 1999;18(4): 313-318.

Min Hee Lee, Sun Wha Lee, Byung Chul Kang

¹Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine.
²Department of Diagnostic Radiology, College of Medicine, Ewha Womans University.

Published online: January 1, 2001.

ABSTRACT

PURPPOSE: To analyze the US findings of suppurative cervical lymphadenitis in children and to define the US features of drainable abscess. MATERIALS AND METHODS: We retrospectively evaluated the US findings of suppurative cervical lymphadenitis in 22 children (age; 40 days-14 years). Among them, eighteen were confirmed by drainage or needle aspiration, and four diagnosed on the basis of typical findings of abscess on enhanced CT. Echogenicity, shape (ratio of long/short diameter) of suppurative lymph nodes, and the changes of adjacent soft tissue on US were assessed, and color signal patterns of 17 suppurative lymph nodes on color Doppler imaging were also recorded. We compared the US with CT findings (n=14). RESULTS: Eight of 22 were abscesses of typical US pattern, showing the characteristic anechoic central cores. Forteen demonstrated low echogenicity with mottled anechoic portions, atypical US pattern. Ratio of long/short diameter measured more than 2 in 16 of 22, and less than 2 in 6. Adjacent subcutaneous tissue was thickened and increased in echogenicity with hypoechoic irregular lines in all cases. On color Doppler imaging, only peripheral pattern was seen in four of 5 suppurative lymph nodes of typical pattern. In 12 suppurative lymph nodes of atypical pattern, there were 4 peripheral patterns, 2 central patterns and 6 mixed patterns. Compared the US findings with CT, all three suppurative lymph nodes of typical US pattern showed peripheral rim enhancement. Peripheral rim enhancement containing low attenuated internal portion (n=8) and inhomogeneous enhancement (n=3) were observed in 11 suppurative lympy nodes of atypical pattern. CONCLUSION: Any lymph node with complex echogenicity containing mottled anechoic portions with adjacent edematous subcutaneous tissue as well as central anechoic core could be regarded as the findings of drainable abscess in US diagnosis of suppurative cervical lymphadenitis in children.

Keywords: Lymphatic system diseases; Lymphatic system; US Neck abscess