MEDIASTINAL LYMPH NODES IN HEALTHY CHILDREN; FREQUENCY, SIZE RANGE AND DISTRIBUTION BY AGE

Abstract

Objective: Decision making about clinically significant lymph nodes (LN) is crucial. We elaborated the mediastinal LNs based on location, size and age groups. Material and Method: Contrast enhanced chest computed tomography scans of 150 children who were referred to the radiology department after trauma, were evaluated retrospectively. All participants were divided into five age groups (0-24, 25-60, 61120, 121-180 and 181-216 months) which included thirty children each. We documented the shortest and longest axis diameters of the largest LNs and their location along with the age and gender of the children. Kolmogorov-Smirnov test, t test, Spearman’s correlation analysis assessment and descriptive statistics were expressed using SPSS 22. Results: Mean ages were 11.53±10.1, 39.4±11.1, 84±15.9, 154.9±17.6, 190±9.3 months in consecutive age groups and 96±69.17 months in general. The most frequent locations with detectable LNs were subcarinal (n:98, 64%), right lower paratracheal (n:88, 57%), right tracheobronchial (n:82, 56%), right upper paratracheal (n:75, 49%) and left tracheobronchial (n:61, %39) lymphatic stations. Mean short and long axis diameters were 3.97±1mm (interquartile range:3.4-5.2) and 7.48±1.98mm (interquartile range:6.3-9.1) among detected 648 LNs, respectively. Both short and long axis diameters of LNs in low cervical, prevascular, subcarinal, right-left paratracheal and right-left tracheobronchial locations were correlated with the age (p<0.05). Both short and long axis diameters of subcarinal LNs (4.78±1.05mm, 9.30±1.8mm) were significantly larger than right lower paratracheal (4.03±0.9mm, 7.94±1.6mm; p:0.001), right tracheobronchial (4.42±1.26mm, 8.59±2.1mm; p:0.04) and right upper paratracheal LNs (3.64±0.79mm, 7.1±1.49mm). Conclusion: Being aware of the size range for normal mediastinal LNs according to ages and locations would facilitate management and reduce unnecessary interventions and medications.

Keywords

• Children,lymph node,mediastinum,computed tomography

SAĞLIKLI ÇOCUKLARDA MEDİASTİNAL LENF GANGLİONLARI; YAŞA GÖRE SIKLIK, BOYUT ARALIĞI VE DAĞILIM

Abstract

Amaç: Klinik olarak anlamlı lenf nodları (LN) hakkında karar vermek çok önemlidir. Mediastinal LNları lokasyon, boyut ve yaş gruplarına göre değerlendirdik. Gereç ve Yöntem: Travma sonrası radyoloji bölümüne yönlendirilen 150 çocuğun kontrastlı göğüs bilgisayarlı tomografi taramaları retrospektif olarak değerlendirildi. Tüm katılımcılar her biri otuz çocuğu içeren beş yaş grubuna ayrıldı (0-24, 25-60, 61-120, 121-180 ve 181-216 ay). En büyük LNlarının kısa ve uzun eksendeki çapları konumları, yaş ve cinsiyetlerine göre değerlendirildi. SPSS 22 programı ile Kolmogorov-Smirnov testi, t testi, Spearman korelasyon analizi ve tanımlayıcı istatistikler çalışıldı. Bulgular: Ortalama yaş, gruplarda sırasıyla 11,53±10,1 ay, 39,4±11,1 ay, 84±15,9 ay, 154,9±17,6 ay, 190±9,3 ay ve toplamda 96±69,17 aydı. LN’larının en sık görüldüğü lokasyonlar subkarinal (n:98, %64), sağ alt paratrakeal (n:88, %57), sağ trakeobronşiyal (n:82, %56), sağ üst paratrakeal (n:75, %49) ve sol trakeobronşiyal (n:61, % 39) lenfatik istasyonlardı. Ortalama kısa ve uzun eksen çapları sırasıyla 647 LN arasında 3.97±1mm (çeyrekler arası aralık: 3,4-5,2) ve 7,48±1,98mm (çeyrekler arası aralık: 6,3-9,1) idi. Alt servikal, prevasküler, subkarinal, sağ-sol paratrakeal ve sağ-sol trakeobronşiyal lokasyonlarda LNlarının hem kısa hem de uzun eksen çapları yaşla korele idi (p<0,05). Subkarinal LN’larının kısa ve uzun eksen çapları (4,78±1,05 mm, 9,30±1,8mm) sağ alt paratrakeal (4,03±0,9mm, 7,94±1,6mm; p:0,001), sağ trakeobronşiyal (4,42±1,26mm, 8,59±2,1mm; p:0,04) ve sağ üst paratrakeal LN’lerden (3,64±0,79mm, 7.1±1,49mm) anlamlı derecede büyüktü. Sonuç: Yaş ve yerleşime göre normal mediastinal LN’lerin boyut aralığının farkında olmak hasta yönetimi kolaylaştırır, gereksiz müdahaleleri ve ilaç kullanımını azaltır.

Keywords

• Çocuklar,lenf bezi,mediasten,bilgisayarlı tomografi

References

1. 1. Andronikou S, Wieselthaler N. Modern imaging of tuberculosis in children: thoracic, central nervous system and abdominal tuberculosis. Pediatr Radiol 2004;34(11):86175.
2. 2. George A, Andronikou S, Pillay T, Goussard P, Zar HJ. Intrathoracic tuberculous lymphadenopathy in children: a guide to chest radiography. Pediatr Radiol 2017;47(10):127782.
3. 3. Du Toit G, Swingler G, Iloni K. Observer variation in detecting lymphadenopathy on chest radiography. Int J Tuberc Lung Dis 2002;6(9):814-7.
4. 4. Kelly CS, Kelly RE. Lymphadenopathy in children. Pediatr Clin North Am 1998;45(4): 875-88.
5. 5. El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics 2014;34(6):1680-91.
6. 6. Bayramoglu Z, Caliskan E, Karakas Z, Karaman S, Tugcu D, Somer A, et al. Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study. Br J Radiol 2018;91(1087):20180129.
7. 7. Bhatia KS, Cho CC, Tong CS, Yuen EH, Ahuja AT. Shear wave elasticity imaging of cervical lymph nodes. Ultrasound Med Biol 2012;38(2):195-201.
8. 8. Ryu KH, Lee KH, Ryu J, Baek HJ, Kim SJ, Jung HK, et al. Cervical Lymph Node Imaging Reporting and Data System for Ultrasound of Cervical Lymphadenopathy:A Pilot Study. AJR Am J Roentgenol 2016;206(6):1286-91.

9. 9. Shen H, Lv G, Ke L, Li L, Zheng C, Yang S. The Clinical Value of New Scoring System of Cervical Lymph Node. Ultrasound Q 2019;35(3):269-74.
10. 10. Bosch-Marcet J, Serres-Créixams X, Zuasnabar-Cotro A, Codina-Puig X, Català-Puigbó M, Simon-Riazuelo JL.Comparison of ultrasound with plain radiography and CT for the detection of mediastinal lymphadenopathy in children with tuberculosis. Pediatr Radiol 2004;34(11):895900.
11. 11. Wernecke K, Pötter R, Peters PE, Koch P. Parasternal mediastinal sonography: sensitivity in the detection of anterior mediastinal and subcarinal tumors. AJR Am J Roentgenol 1988;150(5):1021-6.
12. 12. Dietrich CF, Chichakli M, Bargon J, Wehrmann T, Wiewrodt R, Buhl R, et al. Mediastinal lymph nodes demonstrated by mediastinal sonography: activity marker in patients with cystic fibrosis. J Clin Ultrasound 1999; 27(1): 9-14.
13. 13. Kapur S, Bhalla AS, Jana M. Pediatric Chest MRI: a review. Indian J Pediatr. 2019;86(9):842-53.
14. 14. Quint LE, Glazer GM, Orringer MB, Francis IR, Bookstein FL. Mediastinal lymph node detection and sizing at CT and autopsy. AJR Am J Roentgenol 1986;147(3):469-72.
15. 15. Genereux GP, Howie JL . Normal mediastinal lymph node size and number: CT and anatomic study. AJR Am J Roentgenol 1984;142(6):1095-100.
16. 16. Miller FH, Fitzgerald SW, Donaldson JS. CT of the azygoesophageal recess in infants and children. RadioGraphics 1993;13(3):623-34.
17. 17. Delacourt C, Mani TM, Bonnerot V, de Blic J, Sayeg N, Lallemand D, et al. Computed tomography with normal chest radiograph in tuberculous infection. Arch Dis Child 1993; 69(4): 430-432.
18. 18. Mukund A, Khurana R, Bhalla AS, Gupta AK, Kabra SK. CT patterns of nodal disease in pediatric chest tuberculosis. World J Radiol 2011;3(1):17-23.
19. 19. Andronikou S, Joseph E, Lucas S, Brachmeyer S, Du Toit G, Zar H, et al. CT scanning for the detection of tuberculous mediastinal and hilar lymphadenopathy in children. Pediatr Radiol 2004;34(3):232-6.
20. 20. Jong PA, Nievelstein RJA. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography. Eur Radiol 2012;22(2):318-21.
21. 21. Hochhegger B, Alves G, dos Santos Marchiori E, Irion KL. Mediastinal lymph nodes and pulmonary nodules in children: multi-detector computed tomography findings in a cohort of healthy subjects. AJR Am J Roentgenol 2015;204(1):35-37.
22. 22. Glazer M, Gross BH, Quint LE, Francis IR, Brookstein FL, Orringer MB. Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. AJR Am J Roentgenol 1985;144(2):261-5.
23. 23. Naranje P, Bhalla AS, Sherwani P. Chest tuberculosis in children. Indian J Pediatr 2019; 86(5):448-58.
24. 24. Andronikou S, Brauer B, Galpin J, Brachmeyer S, Lucas S, Joseph E, et al. Interobserver variability in the detection of mediastinal and hilar lymph nodes on CT in children with suspected pulmonary tuberculosis. Pediatr Radiol 2005;35(4):425-28.
25. 25. Leung AN, Muller NL, Pineda PR, Fitzgerald JM. Primary TB in childhood: radiographic manifestations. Radiology 1992;182(1):87-91.
26. 26. Peng SSF, Chan PC, Chang YC, Shih TTF. Computed tomography of children with pulmonary Mycobacterium tuberculosis infection. J Formos Med Assoc 201;110(12):7449.
27. 27. Swingler GH, Toit GD, Andronikou S, Merwe L, Zar HJ. Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis. Arch Dis Child 2005;90(11): 1153-6.
28. 28. Kim WS, Moon WK, Kim IO, Lee HJ, Im JG, Yeon KM, et. al. Pulmonary tuberculosis in children: evaluation with CT. AJR Am J Roentgenol 1997;168(4):1005-9.
29. 29. Andronikou S. Pathological correlation of CT-detected mediastinal lymphadenopathy in children: the lack of size threshold criteria for abnormality. Pediatr Radiol 2002;32(12):912.