A clinico-etiological study of cervical lymphadenopathy in children with special reference to ultrasonography

Abstract

Objectives: The aim of this study was to evaluate the etiological factors for cervical lymphadenopathy in children and the role of ultrasonography (USG) in diagnosis. Methods: A total of 200 children of significant cervical lymphadenopathy between 3 months to18 years were pro-spectively included in a tertiary referral hospital. All subjects were evaluated by history, examination, hemogram, chest X-ray, mantoux test, fine needle aspiration cytology (FNAC), acid-fast bacillus (AFB) staining, ultrasonography (USG) of lymph node. Open lymph node biopsy, bone marrow examination, serological tests were optional. Results: A total of 84 subjects (42%) identified as benign reactive, 80 (40%) as tuberculosis, 20 (10%) chronic lym-phadenitis, 12 (6%) non-Hodgkin and 4 (2%) Hodgkin\'s lymphoma by USG. However, on USG among 84 subjects of benign reactive lymphadenopathy, 60 (71.4%) were having features of benign reactive lymph node, remaining 24 (28.6%) have normal sonogram; out of 80 subjects of tuberculosis lymphadenitis 66 (82.5%) have features of tuber-culosis and rest14 (17.5%) have nonspecific ultrasound changes; among 16 subjects of lymphoma, 10 (62.5%) have features of malignancy, rest 6 (37.5%) have nonspecific changes in USG examination. Male to Female ratio was1.68:1. Cervical lymphadenopathy was most prevalent in 6 to 10 years age group. Conclusion: Reactive lymphadenitis due to underlying acute bacterial or viral infection was the commonest cause of significant cervical lymphadenopathy in children and ultrasonography is a good noninvasive diagnostic modality, but requires other tests for definitive diagnosis.

Keywords

• Cervical lymphadenopathy, ultrasonography, children, diagnosis.

Çocuklarda servikal lenfadenopatinin özellikle ultrasonografi dikkate alınarak klinik ve etyolojik yönden değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı çocuklarda servikal lenfadenopatinin etyolojik faktörlerini ve ultrasonografinin (USG) ta-nıdaki rolünü değerlendirmektir. Yöntemler: Yaşları 3 ay ile 18 yıl arası değişen önemli servikal lenfadenopatisi bulunan toplam 200 çocuk prospektif olarak bir üçüncü basamak sevk hastanesinde çalışmaya alındı. Bütün hastalar öykü, fizik muayene, USG, hemogram, akciğer grafisi, PPD testi, ince iğne aspirasyon sitolojisi, aside dirençli boyama ve lenf nodu biyopsisi ile araştırıldı. Açık lenf nodu biyopsisi, kemik iliği incelemesi ve serolojik testler belli hastalara uygulandı. Bulgular: Erkek/kız oranı: 1.68/1 idi. Servikal lenfadenopati en sık 6-10 yaşları arasında rastlandı. Ultrason muaye-nesi ile toplam 84 olgu (%42) selim reaktif, 80\'i (%40) tüberküloz, 20\'si (%10) kronik lenfadenit, 12\'si (%6) ve 4\'ü (%2) Hodgkin lenfoma olarak tanı aldı. Ancak, ultrasonografide benin reaktif lenfadenopati olarak bildirilen 84 vakanın 60\'ı (%71.4) sitolojik olarak benin reaktif lenf nodu özelliği taşıyordu, geri kalan 24\'ü (%28.6) normal sonogram özelliğin-deydi. Kesin tanısı tüberküloz lenfadenit olan 80 vakadan 66\'sında (%82.5) ultrasonda tüberküloz özellikleri saptanır-ken, geri kalan 14\'ünde (%17.5) nonspesifik ultrasonic değişiklikler saptandı. Lenfomalı 16 hastanın 10\'unda (%62.5) malignite özellikleri, geri kalan 6\'sında (%37.5) ultrasonda nonspesifik değişikler saptandı. Sonuç: altta yatan akut bakteriyel veya viral enfeksiyon nedeniyle oluşan reaktif lenfadenit çocuklarda önemli servikal lenfadenopatinin en sık nedenidir ve ultrasonografi invaziv olmayan iyi bir tanı yöntemi olmakla birlikte hastalığın ke-sin tanısı için diğer testlerin yapılması gerekir.

Anahtar Kelimeler

• Servikal lenfadenopati, ultrasonografi, çocuk, tanı

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