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

Yıl 2010, , 71 - 74, 01.06.2010

Gupta Amit Kumar Tripathi Virendra Nath Mangal Yasoda Agarwal Asha Arya Arun Kumar

https://doi.org/10.5799/ahinjs.01.2010.02.0015

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• American Academy of Pediatrics: Tuberculosis. In 2003 Red Book: Report of the Committee on Infectious Diseases, ed Pickering LK. American Academy of Pediatrics, IL 2003, 642-660.
• Ahuja A, Ying M. An overview of neck node sonography. Invest Radiol 2002;37:333-42.
• Ahuja A, Ying M, Yuen YH, Metreweli C. Power Doppler sonography to differentiate tuberculous cervical lympahde- nopathy from nasopharyngeal carcinoma. Am J Neurora- diol 2001; 22:735-40.
• Ahuja A, Ying M . Evaluation of cervical lymph node vas- cularity : a comparision of colour Doppler, power Doppler and 3-D power Doppler sonography. Ultrasound Med Biol 2004;30:1557-64.
• Buchino JJ, Jones VF. Fine needle aspiration in the evalua- tion of children with lymphadenopathy. Arch Pediatrics & Adolescent Med 1994;148:1327-1330.
• Dajani AS, Garcia RE, Wolanski E. Etiology of cervical lymphadenitis in children. N Eng J Med 1963; 263:1329- 35.
• Darville T, Jacobs RF. Lymphadenopathy, lymphadenitis, and lymphangitis. In Pediatric infectious diseases: Princi- ples and practice, eds Jenson HB and Baltimore RS. W. B. Saunders Company, Philadelphia 2002, 610-29.
• Harza R, Robson CD, Perez-Atayde AR, Husson RN. Lymphadenitis due to nontuberculous mycobacteria in chil- dren: Presentation and response to therapy. Clin Infect Dise 1999;28:123-9.
• Mishra SD, Garg BL. Etiology of cervical lymphadenitis in children, Indian Pediatr 1972;9:812-5.
• Peters TR, Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev 2000;21:399-404.
• Eddy MP, Moorchung N, Chaudhary A. Clinico-patholog- ical profile of pediatric lymphadenopathy. Indian J Pediatr 2002; 69:1047-51.
• Schreiber JR, Berman BW. Lymphadenopathy. In Practical strategies in pediatric diagnosis and therapy, eds Kliegman RM, Nieder ML and Super DM. W. B. Saunders Company, Philadelphia 1996, 791-803.
• Swartz MN. Lymphadenitis and lymphangitis. In Mandell, Douglas, and Bennett’s principles and practice of infec- tious diseases, eds Mandell GL, Bennett JE and Dolin R. Churchill Livingstone, Philadelphia 2000, 1066-1072.
• Twist CJ, Link MP. Assessment of lymphadenopathy in children. Pediatr Clin North Am 2000;49:1009-25.
• Niedzielska G, Kotowski M, Niedzielski A, Dybiec E, Wieczorek P. Cervical lymphadenopathy in children inci- dence & diagnostic management. Int J Pediatr Otorhinolar- yngol 2007; 71:51-6.
• Stechenberg BW. Bartonella. In Behrman RE, Kliegman RM, Jenson HB (eds): Nelson Textbook of Pediatrics, Saunders company 2008. pp. 943-947.