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01-08-2009 | Pictorial Essay

Head and neck lymph nodes in children: the spectrum from normal to abnormal

Authors: Ricardo Restrepo, Julieta Oneto, Kathleen Lopez, Kamlesh Kukreja

Published in: Pediatric Radiology | Issue 8/2009

Abstract

Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.

Nield LS, Kamat D (2004) Lymphadenopathy in children: when and how to evaluate. Clin Pediatr (Phila) 43:25–33CrossRef

Twist CJ, Link MP (2002) Assessment of lymphadenopathy in children. Pediatr Clin North Am 49:1009–1025PubMedCrossRef

Chong V (2004) Cervical lymphadenopathy: what radiologists need to know. Cancer Imaging 4:116–120PubMedCrossRef

Chan JM, Shin LK, Jeffrey RB (2007) Ultrasonography of abnormal neck lymph nodes. Ultrasound Q 23:47–54PubMedCrossRef

Hajek PC, Salomonowitz E, Turk R et al (1986) Lymph nodes of the neck: evaluation with US. Radiology 158:739–742PubMed

Som PM (1987) Lymph nodes of the neck. Radiology 165:593–600PubMed

Camita BM (2004) Lymphadenopathy. In: Behrman RE, Kliegman RM, Jenson HB (eds) Nelson textbook of pediatrics, 17th edn. Saunders, Philadelphia, pp 1677–1678

Na DG, Lim HK, Bvun HS et al (1997) Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR 168:1311–1316PubMed

Ahuja AT, Ying M (2005) Sonographic evaluation of cervical lymph nodes. AJR 184:1691–1699PubMed

10.

Toma P, Granata C, Rossi A et al (2007) Multimodality imaging of Hodgkin disease and non-Hodgkin lymphomas in children. Radiographics 27:1335–1354PubMedCrossRef

11.

Suwatanapongched T, Gierada DS (2006) CT of thoracic lymph nodes. Part II: diseases and pitfalls. Br J Radiol 79:999–1000PubMedCrossRef

12.

Solbiati L, Osti V, Cova L et al (2001) Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 11:2411–2424PubMedCrossRef

13.

Evans RM, Ahuja A, Metreweli C (1993) The linear echogenic hilus in cervical lymphadenopathy – a sign of benignity or malignancy? Clin Radiol 47:262–264PubMedCrossRef

14.

Ying M, Ahuja A, Brook F (2004) Accuracy of sonographic vascular features in differentiating different causes of cervical lymphadenopathy. Ultrasound Med Biol 30:441–447PubMedCrossRef

15.

Steinkamp HJ, Maurer J, Cornehl M et al (1994) Recurrent cervical lymphadenopathy: differential diagnosis with color-duplex sonography. Eur Arch Otorhinolaryngol 521:404–409

16.

Silvers AR, Som PM (1998) Salivary glands. Radiol Clin North Am 36:941–966, viPubMedCrossRef

17.

Kelly CS, Kelly RE Jr (1998) Lymphadenopathy in children. Pediatr Clin North Am 45:875–888PubMedCrossRef

18.

Hudgins PA (2000) Nodal and non-nodal inflammatory processes of the pediatric neck. Neuroimaging Clin N Am 10:181–192, ixPubMed

19.

Ridder GJ, Richter B, Disko U et al (2001) Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. J Clin Ultrasound 29:140–145PubMedCrossRef

20.

Ying M, Ahuja A, Brook F (2002) Sonographic appearances of cervical lymph nodes: variations by age and sex. J Clin Ultrasound 30:1–11PubMedCrossRef

21.

Bagla S, Tunkel D, Kraut MA (2003) Nontuberculous mycobacterial lymphadenitis of the head and neck: radiologic observations and clinical context. Pediatr Radiol 33:402–406PubMed

22.

Lindeboom JA, Smets AM, Kuijper EJ et al (2006) The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children. Pediatr Radiol 36:1063–1067PubMedCrossRef

23.

Marais BJ, Ca W, Schaaf HS et al (2006) Tuberculous lymphadenitis as a cause of persistent cervical lymphadenopathy in children from a tuberculosis-endemic area. Pediatr Infect Dis J 25:142–146PubMedCrossRef

24.

Manson DE, Sikka S, Reid B et al (2000) Primary immunodeficiencies: a pictorial immunology primer for radiologists. Pediatr Radiol 30:501–510PubMedCrossRef

25.

Wetzler SB, Gagnon GA, Williams HJ (2003) Pathologic quiz case: a 15-year-old adolescent boy with a groin mass present for 18 months. Arch Pathol Lab Med 127:e251–e252PubMed

26.

Ruggiero A, Attina G, Maurizi P et al (2006) Rosai-Dorfman disease: two case reports and diagnostic role of fine-needle aspiration cytology. J Pediatr Hematol Oncol 28:103–106PubMedCrossRef

27.

Gupta P, Babyn P (2008) Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): a clinicoradiological profile of three cases including two with skeletal disease. Pediatr Radiol 38:721–728PubMedCrossRef

28.

Tsang WY, Chan JK (1994) Fine-needle aspiration cytologic diagnosis of Kikuchi's lymphadenitis. A report of 27 cases. Am J Clin Pathol 102:454–458PubMed

29.

Ramanan AV, Wynn RF, Kelsey A et al (2003) Systemic juvenile idiopathic arthritis, Kikuchi's disease and haemophagocytic lymphohistiocytosis – is there a link? Case report and literature review. Rheumatology (Oxford) 42:596–598CrossRef

30.

Chakrabartty S, Pramanik S, Thapa R (2006) Difficulties in the diagnosis of Kawasaki disease. Indian Pediatr 43:728–731PubMed

31.

Tashiro N, Matsubara T, Uchida M (2002) Ultrasonographic evaluation of cervical lymph nodes in Kawasaki disease. Pediatrics 109:E77PubMedCrossRef

32.

Stamos JK, Corydon K, Donaldson J et al (1994) Lymphadenitis as the dominant manifestation of Kawasaki disease. Pediatrics 93:525–528PubMed

33.

Gujar S, Gandhi D, Mukherji SK (2004) Pediatric head and neck masses. Top Magn Reson Imaging 15:95–101PubMedCrossRef

34.

Steinkamp HJ, Teichgraber UK, Mueffelmann M et al (1999) Differential diagnosis of lymph node lesions. A semiquantitative approach with power Doppler sonography. Invest Radiol 34:509–515PubMedCrossRef

35.

Brennan B (2006) Nasopharyngeal carcinoma. Orphanet J Rare Dis 1:23PubMedCrossRef

36.

Stambuk HE, Patel SG, Mosier KM et al (2005) Nasopharyngeal carcinoma: recognizing the radiographic features in children. AJNR 26:1575–1579PubMed

37.

Kane AG, Reilly KC, Murphy TF (2004) Swimmer's CT: improved imaging of the lower neck and thoracic inlet. AJNR 25:859–862PubMed

Title: Head and neck lymph nodes in children: the spectrum from normal to abnormal
Authors: Ricardo Restrepo
Julieta Oneto
Kathleen Lopez
Kamlesh Kukreja
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Pediatric Radiology / Issue 8/2009
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-009-1250-5

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Head and neck lymph nodes in children: the spectrum from normal to abnormal

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