Evaluation of Mesenteric Lymph Nodes in a Pediatric Population with Mesenteric Lymphadenitis Using Superb Microvascular Imaging.

BACKGROUND This study aimed to evaluate superb microvascular imaging (SMI) as an adjunctive imaging method to evaluate mesenteric lymph nodes in children with mesenteric lymphadenitis compared with healthy children. MATERIAL AND METHODS A retrospective study compared children with mesenteric lymphadenitis (n=27) and healthy children (n=30). Lymph node size was determined using grayscale ultrasonography and parameters of lymph node vascularity were compared using color Doppler flow imaging (CDFI) and SMI. The diagnostic performance of ultrasound (US), US combined with SMI, and US combined with CDFI were compared. RESULTS Lymph nodes from children with mesenteric lymphadenitis (n=77) and normal lymph nodes (n=84) were evaluated by SMI, which showed that the least diameter of lymph nodes in cases of mesenteric lymphadenitis was 0.58±0.15 mm and of normal mesenteric lymph nodes was 0.47±0.08 mm (p<0.001). SMI identified 92.6% of abnormal mesenteric lymph nodes while CDFI detected 85.2%. US combined with SMI had the highest sensitivity (81.5%), and specificity (78.9%) compared with US alone (sensitivity, 63.0%; specificity, 64.9%), and compared with US combined with CDFI (sensitivity, 74.1%; specificity, 75.4%). US combined with SMI and US combined with CDFI achieved the same specificity (76.7%), which was higher than that of US alone (66.7%). CONCLUSIONS SMI was superior to color Doppler flow imaging in evaluating the microvasculature in lymphadenopathy in mesenteric lymphadenitis. SMI may be used as an adjunct to grayscale ultrasonography to assist in identifying mesenteric lymphadenopathy in pediatric patients.

Course of acute nonspecific mesenteric lymphadenitis: single-center experience.

Available reports dealing with acute nonspecific mesenteric lymphadenitis do not address the total duration of symptoms. However, it is commonly assumed a time for recovery ≤ 4 weeks. The purpose of this report was to investigate the course of acute nonspecific mesenteric lymphadenitis in childhood. A review was made of the patients aged ≤ 16 years in whom the diagnosis of acute nonspecific mesenteric lymphadenitis was established between 2011 and 2015 at the Pediatric Emergency Unit. The records of the Pediatric Emergency Unit, those of the referring family doctors, and the results of a structured telephone interview with each family were used. Forty-four patients (25 girls and 19 boys) aged 2.5 to 16, median 8.2, years were included. A bimodal distribution in duration of symptoms was observed: symptoms persisted for ≤ 2 weeks in 22 patients and 3 to 10 weeks in 22. Clinical and laboratory characteristics were similar in children with symptoms persisting for 2 weeks or less 28 and in those with symptoms persisting for 3-10 weeks. CONCLUSION: In patients affected with acute nonspecific mesenteric lymphadenitis, it is advantageous to think of the time span for recovery in terms of ≥ 4 weeks. What is Known: • Mesenteric adenitis is a self-limiting inflammatory condition with well-characterized clinical presentation and imaging features. • A total duration of symptoms of ≤ 4 weeks is usually hypothesized. What is New: • Symptoms persist for 3 to 10 weeks in half of the patients. • At presentation, clinical and laboratory characteristics are similar in children with symptoms persisting for 2 weeks or less and in those with 45 symptoms persisting for 3-10 weeks.

Characteristics of mesenteric lymphadenitis in comparison with those of acute appendicitis in children.

Mesenteric lymphadenitis (ML) is considered as one of the most common alternative diagnosis in a child with suspected acute appendicitis (AA). In this retrospective study, patients diagnosed with ML (n = 99) were compared in terms of demographic, clinical, and laboratory findings to patients diagnosed with AA (n = 102). This comparison was applied for both lymph nodes smaller and larger than 10 mm. When compared to patients with AA, patients with ML had significantly longer duration of symptoms prior to emergency department (ED) presentation (2.4 ± 2.6 vs 1.4 ± 1.4 days, P = 0.002) and multiple ED presentations (1.3 ± 0.7 vs 1.05 ± 0.3, P < 0.001) and had longer duration of stay in the ED (9.2 ± 5.9 vs 5.2 ± 4 h, P < 0.001), respectively. They also had significantly lower WBC (10.16 ± 4.7 × 103/dl vs 15.8 ± 4.4 × 103/dl, P < 0.001) with lymphocyte predominance (24.6 ± 14 vs 13 ± 8.7%, P < 0.001) and lower CRP levels (0.48 vs 1.6 mg/dl). Migration of pain (28 vs 7%), vomiting (62 vs 34%), and classic abdominal findings of AA (72 vs 20%) were all significantly more common for children with AA. When comparing lymph node size, no significant difference was found between those presenting with small and large nodes. CONCLUSION: This study highlights multiple clinical and laboratory findings that differentiate ML and AA. Moreover, the absence of any difference with regard to the lymph nodes size might suggest that lymph nodes enlargement is a non-specific finding. What is Known : • Mesenteric lymphadenitis is a very common diagnosis in children with suspected acute appendicitis. • Despite its prevalence, only few studies addressed the clinical characteristics of this clinical entity and their comparison with acute appendicitis. What is New: • Mesenteric lymphadenitis and acute appendicitis could be differentiated by multiple clinical and laboratory parameters. • No significant difference was found between those presenting with small and large lymph nodes.

[Mesadenitis in children with acute abdominal pain syndrome: clinical and echographic parallels].

The paper pools the experience of ultrasound assessment of acute mesadenitis in children with acute abdominal pain syndrome. It reviews the literature on its etiology, pathology, and diagnosis and treatment principles. B-mode and Doppler echograms made by general practice ultrasound diagnosticians are shown. The technique is demonstrated to be effective and of informative value in the early stages of diagnosis in the patient contingent in question.

A case of mesenteric lymphadenitis with long-acting symptom, showing marked response to corticosteroid.

A 17-year-old girl who had right lower abdominal pain with multiple swelling of lymph nodes in the ileocecal region and she was admitted to a neighboring hospital. Since there was no improvement of condition with antibiotic resistance, we were consulted. Lymph node biopsy under laparoscopy demonstrated nonspecific findings. She then developed erythema nodosum, suggesting the presence of autoimmune etiology. Treatment with systemic corticosteroid resulted in symptomatic improvement. Mesenteric lymphadenitis like this case is rare.

Hipertrofia amigdalar y adenopatías mesentéricas como manifestaciones predominantes en un paciente con enfermedad de Whipple / Tonsillar hypertrophy and mesenteric adenopathies as the main manifestations in a patient with Whipple’s disease

La enfermedad de Whipple es una infección crónica poco habitual, cuyo germen causal, Tropheryma whipplei, fue identificado en 1992. En esta entidad es frecuente la participación del intestino, las articulaciones, el sistema nervioso central y el corazón. La presencia de adenopatías abdominales, sobre todo mesentéricas, sin adenopatías periféricas ni síntomas digestivos, articulares, neurológicos o cardíacos, es rara. Se presenta el caso de un paciente con hipertrofia amigdalar, adenopatías mesentéricas, fiebre y síndrome constitucional, en el que se sospechó un linfoma. La biopsia de la amígdala lingual y las adenopatías mesentéricas fueron compatibles con enfermedad de Whipple, diagnóstico que se confirmó mediante reacción en cadena de la polimerasa en sangre

Whipple's disease is an infrequent chronic infection caused by Tropheryma whipplei, identified in 1992. Intestinal, articular, central nervous system and cardiac involvement is common. The presence of abdominal adenopathies, especially mesenteric adenopathies, without peripheral adenopathies or gastrointestinal, articular, neurological or cardiac symptoms is rare. We present the case of a male patient with tonsillar hypertrophy, mesenteric adenopathies, fever and constitutional syndrome, leading to suspicion of lymphoma. Biopsy findings of the lingual tonsil and mesenteric adenopathies were compatible with Whipple's disease. The diagnosis was confirmed by blood polymerase chain reaction (AU)

Histoplasmose mesentérica em paciente com Aids / Mesentery histoplasmosis in Aids patient

Histoplasmose disseminada progressiva é a forma mais comum da doença em pacientes com Aids e a forma mais comum de manifestação é a febre e perda de peso. O Rx de tórax é normal em 30 por cento - 40 por cento; e o restante dos casos apresenta, geralmente, um ilfiltrado nodular difuso. Relatamos um caso de histoplasmose mesentérica em Aids

The etiology and clinical characteristics of mesenteric adenitis in Korean adults.

This study is aimed at investigating the etiology and clinical characteristics of mesenteric adenitis in Korean adults, prospectively. Clinical manifestations of fifteen patients who presented with the acute onset of right lower quadrant pain and sonographically enlarged mesenteric lymph nodes and normal appendix were evaluated. For etiologic diagnosis, stool culture, serologic test for Epstein-Barr virus, and Widal test were performed. Colonoscopy with mucosal biopsies and microbial tissue cultures were performed in 12 of 15 patients. Of fifteen patients 6 were male and the average age was 29.9 (17 approximately 41) years. Associated symptoms were diarrhea (80%), fever (73%), nausea and vomiting (27%). Right lower quadrant tenderness was observed in all cases but rebound tenderness was observed only in 26.7% of the cases. Etiology was identified in 7 cases (47%): 2 Yersinia enterocolitica infection, 2 non-typhoidal Salmonella infection, 2 tuberculosis, and 1 typhoid fever. In colonoscopic examination, signs of active inflammation were observed in 9 cases (75%) and inactive or normal findings in 3 cases (25%). All of our patients, except for the patients with tuberculosis and typhoid fever who needed specific antibiotic therapy, improved spontaneously without using antibiotics. In conclusion, the etiology of mesenteric adenitis in Korean adults seems to be different from that of western countries. Furthermore, mesenteric adenitis in Korean adults is a clinical syndrome, frequently found in a relatively young age group, which improves spontaneously unless specific anti-microbial agents are indicated by microbiological tests, such as tuberculosis or typhoid fever.