A Pictorial Essay on Ultrasonography of Lymphadenopathies in Children

Abstract

The purpose of this review is to become familiar with ultrasound (US) characteristics of normal and pathological lymph nodes and with diagnostic imaging approach to lymphadenopaties. Lymphadenopathy is a common finding in the paediatric population. Due to the many pathologies that can present in a similar fashion, imaging is a valuable method used in diagnostic process. Ultrasound is the modality of choice for lymph node detection in children, with a high safety profile as it does not use radiation. In this review the US appearance and characteristics of normal lymph nodes, and of some more common lymphadenopathies, are presented. Special attention is paid to distinguishing between benign and malignant lymph nodes on the basis of US characteristics. All findings must always be correlated with clinical and laboratory findings, and frequently followed by fine-needle aspiration or excisional biopsy as some US morphologies of benign and malignant nodes may overlap. However, the criteria that raise suspicion for malignancy are round shape, predominantly hypoechoic echogenicity, heterogenous echotexture, absent or displaced hilum, irregular outlines, necrosis, multiple confluent lymph nodes, the presence of microcalcifications, and peripheral or mixed flow pattern on colour Doppler imaging.

Conclusion - US is the first line imaging method in palpable masses in children, first to confirm the presence of lymph nodes, and second to better delineate the lymph node’s characteristics, which guides further diagnostic decisions and treatment.