Original Article

Pediatric Radiology

, Volume 36, Issue 10, pp 1063-1067

First online:

The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children

  • Jerome A. LindeboomAffiliated withDepartment of Oral and Maxillofacial Surgery, Academic Medical Center, University of AmsterdamAcademic Center for Dentistry (ACTA), University of Amsterdam Email author 
  • , Anne M. J. B. SmetsAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , Ed J. KuijperAffiliated withDepartment of Medical Microbiology, Leiden University Medical Center
  • , Rick R. van RijnAffiliated withDepartment of Radiology, Academic Medical Center, University of Amsterdam
  • , Jan M. PrinsAffiliated withDepartment of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of AmsterdamCenter for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam

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Nontuberculous mycobacteria (NTM) are a common cause of chronic cervicofacial lymphadenitis in young children. The differential diagnosis includes other infections, lymphoepithelial cysts and malignancies.


To assess the sonographic findings of NTM cervicofacial lymphadenitis in children.

Materials and methods

We analysed the sonograms of cervicofacial lymph nodes of 145 children with microbiologically proven NTM lymphadenitis.


The size of the involved lymph nodes ranged from 1.9 cm to 4.4 cm. Most of the NTM patients (85%) presented in a stage of lymph node fluctuation with violaceous skin discoloration. On sonography, marked decreased echogenicity was seen in all cases. In 133 of the patients (92%) liquefaction with intranodal cystic necrosis, nodal matting and adjacent soft-tissue oedema were present. 66 children received antibiotic treatment, and the other children underwent surgical excision of the involved lymph nodes. In 69% of the patients successfully treated with antibiotics, multiple intranodal calcifications were present on sonography after 1 year.


Sonographic findings can provide additional diagnostic clues for NTM lymphadenitis in childhood. A marked decrease of echogenicity in the early stages, with intranodal liquefaction in the advanced stages, are universal features, albeit not entirely specific. Multiple intranodal calcifications are rather characteristic of end-stage mycobacterial infection.


Nontuberculous mycobacteria Chronic cervical lymphadenitis Ultrasound Children