Pediatric Radiology

, Volume 36, Issue 10, pp 1063–1067 | Cite as

The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children

  • Jerome A. Lindeboom
  • Anne M. J. B. Smets
  • Ed J. Kuijper
  • Rick R. van Rijn
  • Jan M. Prins
Original Article



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 


  1. 1.
    Wolinsky E (1995) Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up. Clin Infect Dis 20:954–963PubMedGoogle Scholar
  2. 2.
    Ahuja A, Ying M, Yuen YH, et al (2001) Power Doppler sonography to differentiate tuberculous cervical lymphadenopathy from nasopharyngeal carcinoma. AJNR 22:735–740PubMedGoogle Scholar
  3. 3.
    Ahuja AT, Ying M (2005) Sonographic evaluation of cervical lymph nodes. AJR 184:1691–1699PubMedGoogle Scholar
  4. 4.
    Bruijnesteijn van Coppenraet ES, Lindeboom JA, Prins JM, et al (2004) Real-time PCR assay using fine-needle aspirates and tissue biopsy specimens for rapid diagnosis of mycobacterial lymphadenitis in children. J Clin Microbiol 42:2644–2650PubMedCrossRefGoogle Scholar
  5. 5.
    Bruijnesteijn van Coppenraet ES, Kuijper EJ, Lindeboom JA, et al (2005) Mycobacterium haemophilum and lymphadenitis in children. Emerg Infect Dis 11:62–68PubMedGoogle Scholar
  6. 6.
    Lindeboom JA, Prins JM, Bruijnesteijn van Coppenraet ES, et al (2005) Cervicofacial lymphadenitis in children caused by Mycobacterium haemophilum. Clin Infect Dis 41:1569–1575PubMedCrossRefGoogle Scholar
  7. 7.
    Hajek PC, Salomonowitz E, Turk R, et al (1986) Lymph nodes of the neck: evaluation with US. Radiology 158:739–742PubMedGoogle Scholar
  8. 8.
    Ridder GJ, Richter B, Disko U, et al (2001) Gray-scale sonographic evaluation of cervical lymphadenopathy in cat-scratch disease. J Clin Ultrasound 29:140–145PubMedCrossRefGoogle Scholar
  9. 9.
    Robson CD, Hazra R, Barnes PD, et al (1999) Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings. AJNR 20:1829–1835PubMedGoogle Scholar
  10. 10.
    Görges R, Eising EG, Fotescu D, et al (2003) Diagnostic value of high resolution B-mode and power mode sonography in the follow up of thyroid cancer. Eur J Ultrasound 16:191–206PubMedCrossRefGoogle Scholar
  11. 11.
    Schulte-Altedorneburg G, Demharter J, Linne R, et al (2003) Does ultrasound contrast agent improve the diagnostic value of colour and power Doppler sonography in superficial lymph node enlargement? Eur J Radiol 48:252–257PubMedCrossRefGoogle Scholar
  12. 12.
    Ahuja AT, Ying M (2004) Evaluation of cervical lymph node vascularity: a comparison of colour Doppler, power Doppler and 3-D power Doppler sonography. Ultrasound Med Biol 12:1557–1564CrossRefGoogle Scholar
  13. 13.
    Solbiati L, Osti V, Cova L, et al (2001) Ultrasound of thyroid, parathyroid gland and neck nodes. Eur Radiol 11:2411–2424PubMedCrossRefGoogle Scholar
  14. 14.
    Bagla S, Tunkel D, Kraut MA (2003) Nontuberculous mycobacterial lymphadenitis of the head and neck: radiologic observations and clinical context. Pediatr Radiol 33:402–406PubMedGoogle Scholar
  15. 15.
    Danielides V, Patrikakos G, Moerman M, et al (2003) Diagnosis, management and surgical treatment of non-tuberculous mycobacterial head and neck infection in children. ORL J Otorhinolaryngol Relat Spec 64:284–289Google Scholar
  16. 16.
    Schaad UB, Votteler TP, McCracken GH Jr, et al (1979) Management of atypical mycobacterial lymphadenitis in childhood: a review based on 380 cases. J Pediatr 95:356–360PubMedCrossRefGoogle Scholar
  17. 17.
    Margileth AM, Chandra R, Altman RP (1984) Chronic lymphadenopathy due to mycobacterial infection. Am J Dis Child 138:917–922PubMedGoogle Scholar
  18. 18.
    Rahal A, Abela A, Arcand PH, et al (2001) Nontuberculous mycobacterial adenitis of the head and neck in children: experience from a tertiary care pediatric center. Laryngoscope 111:1791–1796PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Jerome A. Lindeboom
    • 1
    • 5
  • Anne M. J. B. Smets
    • 4
  • Ed J. Kuijper
    • 6
  • Rick R. van Rijn
    • 4
  • Jan M. Prins
    • 2
    • 3
  1. 1.Department of Oral and Maxillofacial Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Department of Radiology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  5. 5.Academic Center for Dentistry (ACTA)University of AmsterdamAmsterdamThe Netherlands
  6. 6.Department of Medical MicrobiologyLeiden University Medical CenterLeidenThe Netherlands

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