Features of lymphatic system diseases diagnosing in children

Aim. To study the structural and pathological changes in lymph nodes in children, taking into account their anatomical and physiological characteristics, and to assess the effectiveness of instrumental diagnostic methods used to detect these pathological changes.

Materials and methods. The study used data from modern medical literature, clinical observations, and instrumental diagnostic methods. The anatomical features of lymph nodes in children and their pathological changes were discussed. A comparative analysis of different instrumental methods for diagnosing inflammatory and oncological diseases was conducted.

Results and discussion. It was found that the size and structure of lymph nodes in children vary depending on their location and age. Ultrasound (US) is the safest and most accessible method, allowing the assessment of the size, shape, and echogenicity of nodes. Contrast-enhanced ultrasound (CEUS) was found to be effective in differentiating between inflammatory and metastatic changes. Positron emission tomography combined with magnetic resonance imaging (PET/MRI) and computed tomography (PET/CT) demonstrated high sensitivity in detecting malignant structures. The study also confirmed the important role of computed tomography (CT) and magnetic resonance imaging (MRI) in identifying structural changes in lymph nodes.

Conclusion. For the early detection and diagnosis of lymph node pathology in children, the use of US, CT, MRI, PET/CT, and PET/MRI is recommended. US is the primary method for initial diagnosis, CT and MRI are essential for determining structural changes, while PET/CT and PET/MRI are used to detect malignant processes.

1. Konotopceva A.N. Opyt ul’trazvukovogo issle-dovanija limfaticheskoj sistemy u detej. Acta Biomedica Scientifica. 2013; 5: 33-38.

2. Agafonov G.M., Agafonova M.K., Kondrat’ev G.V., Kanina L.Ja., Sahno L.V., Malekov D.A., Grebenjuk M.M., Mahin Ju.Ju., Krasnogorskaja O.L., Gabrusskaja T.V. Osobennosti diagnostiki i lechenija diffuznogo limfangiomatoza u rebenka 8 let. Voprosy prakticheskoj pediatrii. 2022; 1: 222-226.

3. Pykov M.I., Sokolov Ju.Ju., Balashov V.V., Korovin S.A. Ul’trazvukovaja ocenka sostojanija limfaticheskih uzlov brjushnoj polosti u detej v norme i pri ostrom abdominal’nom sindrome. Sovremennye tehnologii v diagnostike i lechenii. 2013; 1: 28-37.

4. Pikuza O.I., Samorodnova E.A. Limfadenopatii v pediatricheskoj praktike. Prakticheskaja medicina. 2020; 18 (6): 63-68. https://doi.org/10.32000/2072-1757-2020-6-63-68

5. Nikitin S.S., Guseva N.B., Karceva A.A., Leuhin M.V., Lepiseva I.V. Sovremennyj vzgljad na differencial’nuju diagnostiku ul’trazvukovyh harakteristik limfaticheskih uzlov pri mezadenite u detej. Medicinskij sovet. 2023; 17 (17): 231-237. https://doi.org/10.21518/ms2023-2696

6. Muehe A.M., Siedek F., Theruvath A.J., Seekins J., Spunt S.L., Pribnow A., Hazard F.K., Liang T., Daldrup-Link H. Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Theranostics. 2020; 10 (8): 3612-3621. https://doi.org/10.7150/thno.40606

7. Karmazyn B., Supakul N., Lehnert S.J., Shan M., Vik T.A., Jennings S.G., Billmire D.F. Retroperitoneal and Pelvic Lymph Nodes in Children: What Is Normal? AJR Am. J. Roentgenol. 2020; 214 (6): 1384-1388. https://doi.org/10.2214/AJR.19.22316

8. Koumanidou C., Vakaki M., Pitsoulakis G., Kakavakis K., Mirilas P. Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction. AJR Am. J. Roentgenol. 2002; 178 (2): 445-450. https://doi.org/10.2214/ajr.178.2.1780445

9. Richardson C., Redfern A., Sher-Locketz C.L., Schubert P.T., Schaaf H.S. Fine Needle Aspiration Biopsy of Peripheral Lymph Nodes in Children: Practical Experience in a Tertiary Hospital. J. Trop. Pediatr. 2021; 67 (3): fmaa040. https://doi.org/10.1093/tropej/fmaa040

10. Zu D.M., Feng L.L., Zhang L., Ma S.L., Zhu Y.C. Evaluation of Mesenteric Lymph Nodes in a Pediatric Population with Mesenteric Lymphadenitis Using Superb Microvascular Imaging. Med. Sci. Monit. 2019; 25: 5336-5342. https://doi.org/10.12659/MSM.914903

11. Cohen J.M., Banks M., Kon O.M., Eisen S. Utility of Esophageal Ultrasound-guided Biopsy of Mediastinal Lymph Nodes in Diagnosis of Childhood Tuberculosis. Pediatr. Infect. Dis. J. 2022 May 1; 41 (5): e246-e248. https://doi.org/10.1097/INF.0000000000003498

12. Cho J.Y., Winant A.J., Sohn J.H., Vargas S.O., Lee E.Y. CT Features of Benign Intrapulmonary Lymph Nodes in Pediatric Patients With Known Extrapulmonary Solid Malignancy. AJR Am. J. Roentgenol. 2021; 216 (5): 1357-1362. https://doi.org/10.2214/AJR.20.23363

13. Pérez-Marrero L., Norambuena M.F., Whittle C., Fuentealba I.M., Spralja B. «Truffle sign». A suspicious malignant pattern of lymphadenopathies in children observed on ultrasound. Preliminary study. J. Ultrasound. 2023; 26 (4): 823-827. https://doi.org/10.1007/s40477-023-00798-0

14. Piskunowicz M., Back S.J., Darge K., Humphries P.D., Jüngert J., Ključevšek D., Lorenz N., Mentzel H.J., Squires J.H., Huang D.Y. Contrastenhanced ultrasound of the small organs in children. Pediatr. Radiol. 2021; 51 (12): 2324-2339. https://doi.org/10.1007/s00247-021-05006-x

15. Ingolfsdottir M., Balle V., Hahn C.H. Evaluation of cervical lymphadenopathy in children: advantages and drawbacks of diagnostic methods. Dan. Med. J. 2013; 60 (8): A4667.

16. Costa N.S., Salisbury S.R., Donnelly L.F. Retropharyngeal lymph nodes in children: a common imaging finding and potential source of misinterpretation. AJR Am. J. Roentgenol. 2011; 196 (4): W433-7. https://doi.org/10.2214/AJR.10.4953

17. de Jong P.A., Nievelstein R.J. Normal mediastinal and hilar lymph nodes in children on multi-detector row chest computed tomography. Eur. Radiol. 2012; 22 (2): 318-21. https://doi.org/10.1007/s00330-011-2253-9

18. Yan Q., Xu L., Chao J., Zhang Z., Wang H. Characteristics of intestinal-related lymphoid hyperplasia in children and its correlation with intussusception of children. BMC Pediatr. 2022; 22 (1): 641. https://doi.org/10.1186/s12887-022-03675-7

19. Durand R., Reid J.R., Belasco J.B., Shellikeri S., Calle-Toro J.S., Cahill A.M., Srinivasan A. MRI for Response Assessment of Extensive Lymphatic Malformations in Children Treated With Sirolimus. AJR Am. J. Roentgenol. 2021; 217 (3): 741-752. https://doi.org/10.2214/AJR.20.24378

20. Chaber R., Łasecki M., Kwaśnicka J., Łach K., Podgajny Z., Olchowy C., Zaleska-Dorobisz U. Hounsfield units from unenhanced 18F-FDG-PET/CT are useful in evaluating supradiaphragmatic lymph nodes in children and adolescents with classical Hodgkin’s lymphoma. Adv. Clin. Exp. Med. 2018; 27 (6): 795-805. https://doi.org/10.17219/acem/68990

21. Helbling R., Conficconi E., Wyttenbach M., Benetti C., Simonetti G.D., Bianchetti M.G., Hamitaga F., Lava S.A., Fossali E.F., Milani G.P. Acute Nonspecific Mesenteric Lymphadenitis: More Than «No Need for Surgery». Biomed. Res. Int. 2017; 2017: 9784565. https://doi.org/10.1155/2017/9784565

22. Spijkers S., Littooij A.S., Humphries P.D., Lam M.G.E.H., Nievelstein R.A.J. Imaging features of extranodal involvement in paediatric Hodgkin lymphoma. Pediatr. Radiol. 2019; 49 (2): 266-276. https://doi.org/10.1007/s00247-018-4280-z

23. Spijkers S., Littooij A.S., Nievelstein R.A.J. Measurements of cervical lymph nodes in children on computed tomography. Pediatr. Radiol. 2020; 50 (4): 534-542. https://doi.org/10.1007/s00247-019-04595-y

24. Spijkers S., Staats J.M., Littooij A.S., Nievelstein R.A.J. Abdominal lymph node size in children at computed tomography. Pediatr. Radiol. 2020; 50 (9): 1263-1270. https://doi.org/10.1007/s00247-020-04715-z

25. Yu T.Z., Zhang Y., Zhang W.Z., Yang G.Y. Role of ultrasound in the diagnosis of cervical tuberculous lymphadenitis in children. World J. Pediatr. 2021; 17 (5): 544-550. https://doi.org/10.1007/s12519-021-00453-w

26. Zhou Y., Shen N., Luo L., Liu Y., Cao Q. Clinical and metagenomic characteristics of lymphadenopathy related to fever of unknown origin in children. Pediatr. Res. 2024; 96 (4): 1037-1044. https://doi.org/10.1038/s41390-024-03187-3

27. Bayramoglu Z., Caliskan E., Karakas Z., Karaman S., Tugcu D., Somer A., Acar M., Akıcı F., Adaletli I. Diagnostic performances of superb microvascular imaging, shear wave elastography and shape index in pediatric lymph nodes categorization: a comparative study. Br. J. Radiol. 2018; 91 (1087): 20180129. https://doi.org/10.1259/bjr.20180129