Mesenteric adenitis in children Geetha M Pediatric
Gastroenterologist Amrita Hospital, Cochin
Slide 2
Scenario Mesenteric Lymphadenopathy not a diagnosis Incidental
finding in Recurrent Abdominal Pain USG abdomen is one primary
investigation Organic causes 4-11% USG findings- Mesenteric nodes,
GB Stones ? Significance
Slide 3
MLN Medical literature Pediatric Literature specific
inflammation by Yersinia, Staph, Salmonella Radiological literature
- LN > 5mm size What is the significance? Importance of
Sonographic Detection of Enlarged Abdominal Lymph Nodes in Children
Natalia Simanovsky, MD, Nurith Hiller, MD J Ultrasound Med 2007;
26:581584
Slide 4
What is mesenteric adenitis? 3 or > LN 4 mm or > in short
axis: 8mm > in long axis Primary- when LN are the only finding
Secondary when another pathology is identified Incidence varies Rao
PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis.
Radiology 1997; 202:145149.
Slide 5
Slide 6
Measurement of LN
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Causes - Local Infections Gastroenteritis Appendicitis
Parasitic infections IBD
Slide 8
Parasitic Infection Parasitic infec is a cause of RAP ?? Cause
for MLN?? 2002-2008, 224 children with RAP 89 boys: 135 girls ;
Mean age 9 yrs Ped sonologist Short axis >8mm = enlarged MLN
Enlarged mesenteric lymph nodes in children with recurrent
abdominal pain: Is there an association with intestinal parasitic
infections? Fraukje Wiersma et al
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Contd.. All children had MLN at least 5mm 86% (193/224) - had
all nodes < 5mm 6/224 (2.5%) > 8mm: 25/224 (11.2%) 5-7mm None
of the 6 had parasites 25% (56) had parasitic infection 47 - <
5mm 9 5-7 mm Concluded not related to parasitic infection
Simanovsky N et al. Importance of sonographic detection of enlarged
abdominal lymph nodes in children. J Ultrasound Med 2007;
26:581-584
Slide 10
Infections associated with MLN Yersinia enterocolitica - RIF
syndrome Atypical Mycobacteria Campylobacter spp Coxackie virus,
EBV HIV Jelloul I, Fremond B, Dyon JF, Orme RI, Babut JM.
Mesenteric adenitis caused by Yersinia pseudotuberculosis
presenting as abdominal mass. Eur J Pediatr Surg 1997; 7:180183.
Nilehn B, Sjostrom B. Studies on Yersinia enterocolitica.
Occurrence in various groups of acute abdominal disease. Acta
Pathol Microbiol Scand 1967; 71:612-628.
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Symptomatology Mostly asymptomatic Diffuse abd pain sometimes
localised in RLQ Concomittant/ antecedent URI Anorexia Diarrhoea
Nausea/ vomiting
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Symptoms.Contd Fever Rhinorrhoea RLQ tenderness 20% peripheral
lymphadenopathy LN Biopsy mostly reactive/ non specific
inflammation
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Early Studies LN > 4mm in AP diameter 4% asymp children
10-20 mm long axis 89% asymp children MLN (long axis) in almost all
children Sivit CJ, et al. Visualization of enlarged mesenteric
lymph nodes at US examination. Pediatr Radiol 1993; 23:471-475
Healy MV, Graham PM. Assessment of abdominal lymph nodes in a
normal pediatric population: an ultrasound study. Australas Radiol
1993; 37:171172. Watanabe M, Ishii E, Hirowatari Y, et al.
Evaluation of abdominal lymphadenopathy in children by
ultrasonography. Pediatr Radiol 1997; 27:860864
Slide 14
CT and MLN All non contrast CT images done for renal stones
were evaluated for MLN 33/61 had MLN mostly in RLQ Max size 10 mm
also in RLQ Cluster of 3 nodes RLQ 5mm size nodes in almost all
Hence a measurement of 8mm or > chosen Karmazyn B, Werner EA,
Rejaie B, Applegate KE. Mesenteric lymph nodes in children: what is
normal? Pediatr Radiol 2005; 35:774-777
Slide 15
Which size is significant ? MLN in children asymptomatic and
RAP 200 children Acute abd / RAP/ others Only > 10 mm was
statistically significant Group I (24)Group II (65)Group III (111)
> 5mm83.3%73.8%64% > 8 mm41.6%32.3%27% >
10mm22.1%27.6%9.9% Importance of Sonographic Detection of Enlarged
Abdominal Lymph Nodes in Children Natalia Simanovsky, MD, Nurith
Hiller, MD. J Ultrasound Med 2007; 26:581584
Slide 16
Does Size Matter ? LN > 4mm seen in 4-64% asymp children
14-83% of symp children MLN are seen in all children asymp, symp-
acute abd, CAP, gastroenteritis Tendency to have larger nodes in
acute infect As an isolated finding not much importance Nan Fang Yi
Ke Da Xue Xue Bao.Nan Fang Yi Ke Da Xue Xue Bao. 2011
Mar;31(3):522-4. [Enlarged mesenteric lymph nodes in children: a
clinical analysis with ultrasonography and the implications]. [WANG
WG, TIAN H, YAN JY, LI T, ZHANG TD, ZHAO YP, ZHANG LY, XING HG.WANG
WGTIAN HYAN JYLI TZHANG TDZHAO YPZHANG LYXING HG Sivit CJ, et al.
Visualization of enlarged mesenteric lymph nodes at US examination.
Pediatr Radiol 1993; 23:471-475 Rathaus Vet al Enlarged mesenteric
lymph nodes in asymptomatic children: the value of the finding in
various imaging modalities. Br J Radiol 2005; 78:30-33
Slide 17
Distribution of EALNs of 5 mm or larger in the shortest
diameter by age Importance of Sonographic Detection of Enlarged
Abdominal Lymph Nodes in Children Natalia Simanovsky, MD, Nurith
Hiller, MD. J Ultrasound Med 2007; 26:581584
Slide 18
Indian Experience MLN almost universally seen Enlarged nodes
> 8mm upto 20mm If isolated and clinically well only follow up
If symptomatic - course of antibiotics Usually pain tends to settle
but nodes persist If persistent and symptomatic - evaluate
Slide 19
Conclusions Frequent in asymptomatic children Nodes 10 mm or
> in setting of abdominal pain considered as ML Usually increase
in size till 10 yrs and then regress Mostly non specific but follow
up if necessary
