Download PDF
Endoskopie heute 2015; 28(02): 149-152
DOI: 10.1055/s-0035-1553313
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Sonografische Darstellung mesenterialer Lymphknoten bei gesunden Kindern

Ultrasound Evaluation of Normal Mesenterial Lymph Nodes in Children
D. Schreiber-Dietrich
1   Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
,
B. Braden
2   Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
,
L. Chiorean
1   Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
3   Département d’imagerie médicale, Clinique des Cévennes, France
,
C. F. Dietrich
1   Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim
› Author Affiliations
Further Information

Publication History

Publication Date:
07 December 2015 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Einleitung: Der Nachweis intraabdomineller Lymphknoten wurde lange Zeit als Hinweis auf das Vorliegen entzündlicher oder neoplastischer Erkrankungen aufgefasst. Mittels moderner Ultraschallsysteme gelingt jedoch auch die sonografische Darstellung physiologischer, nicht vergrößerter Lymphknoten im Bauchraum. Wenig ist bisher über den physiologischen intraabdominellen Lymphknotenstatus bei Kindern, insbesondere im Mesenterium, bekannt.

Methodik: 60 gesunde Kinder im Alter von 4 – 17 Jahren wurden transabdominell sonografisch untersucht, wobei Anzahl, Lage und Größe mesenterialer Lymphknoten bestimmt wurden sowie die Darmwanddicke an 5 definierten Stellen gemessen und dokumentiert wurde.

Ergebnisse: Mesenteriale Lymphknoten ≥ 7 mm fanden sich bei 51/60 (85 %) der gesunden Kinder. Bei 31/60 (52 %) der gesunden Kinder fanden sich bis zu 5 Lymphknoten ≥ 7 × 3 mm und bei 20/60 (33 %) mehr als 5 abgrenzbare mesenteriale Lymphknoten ≥ 7 × 3 mm. Die Darmwanddicke lag bei allen gesunden Kindern an allen 5 Lokalisationen unter 2 mm.

Zusammenfasssung: Bei gesunden Kindern lassen sich regelhaft Lymphknoten > 7 mm im Mesenterium sonografisch darstellen.

Abstract

Background: For a long time, the detection of intraabdominal lymph nodes has been considered a sign of inflammatory or neoplastic disease. However, modern ultrasound machines enable the visualisation not only of pathologically enlarged lymph nodes, but normal lymph nodes can also be evaluated. The knowledge of the physiological state of intraabdominal lymph nodes in children is still very limited.

Methods: 60 healthy children between 4 – 17 years of age were examined using transabdominal ultrasound. Number, location and dimension of mesenterial lymph nodes, as well as bowel wall thickness in 5 defined locations were measured and documented.

Results: Mesenteric lymph nodes ≥ 7 mm were found in 51/60 (85 %) of healthy children. In 31/60 (52 %) of the healthy children up to 5 lymph nodes and in 20/60 (33 %) more than 5 mesenteric lymph nodes ≥ 7 × 3 mm were found. The sonographically measured bowel wall thickness was less than 2 mm in all healthy children, at all locations.

Conclusion: In healthy children, mesenterial lymph nodes (> 7 mm) are a normal finding.

Schlüsselwörter

Leitlinien - Normwerte - Lymphadenopathie

Key words

guidelines - normal value - lymphadenopathy
 

  • Literatur

  • 1 Neri S, Ierna D, Mauceri B et al. Can ultrasonographic findings of perihepatic lymphadenopathy promote investigations to detect possible presence of virus C infection in non-symptomatic subjects?. Hepatol Res 2003; 27 (02) 124-128
    CrossrefPubMedSearch in Google Scholar
  • 2 Watanabe T, Sassa T, Hiratsuka H et al. Clinical significance of enlarged perihepatic lymph node on ultrasonography. Eur J Gastroenterol Hepatol 2005; 17 (02) 185-190
    CrossrefPubMedSearch in Google Scholar
  • 3 Choi MS, Lee JH, Koh KC et al. Clinical significance of enlarged perihepatic lymph nodes in chronic hepatitis B. J Clin Gastroenterol 2001; 32 (04) 329-332
    CrossrefPubMedSearch in Google Scholar
  • 4 Hikita H, Nakagawa H, Tateishi R et al. Perihepatic lymph node enlargement is a negative predictor of liver cancer development in chronic hepatitis C patients. J Gastroenterol 2013; 48 (03) 366-373
    CrossrefPubMedSearch in Google Scholar
  • 5 Soresi M, Bonfissuto G, Sesti R et al. Perihepatic lymph nodes and antiviral response in chronic HCV-associated hepatitis. Ultrasound Med Biol 2004; 30 (06) 711-717
    CrossrefPubMedSearch in Google Scholar
  • 6 Wedemeyer H, Ockenga J, Frank H et al. Perihepatic lymphadenopathy: a marker of response to interferon alpha in chronic hepatitis C. Hepatogastroenterology 1998; 45 (22) 1062-1068
    PubMedSearch in Google Scholar
  • 7 Ierna D, D'Amico RA, Antoci S et al. Perihepatic lymphadenopathy in chronic hepatitis C: a complementary diagnostic element?. J Gastroenterol Hepatol 2000; 15 (07) 783-785
    CrossrefPubMedSearch in Google Scholar
  • 8 Dietrich CF, Zeuzem S, Caspary WF et al. [Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands]. Ultraschall in Med 1998; 19 (06) 265-269
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Braden B, Faust D, Ignee A et al. Clinical relevance of perihepatic lymphadenopathy in acute and chronic liver disease. J Clin Gastroenterol 2008; 42 (08) 931-936
    CrossrefPubMedSearch in Google Scholar
  • 10 Dietrich CF, Zeuzem S. Sonographic detection of perihepatic lymph nodes: technique and clinical value. Z Gastroenterol 1999; 37 (02) 141-151
    PubMedSearch in Google Scholar
  • 11 Hirche TO, Russler J, Braden B et al. Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease. Int J Colorectal Dis 2004; 19 (06) 586-594
    CrossrefPubMedSearch in Google Scholar
  • 12 Metreweli C, Ward SC. Ultrasound demonstration of lymph nodes in the hepatoduodenal ligament (“Daisy Chain nodes”) in normal subjects. Clin Radiol 1995; 50 (02) 99-101
    CrossrefPubMedSearch in Google Scholar
  • 13 Dietrich CF, Schall H, Kirchner J et al. Sonographic detection of focal changes in the liver hilus in patients receiving corticosteroid therapy. Z Gastroenterol 1997; 35 (12) 1051-1057
    PubMedSearch in Google Scholar
  • 14 Dietrich CF, Liesen M, Buhl R et al. Detection of normal mediastinal lymph nodes by ultrasonography. Acta Radiol 1997; 38 (06) 965-969
    CrossrefPubMedSearch in Google Scholar
  • 15 Dietrich CF, Liesen M, Wehrmann T et al. Mediastinalsonographie, eine neue Bewertung der Befunde. Endokopie heute 1995; 4: 278-294
    PubMedSearch in Google Scholar
  • 16 Dietrich CF, Chichakli M, Bargon J et al. Mediastinal lymph nodes demonstrated by mediastinal sonography: activity marker in patients with cystic fibrosis. J Clin Ultrasound 1999; 27 (01) 9-14
    CrossrefPubMedSearch in Google Scholar
  • 17 Rettenbacher T. Sonography of peripheral lymph nodes part 1: normal findings and B-image criteria. Ultraschall in Med 2010; 31 (04) 344-362
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Gritzmann N, Hollerweger A, Macheiner P et al. Sonography of soft tissue masses of the neck. J Clin Ultrasound 2002; 30 (06) 356-373
    CrossrefPubMedSearch in Google Scholar
  • 19 Cui XW, Hocke M, Jenssen C et al. Conventional ultrasound for lymph node evaluation, update 2013. Z Gastroenterol 2014; 52 (02) 212-221
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Schreiber-Dietrich D, Pohl M, Cui XW et al. Perihepatic lymphadenopathy in children with chronic viral hepatitis. J Ultrason 2015; in press
    PubMedSearch in Google Scholar
  • 21 Chiorean L, Schreiber-Dietrich D, Braden B et al. Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn's disease. Med Ultrason 2014; 16 (04) 319-324
    PubMedSearch in Google Scholar
  • 22 Dietrich CF, Jedrzejczyk M, Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol 2007; 64 (02) 202-212
    CrossrefPubMedSearch in Google Scholar
  • 23 Mantegazza C, Maconi G, Giacomet V et al. Gut and mesenteric lymph node involvement in pediatric patients infected with human immunodeficiency virus. HIV AIDS (Auckl) 2014; 6: 69-74
    PubMedSearch in Google Scholar
  • 24 Civitelli F, Di Nardo G, Oliva S et al. Ultrasonography of the colon in pediatric ulcerative colitis: a prospective, blind, comparative study with colonoscopy. J Pediatr 2014; 165 (01) 78-84
    CrossrefPubMedSearch in Google Scholar
  • 25 Moustaki M, Zeis PM, Katsikari M et al. Mesenteric lymphadenopathy as a cause of abdominal pain in children with lobar or segmental pneumonia. Pediatr Pulmonol 2003; 35 (04) 269-273
    CrossrefPubMedSearch in Google Scholar
  • 26 Dietrich CF, Lembcke B, Jenssen C et al. Intestinal ultrasound in rare gastrointestinal diseases, update, part 1. Ultraschall in Med 2014; 35 (05) 400-421
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Meckler U, Hollerweger A, Dietrich CF. Sonographische Differenzialdiagnose. Krankheiten des Gastrointestinaltraktes. Systematischer Atlas. Deutscher Ärzte-Verlag; 2004
    Search in Google Scholar
  • 28 Hollerweger A, Dietrich CF. "White bowel". A sonographic sign of intestinal lymph edema?. Ultraschall in Med 2005; 26 (02) 127-133
    Thieme ConnectPubMedSearch in Google Scholar
  • 29 Hollerweger A, Macheiner P, Dirks K et al. Differential diagnosis of severe hypoechoic oedema of the small bowel. Ultraschall in Med 2006; 27 (03) 234-239
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Barreiros AP, Braden B, Schieferstein-Knauer C et al. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol 2008; 43 (10) 1224-1231
    CrossrefPubMedSearch in Google Scholar
  • 31 Chiorean L, Schreiber-Dietrich D, Braden B et al. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World J Gastroenterol 2015; 21 (17) 5231-5241
    CrossrefPubMedSearch in Google Scholar
  • 32 Allgayer H, Braden B, Dietrich CF. Transabdominal ultrasound in inflammatory bowel disease. Conventional and recently developed techniques--update. Med Ultrason 2011; 13 (04) 302-313
    PubMedSearch in Google Scholar
  • 33 Dietrich CF, Hermann S, Klein S et al. Sonographic signs of neutropenic enterocolitis. World J Gastroenterol 2006; 12 (09) 1397-1402
    CrossrefPubMedSearch in Google Scholar
  • 34 Dietrich CF, Braden B. Sonographic assessments of gastrointestinal and biliary functions. Best Pract Res Clin Gastroenterol 2009; 23 (03) 353-367
    CrossrefPubMedSearch in Google Scholar
  • 35 Braden B, Ignee A, Hocke M et al. Diagnostic value and clinical utility of contrast enhanced ultrasound in intestinal diseases. Dig Liver Dis 2010; 42 (10) 667-674
    CrossrefPubMedSearch in Google Scholar
  • 36 Cassani F, Costigliola P, Zoli M et al. Abdominal lymphadenopathy detected by ultrasonography in HIV-1 infection: prevalence and significance. Scand J Infect Dis 1993; 25 (02) 221-225
    CrossrefPubMedSearch in Google Scholar
  • 37 Gimondo P, Mirk P, Messina G et al. Abdominal lymphadenopathy in benign diseases: sonographic detection and clinical significance. J Ultrasound Med 1996; 15 (05) 353-359
    PubMedSearch in Google Scholar
  • 38 Nakachi S, Nakamura T, Agha N et al. Clinical features and early diagnosis of typhoid fever emphasizing usefulness of detecting mesenteric lymphadenopathy with ultrasound as diagnostic method. Southeast Asian J Trop Med Public Health 2003; 34 (Suppl. 02) 153-157
    PubMedSearch in Google Scholar
  • 39 Watanabe M, Ishii E, Hirowatari Y et al. Evaluation of abdominal lymphadenopathy in children by ultrasonography. Pediatr Radiol 1997; 27 (11) 860-864
    CrossrefPubMedSearch in Google Scholar
  • 40 Hirche TO, Hirche H, Cui XW et al. Ultrasound evaluation of mediastinal lymphadenopathy in patients with sarcoidosis. Med Ultrason 2014; 16 (03) 194-200
    PubMedSearch in Google Scholar
  • 41 Dietrich CF, Hocke M, Jenssen C. Ultrasound for abdominal lymphadenopathy. Dtsch Med Wochenschr 2013; 138 (19) 1001-1018
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Kanamori A, Hirooka Y, Itoh A et al. Usefulness of contrast-enhanced endoscopic ultrasonography in the differentiation between malignant and benign lymphadenopathy. Am J Gastroenterol 2006; 101 (01) 45-51
    CrossrefPubMedSearch in Google Scholar
  • 43 De Gaetano AM, Vecchioli A, Minordi LM et al. Role of diagnostic imaging in abdominal lymphadenopathy. Rays 2000; 25 (04) 463-484
    PubMedSearch in Google Scholar
  • 44 Dietrich CF, Viel K, Braden B et al. Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C?. Z Gastroenterol 2000; 38 (02) 143-152
    Thieme ConnectPubMedSearch in Google Scholar
  • 45 Sikorska-Wisniewska G, Liberek A, Gora-Gebka M et al. Mesenteric lymphadenopathy – a valid health problem in children. Med Wieku Rozwoj 2006; 10 (02) 453-462
    PubMedSearch in Google Scholar
  • 46 Vayner N, Coret A, Polliack G et al. Mesenteric lymphadenopathy in children examined by US for chronic and/or recurrent abdominal pain. Pediatr Radiol 2003; 33 (12) 864-867
    CrossrefPubMedSearch in Google Scholar
  • 47 Dietrich CF, Rees C, Schreiber-Dietrich D et al. Correlation of perihepatic lymph node enlargement with treatment outcome in patients with chronic hepatitis C. European Journal of Lymphology and related Problems 2000; 29: 6-10
    PubMedSearch in Google Scholar
  • 48 Dietrich CF, Lee JH, Herrmann G et al. Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology 1997; 26 (02) 467-472
    CrossrefPubMedSearch in Google Scholar
  • 49 Dorfman RE, Alpern MB, Gross BH et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991; 180 (02) 319-322
    CrossrefPubMedSearch in Google Scholar
  • 50 Makhmudov ZA. Superior mesenteric lymph nodes in adult humans of different body constitution types. Morfologiia 1997; 112 (05) 58-61
    PubMedSearch in Google Scholar
  • 51 Sivit CJ, Newman KD, Chandra RS. Visualization of enlarged mesenteric lymph nodes at US examination. Clinical significance. Pediatr Radiol 1993; 23 (06) 471-475
    CrossrefPubMedSearch in Google Scholar
  • 52 Toppet V, Souayah H, Delplace O et al. Lymph node enlargement as a sign of acute hepatitis A in children. Pediatr Radiol 1990; 20 (04) 249-252
    CrossrefPubMedSearch in Google Scholar
  • 53 Simanovsky N, Hiller N. Importance of sonographic detection of enlarged abdominal lymph nodes in children. J Ultrasound Med 2007; 26 (05) 581-584
    PubMedSearch in Google Scholar
  • 54 Jenssen C, Dietrich CF, Burmester E. Malignant neoplasias of the gastrointestinal tract--endosonographic staging revisited. Z Gastroenterol 2011; 49 (03) 357-368
    Thieme ConnectPubMedSearch in Google Scholar
  • 55 Moehler M, AlBatran SE, Andus T et al. German S3-guideline "Diagnosis and treatment of esophagogastric cancer". Z Gastroenterol 2011; 49 (04) 461-531
    Thieme ConnectPubMedSearch in Google Scholar
  • 56 Monig SP, Baldus SE, Zirbes TK et al. Lymph node size and metastatic infiltration in colon cancer. Ann Surg Oncol 1999; 6 (06) 579-581
    CrossrefPubMedSearch in Google Scholar
  • 57 Prenzel KL, Monig SP, Sinning JM et al. Lymph node size and metastatic infiltration in non-small cell lung cancer. Chest 2003; 123 (02) 463-467
    CrossrefPubMedSearch in Google Scholar
  • 58 Schroder W, Baldus SE, Monig SP et al. Lymph node staging of esophageal squamous cell carcinoma in patients with and without neoadjuvant radiochemotherapy: histomorphologic analysis. World J Surg 2002; 26 (05) 584-587
    CrossrefPubMedSearch in Google Scholar
  • 59 Monig SP, Schroder W, Baldus SE et al. Preoperative lymph-node staging in gastrointestinal cancer – correlation between size and tumor stage. Onkologie 2002; 25 (04) 342-344
    CrossrefPubMedSearch in Google Scholar
  • 60 Jenssen C. Clinical value of lymph node sonography. Praxis (Bern 1994) 2009; 98 (11) 581-588
    CrossrefPubMedSearch in Google Scholar
  • 61 Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes seen at imaging: causes and significance. Radiographics 2005; 25 (02) 351-365
    CrossrefPubMedSearch in Google Scholar
  • 62 Karmazyn B, Werner EA, Rejaie B et al. Mesenteric lymph nodes in children: what is normal?. Pediatr Radiol 2005; 35 (08) 774-777
    CrossrefPubMedSearch in Google Scholar
  • 63 Sienz M, Ignee A, Dietrich CF. Reference values in abdominal ultrasound – biliopancreatic system and spleen. Z Gastroenterol 2011; 49 (07) 845-870
    Thieme ConnectPubMedSearch in Google Scholar
  • 64 Sienz M, Ignee A, Dietrich CF. Sonography today: reference values in abdominal ultrasound: aorta, inferior vena cava, kidneys. Z Gastroenterol 2012; 50 (03) 293-315
    Thieme ConnectPubMedSearch in Google Scholar
  • 65 Lucey BC, Stuhlfaut JW, Soto JA. Mesenteric lymph nodes: detection and significance on MDCT. Am J Roentgenol Am J Roentgenol 2005; 184 (01) 41-44
    PubMedSearch in Google Scholar
  • 66 Dietrich CF, Stryjek-Kaminska D, Teuber G et al. Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. Am J Roentgenol Am J Roentgenol 2000; 174 (03) 699-704
    PubMedSearch in Google Scholar
  • 67 Sienz M, Ignee A, Dietrich CF. Reference values in abdominal ultrasound – liver and liver vessels. Z Gastroenterol 2010; 48 (09) 1141-1152
    Thieme ConnectPubMedSearch in Google Scholar
  • 68 Cui XW, Ignee A, Bachmann NM et al. Contrast enhanced ultrasound of sentinel lymph nodes. J Ultrason 2013; 13: 73-81
    CrossrefPubMedSearch in Google Scholar
  • 69 Cui XW, Jenssen C, Saftoiu A et al. New ultrasound techniques for lymph node evaluation. World J Gastroenterol 2013; 19 (30) 4850-4860
    CrossrefPubMedSearch in Google Scholar