[Mesenteric lymphadenopathy - a valid health problem in children]

Abstract

The aim: of the study is to evaluate the reasons of mesenteric lymphadenopathy and its clinical picture in hospitalized children.

Material and methods: the study was performed on 127 children (49 girls and 78 boys age of 8 months to 18 years; mean age 9 years and 3 months) hospitalized in the Department of Paediatrics, and Paediatric Gastroenterology and Oncology, Medical University of Gdansk. Ultrasonography showed enlarged abdominal lymph nodes in all children. According to definition of mesenteric lymphadenopathy, the clinical course of disease was analyzed in children, in whom there were at least three lymph nodes in ultrasonography with the peroneal diameter of 5 mm or more. Inflammatory parameters were examined in all children. In selected cases culture, viral and parasitic, as well as endoscopic examination, were also performed.

Results: analyzing accompanying clinical symptoms, it was found, that abdominal pain was the most dominant complaint in children with mesenteric lymphadenopathy; it was observed in 63 children (49.6%). In 33 (26%) of them the pain was the sole complaint, while in the rest vomiting and fever were present. 8 children (6.3%) with generalized lymphadenopathy were diagnosed. Ultrasonographic evaluation demonstrated that numerous enlarged lymph nodes were present the most frequently, in 65 (51.2%), less numerous, in 42 (33.1%), while sparse lymph nodes were seen only in 20 (15.7%) children. In 85 patients (66.9%) long axis of the lymph nodes reached min. 10 mm, in 39 (30.1%) was smaller than 10 mm, in 3 (2.4%) exceed 20 mm. Conglomerates of lymph nodes were described in 9 (7.1%) patients with various diagnosis (acute diarrhea - 3 children, ulcerative colitis - 3 children, celiac disease, cytomegaly, lambliosis). Tendency to invagination was observed in 5 (3.9%) children. In 4 of them acute infection (acute diarrhea, pneumonia) with high inflammatory parameters was diagnosed. Elevated inflammatory parameters were present in 42 (33.1%) patients. Examining the reasons of the abdominal lymph nodes enlargement, it was found that primary mesenteric lymphadenopathy was the most frequent diagnosis; it was recognized in 27 (21.3%) children. In 20 (15.7%) lymphadenopathy was caused by acute diarrhea, in 19 (14.9%) patients - by respiratory tract infection. Cytomegaly was recognized in 4 (3.1%), toxoplasmosis in 3 (2.3%), lambliosis in 9 (7.0%) patients. Both gastritis and colitis were diagnosed in 12 (9.4%) children. In 7 (5.5%) patients generalized lymphadenopathy with unknown etiology was described. In single cases other diseases were diagnosed.

Conclusions: the enlargement of mesenteric lymph nodes frequently causes abdominal pain in children, being an indication for laboratory investigations. Vomiting and fever are the most common other symptoms in these patients. Ultrasonographic examination usually shows large enlargement of lymph nodes, sometimes in conglomerates, with tendency to invagination. Acute diarrhea and respiratory tract infection are the most frequent reasons of the enlargement of abdominal lymph nodes. In about 20% of the children primary mesenteric lymphadenopathy is diagnosed.