J Cardiovasc Imaging.  2018 Dec;26(4):238-246. 10.4250/jcvi.2018.26.e29.

Imaging and Clinical Data Distinguish Lymphadenopathy-First-Presenting Kawasaki Disease from Bacterial Cervical Lymphadenitis

• Park BS
• Bang MH
• Kim SH

• KMID: 2429999
• DOI: http://doi.org/10.4250/jcvi.2018.26.e29

Abstract

BACKGROUND
Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL.
METHODS
We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018.
RESULTS
We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA).
CONCLUSIONS
LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.

Keyword

Kawasaki disease; Coronary artery; Computed tomography; Bacterial lymphadenitis

MeSH Terms

Abscess
C-Reactive Protein
Coronary Vessels
Echocardiography
Fever
Hand
Humans
Incidence
Logistic Models
Lymph Nodes
Lymphadenitis*
Lymphatic Diseases
Mucocutaneous Lymph Node Syndrome*
Pyuria
Ultrasonography
C-Reactive Protein

Figure

• 

  Figure 1 (A) Neck computed tomography image performed in a patient with lymphadenopathy-first-presenting Kawasaki disease; white arrow indicates multiple enlarged lymph nodes without abscess. (B) Neck computed tomography image performed in a patient with bacterial cervical lymphadenitis; white arrow indicates multiple enlarged lymph nodes with internal low density, suggesting abscess.

• 

  Figure 2 Echocardiographic images of a left coronary artery in parasternal short axis view. (A) In a patient with lymphadenopathy-first-presenting Kawasaki disease, the left coronary artery shows ectasia. (B) In a patient with typical Kawasaki disease, a marked dilated and tortuous coronary artery was revealed.

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