Clinical, laboratory and radiologic factors for early diagnosis of cervical lymphadenitis

Abstract

Cervical lymphadenitis is composed of various different diseases. The treatment and prognosis of each disease is multifarious. So, this study aimed to evaluate different factors among Reactive lymphadenitis (RL), Kikuchi’s disease (KD) and Tuberculous lymphadenitis (TL) which are common cervical lymphadenitis.

We reviewed medical records of Gangnam Severance Hospital with cervical lymphadenitis between May 2005 and November 2014, retrospectively. And compared the clinical, laboratory and radiologic factors among three groups (n, RL=80, KD=80, TL=80).

The study included 240 Patients with the mean age 36.9. Longer duration of fever, lower level of leukocyte, lower level of Hb, lower level of platelet, lower level of albumin and higher level of AST were significant characteristics of KD than other cervical lymphadenitis. Neck mass was dominant chief complaint in RL and TL whereas it were neck swelling and fever in KD. And fever, weight loss, fatigue and headache were common clinical features in KD. Anatomically dominant areas of lymphadenopathy were level II in RL, however it were level III, IV in KD and TL.

Comparing of radiologic features by sonography, discrete, oval shape, regular margin, homogenous lymph nodes are predominant in RL and KD rather than TL. On the contrary, presence of hypoechoic center and intranodal necrosis are distinctive features of TL. By CT images, matted nodes, presence of nodal necrosis, multiple necrosis, perinodal infiltration and calcification were remarkable features of TL.

Lastly we made a multivariate analysis among three groups, fever and leukopenia were significant predictive factors for KD comparing with RL. Leukopenia, CRP/albumin ratio and headache were significant predictive factors for RL comparing with TL. Fever, leukopenia and hypoalbuminemia were significant predictive factors for KD comparing with TL.

This knowledge about clinico-laboratoric and radiologic perspectives of cervical lymphadenitis will help to detect the disease early.