Various Ultrasonographic Manifestations of Bacille Calmette-Guerin (BCG) Lymphadenitis in Infants after BCG Vaccination

Abstract

PURPOSE: To evaluate the various ultrasonographic manifestations of BCG lymphadenitis complicated by BCG vaccination in infantsMATERIALS and METHODS:Among a total of 59 patients of BCG lymphadenitis, we retrospectively evaluated the ultrasonographic findings of five patients (seven involved areas), who were operated and confirmed by histopathology. Three cases were male and two were female and the age range is from 3 months to 9 months (mean: 5.5 months).RESULTS: Among five cases two had only a single lesion and three had multiple lesions, and two of those had multiple lesions at 2 separate locations. All five cases had ipsilateral supraclavicular lesions with same BCG vaccination site and two also had ipsilateral axillary lesions. Ultrasonography showed enlarged lymph nodes and heterogeneous hypoechoic changes suggesting internal necrosis or suppurative changes in three cases, but 1 had cystic necrotic change with fluid-fluid level and another had conglomerated mass with intermingled hyper and hypoechoic areas, which were initially suspected to be a tumorous condition but revealed conglomerated lymph nodes on follow-up ultrasonography and MRI. CONCLUSION: BCG lymphadenitis is usually located adjacent to a BCG vaccination site, but ultra-sonography can show single or multiple lymph node enlargement and various manifestations from homogeneous lymphadenitis to cystic abscess changes and even a mass-like appearance , demonstrating that the evaluation of ultrasonography should be done very carefully.