ABSTRACT
Lymphadenopathy of the head and neck region is a common finding in children and a very common reason to image the craniocervical region. Enlarged lymph nodes are commonly palpated by the pediatrician in the office and commonly imaged by the pediatric radiologist. The difficult task of the clinician is to determine whether the adenopathy is acute (<3 weeks) or chronic (>6 weeks) and when imaging is indicated. In children, radiation is always a consideration when choosing an imaging modality; thus, US is usually the first imaging study at our institution, and CT the second option, usually reserved for the very ill child or for when there is a high index of suspicion for malignancy. We present the normal anatomy of head and neck lymph nodes and the US, CT, and MRI appearances in normal and pathologic states to help clinicians generate a reasonable differential diagnosis and prevent unnecessary procedures.
Subject(s)
Head and Neck Neoplasms/diagnosis , Lymphatic Diseases/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ultrasonography , Child , Head , Head and Neck Neoplasms/complications , Humans , Lymph Nodes/diagnostic imaging , Lymph Nodes/pathology , Lymphatic Diseases/etiology , Lymphatic Metastasis , NeckABSTRACT
A wide variety of bowel diseases, some of which are unique to or more prevalent in pediatric patients, may manifest with intestinal wall thickening at computed tomography (CT). Common causes of bowel wall thickening include edema, hemorrhage, infection, graft-versus-host disease, and inflammatory bowel disease; more unusual causes include immunodeficiencies, lymphoma, hemangioma, pseudotumor, and Langerhans cell histiocytosis. Radiologists must be familiar with the CT signs of bowel disease and should take careful note of the bowel characteristics (eg, extent and distribution of disease involvement, bowel dilatation, mural stratification, perienteric findings) to generate an adequate differential diagnosis. The study should be tailored and optimized in advance according to the clinical scenario to decrease radiation exposure due to repeated or delayed scanning. With spiral CT scanners, studies can be performed quickly, thereby eliminating the need for sedation, and multiple reconstructed images can be generated. CT is an invaluable diagnostic tool in the evaluation of pediatric diseases involving the bowel, in spite of the use of ionizing radiation.
