John Paul Hauschildt MD, Presenter: Nothing to Disclose

Peter G. Kruk MD, Abstract Co-Author: Nothing to Disclose

Dawn Renae Engelkemier MD, Abstract Co-Author: Nothing to Disclose

Jane C Burns MD, Abstract Co-Author: Nothing to Disclose

Adriana H Tremoulet MD, Abstract Co-Author: Nothing to Disclose

John T Kanegaye MD, Abstract Co-Author: Nothing to Disclose

To evaluate which findings on CT scans of the neck were most indicative of Kawasaki Disease, in order to expedite appropriate treatment in those patients who might otherwise be initially diagnosed with bacterial adenitis.

Two pediatric radiologists blinded to the original readings and patient diagnoses reviewed the CT scans from 50 patients admitted for the treatment of suspected bacterial cervical adenitis between June 1996 and March 2010.  Scans were evaluated for the location and morphology of the dominant nodal abnormality, presence or abscence of phlegmon or abscess, and presence of adjacent or remote inflammation.

11 patients were eventually diagnosed with Kawasaki Disease after other diagnostic criteria appeared.  In these patients, only one had early phlegmon formation, and none presented with findings of abscess formation, while 28 of the 39 patients with bacterial adenitis presented with phlegmon or abscess.  The location and morphology of the adenopathy were not reliable in discriminating KD from bacterial disease.  Both diseases demonstrated adjacent inflammation, while retropharyngeal edema was present in 9/11 KD patients and 19/39 bacterial adenitis patients.

When interpreting CT scans of the neck in children for suspected bacterial adenitis, node-first presentation of Kawasaki Disease should be considered in the differential diagnosis in patients without phlegmon or abscess.  Early consideration of KD will lead to earlier treatment and avoidance of cormplications.

Delayed diagnosis and treatment of KD leads to a higher incidence of long-term complications including coronary aneurysms.  These patients may present with findings similar to bacterial adenitis.

Hauschildt, J, Kruk, P, Engelkemier, D, Burns, J, Tremoulet, A, Kanegaye, J, Differentiating Node-First Presentation of Kawasaki Disease from Bacterial Cervical Adenitis Using Computed Tomography of the Neck.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013828.html