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Suppurative Adenitis
KEY FACTS
Terminology
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Pus formation within nodes from bacterial infection
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Synonyms: Adenitis, lymphadenitis, intranodal abscess
Imaging
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Enlarged node(s) with internal fluid & surrounding inflammation (cellulitis)
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Most often jugulodigastric, submandibular, or retropharyngeal
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Loss of normal nodal architecture & internal vascularity/enhancement
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Conglomeration of necrotic nodes progressing to abscess shows marked heterogeneity of irregular collection
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Well-defined enhancing/hyperemic wall
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Complex hypoechoic/nonenhancing center
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US useful to confirm true liquefaction with drainable pus
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Swirling internal debris upon compression
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CECT best defines deep extent & complications
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Lemierre syndrome (venous thrombophlebitis), internal carotid artery spasm or pseudoaneurysm, airway compression, mediastinal extension
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Top Differential Diagnoses
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Nontuberculous Mycobacterium adenopathy, tuberculous adenopathy, 2nd branchial cleft anomaly, rhabdomyosarcoma, lymphoma, lymphatic malformation
Pathology
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Staphylococcus & Streptococcus most frequent organisms
Clinical Issues
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Painful neck mass, fever, poor oral intake; symptoms referable to primary infection
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Treatment: Antibiotics
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Incision & drainage for large suppurative nodes, abscesses, or poor response to antibiotics
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Transverse (left) & longitudinal (right) color Doppler & grayscale US images of an infant with suppurative adenopathy show an enlarged, heterogeneous conglomeration of cervical nodes
with internal debris
, posterior acoustic enhancement
, & peripheral hyperemia
.
with internal debris , posterior acoustic enhancement , & peripheral hyperemia .
Transverse color Doppler US in a 6 year old with fever & a tender neck mass shows an irregular hypoechoic abscess
with posterior acoustic enhancement
, internal echoes, & no internal vascularity.
with posterior acoustic enhancement , internal echoes, & no internal vascularity.
Coronal CECT in a 6 year old with fever & a fluctuant neck mass shows an irregular, rim-enhancing abscess
with overlying myositis/cellulitis
& an adjacent nonsuppurative lymph node
.
with overlying myositis/cellulitis & an adjacent nonsuppurative lymph node .
More inferior image from an axial CECT in the same child shows a round focus of nonenhancement representing segmental clot
in the right internal jugular vein, consistent with Lemierre syndrome. Note the right-greater-than-left nonsuppurative nodes
as well as the overlying myositis/cellulitis
.
in the right internal jugular vein, consistent with Lemierre syndrome. Note the right-greater-than-left nonsuppurative nodes as well as the overlying myositis/cellulitis .
TERMINOLOGY
Definitions
-
Pus formation within nodes from bacterial infection
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