Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

CT Analysis of Retropharyngeal Abnormality in Kawasaki Disease

  • Roh, Kyung-Min (Department of Radiology, School of Medicine, Ewha Womans University) ;
  • Lee, Sun-Wha (Department of Radiology, School of Medicine, Ewha Womans University) ;
  • Yoo, Jeong-Hyun (Department of Radiology, School of Medicine, Ewha Womans University)
  • Published : 2011.12.01
⟨ Previous Next ⟩

Abstract

Objective: To retrospectively compare the imaging characteristics of retropharyngeal density and associated findings for Kawasaki disease with those for non-Kawasaki disease, and identify the distinguishing features which aid the CT diagnosis of Kawasaki disease with retropharyngeal low density. Materials and Methods: Among the enhanced neck CT performed in children less than 8-years old with clinical presentation of fever and cervical lymphadenopathy over a 6-year period, only cases with retropharyngeal low density (RLD) were included in this study. The 56 cases of RLD were divided into two groups; group A included cases diagnosed as Kawasaki disease (n = 34) and group B included cases diagnosed as non-Kawasaki disease (n = 22). We evaluated the CT features including the thickness of RLD and its extent into the deep neck spaces, as well as soft tissue change in the adjacent structure. We also scored the extent of RLD into the deep neck spaces and the soft tissue changes in the adjacent structure. Results: The thickness of RLD was greater in group A than in group B (group A, 6.0 $\pm$ 2.1; group B, 4.6 $\pm$ 1.5, p = 0.01). The score of the RLD extent into the deep neck spaces was significantly greater in group A than in group B (group A, 2.3 $\pm$ 1.3; group B, 0.8 $\pm$ 1.0, p < 0.01). Also, the score of the adjacent soft tissue changes was greater in group A than in group B (group A, 2.0 $\pm$ 1.1; group B, 1.0 $\pm$ 1.0, p < 0.01). Conclusion: If children present with fever and cervical lymphadenopathy that display retropharyngeal low density with extension into more deep neck spaces as well as changes in more adjacent soft tissue, the possibility of Kawasaki disease should be considered.

Keywords

References

  1. Davis WL, Harnsberger HR, Smoker WR, Watanabe AS. Retropharyngeal space: evaluation of normal anatomy and diseases with CT and MR imaging. Radiology 1990;174:59-64 https://doi.org/10.1148/radiology.174.1.2294573
  2. Elden LM, Grundfast KM, Vezina G. Accuracy and usefulness of radiographic assessment of cervical neck infections in children. J Otolaryngol 2001;30:82-89 https://doi.org/10.2310/7070.2001.20808
  3. Gross M, Eliashar R, Attal P, Sichel JY. Radiology quiz case 2: Kawasaki disease (KD) mimicking a retropharyngeal abscess. Arch Otolaryngol Head Neck Surg 2001;127:1507, 1508-1509
  4. Hester TO, Harris JP, Kenny JF, Albernaz MS. Retropharyngeal cellulitis: a manifestation of Kawasaki disease in children. Otolaryngol Head Neck Surg 1993;109:1030-1033 https://doi.org/10.1177/019459989310900610
  5. Homicz MR, Carvalho D, Kearns DB, Edmonds J. An atypical presentation of Kawasaki disease resembling a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol 2000;54:45-49 https://doi.org/10.1016/S0165-5876(00)00337-2
  6. Park AH, Batchra N, Rowley A, Hotaling A. Patterns of Kawasaki syndrome presentation. Int J Pediatr Otorhinolaryngol 1997;40:41-50 https://doi.org/10.1016/S0165-5876(97)01494-8
  7. Pontell J, Rosenfeld RM, Kohn B. Kawasaki disease mimicking retropharyngeal abscess. Otolaryngol Head Neck Surg 1994;110:428-430 https://doi.org/10.1177/019459989411000413
  8. Rooks VJ, Burton BS, Catalan JN, Syms MJ. Kawasaki disease presenting as a retropharyngeal phlegmon. Pediatr Radiol 1999;29:875-876 https://doi.org/10.1007/s002470050717
  9. Stamos JK, Corydon K, Donaldson J, Shulman ST. Lymphadenitis as the dominant manifestation of Kawasaki disease. Pediatrics 1994;93:525-528
  10. Langley EW, Kirse DK, Barnes CE, Covitz W, Shetty AK. Retropharyngeal edema: an unusual manifestation of Kawasaki disease. J Emerg Med 2010;39:181-185 https://doi.org/10.1016/j.jemermed.2008.08.004
  11. Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004;110:2747-2771 https://doi.org/10.1161/01.CIR.0000145143.19711.78
  12. Harnsberger HR, Salzman KL, Osborn AG, Carrasco CR, Ross JS. Suprahyoid and infrahyoid neck. In: Macdonald AJ, ed. Diagnostic and surgical imaging anatomy. Brain, head & neck, spine, 2nd ed. Salt Lake City: AMIRSYS, 2006:186-193
  13. Mukherji SK, Mancuso AA, Kotzur IM, Mendenhall WM, Kubilis PS, Tart RP, et al. Radiologic appearance of the irradiated larynx. Part I. Expected changes. Radiology 1994;193:141-148 https://doi.org/10.1148/radiology.193.1.8090882
  14. Mihmanli I, Karaarslan E, Kanberoglu K. Inflammation of vertebral bone associated with acute calcific tendinitis of the longus colli muscle. Neuroradiology 2001;43:1098-1101 https://doi.org/10.1007/s002340100644
  15. Kawasaki T, Kosaki F, Okawa S, Shigematsu I, Yanagawa H. A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan. Pediatrics 1974;54:271-276
  16. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ, et al. A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324:1633-1639 https://doi.org/10.1056/NEJM199106063242305
  17. Zhang T, Yanagawa H, Oki I, Nakamura Y, Yashiro M, Ojima T, et al. Factors related to cardiac sequelae of Kawasaki disease. Eur J Pediatr 1999;158:694-697 https://doi.org/10.1007/s004310051181
  18. Terai M, Honda T, Yasukawa K, Higashi K, Hamada H, Kohno Y. Prognostic impact of vascular leakage in acute Kawasaki disease. Circulation 2003;108:325-330 https://doi.org/10.1161/01.CIR.0000079166.93475.5F
  19. Vural C, Gungor A, Comerci S. Accuracy of computerized tomography in deep neck infections in the pediatric population. Am J Otolaryngol 2003;24:143-148 https://doi.org/10.1016/S0196-0709(03)00008-5

Cited by

  1. Hoarseness as a Presenting Sign in Children With Kawasaki Disease vol.32, pp.12, 2013, https://doi.org/10.1097/inf.0b013e3182a0960b
  2. Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child vol.47, pp.2, 2011, https://doi.org/10.1016/j.jmii.2012.01.017
  3. Hounsfield unit values of retropharyngeal abscess-like lesions seen in Kawasaki disease vol.134, pp.4, 2011, https://doi.org/10.3109/00016489.2013.878475
  4. Comparison of patients with Kawasaki disease with retropharyngeal edema and patients with retropharyngeal abscess vol.173, pp.3, 2014, https://doi.org/10.1007/s00431-013-2179-0
  5. Comparison between Kawasaki disease with lymph-node-first presentation and Kawasaki disease without cervical lymphadenopathy vol.59, pp.2, 2011, https://doi.org/10.3345/kjp.2016.59.2.54
  6. Cervical ultrasound and computed tomography of Kawasaki disease: Comparison with lymphadenitis vol.58, pp.11, 2011, https://doi.org/10.1111/ped.13017
  7. 경부 림프절염로 발현된 가와사키병과 급성 편측 경부 림프절염의 비교 vol.23, pp.3, 2011, https://doi.org/10.14776/piv.2016.23.3.217
  8. Adult Recurrence of Kawasaki Disease Mimicking Retropharyngeal Abscess vol.56, pp.16, 2011, https://doi.org/10.2169/internalmedicine.8399-16
  9. The Neglected Diagnosis in Retropharyngeal Abnormalities: Kawasaki Disease vol.28, pp.2, 2011, https://doi.org/10.35420/jcohns.2017.28.2.211
  10. Imaging and Clinical Data Distinguish Lymphadenopathy-First-Presenting Kawasaki Disease from Bacterial Cervical Lymphadenitis vol.26, pp.4, 2011, https://doi.org/10.4250/jcvi.2018.26.e29
  11. Differentiation of Kawasaki Disease From Other Causes of Fever and Cervical Lymphadenopathy: A Diagnostic Scoring System Using Contrast-Enhanced CT vol.212, pp.3, 2011, https://doi.org/10.2214/ajr.18.20262
  12. A Case of Incomplete and Atypical Kawasaki Disease Presenting with Retropharyngeal Involvement vol.16, pp.18, 2011, https://doi.org/10.3390/ijerph16183262
  13. Deep Neck Inflammation: Probable Kawasaki Disease in Korean Children vol.13, pp.1, 2011, https://doi.org/10.21053/ceo.2019.00948
  14. Adult onset Kawasaki disease presenting with acute epiglottitis findings vol.86, pp.suppl1, 2011, https://doi.org/10.1016/j.bjorl.2017.09.001
  15. Evaluating Lymph Node Stiffness to Differentiate Bacterial Cervical Lymphadenitis and Lymph Node-First Presentation of Kawasaki Disease by Shear Wave Elastography vol.40, pp.7, 2011, https://doi.org/10.1002/jum.15518