Acute mesenteric lymphadenitis in children: findings related to differential diagnosis and hospitalization

Abstract

Introduction: Diagnostic discrimination between acute appendicitis (AA) and mesenteric lymphadenitis (AML) may require more diagnostic tests or great skill after excluding other diagnoses. This study aimed to make a differential diagnosis between AA and AML patients with previous and new parameters and to examine which parameters should be taken into account regarding whether the AML patient should be hospitalized or discharged. Material and methods: One hundred and twenty-three AML and 134 AA patients, randomly selected, were included in the study. Demographic, clinical, and laboratory data of all subjects were analyzed. Ultrasonographic and rarely computed tomography examinations evaluating for the enlarged lymph nodes with the shortest diameter in the right lower quadrant of the AML patients were performed. Also, the erect abdominal radiographs (EAR) of AML and AA patients were evaluated. Results: While there was no statistically significant difference in age or gender, C-reactive protein, white blood cell count, monocyte percentage as well as symptoms between the AA and AML groups (p > 0.05), neutrophil and lymphocyte percentage, appearance of EAR and L/M ratio were significantly different between the two groups (p < 0.05). There was no correlation between the short-axis diameter of the mesenteric lymph node and clinical and laboratory findings in the AML group (p > 0.05). Conclusions: Based on the results with ROC curve analysis, we propose to take into account the L/M ratio and the EAR from the parameters in the differential diagnosis between AA and AML in addition to previously reported parameters. Also, we recommend that the same features may be used to decide whether AML patients under observation are hospitalized or not.

Diagnostic value of monocyte-lymphocyte ratio and red cell distribution width- lymphocyte ratio against other biomarkers in children with acute appendicitis, cross-sectional study

“…Thus MLR can differentiate AA and nonspecific abdominal pain (NAP) with a cut-off of 0.47 (sensitivity:75.98%, specificity:72.08%; AUC:0.798) in children, 5 and has excellent diagnostic accuracy. 21…”

“…Thus MLR can differentiate AA and nonspecific abdominal pain (NAP) with a cut-off of 0.47 (sensitivity:75.98%, specificity:72.08%; AUC:0.798) in children, 5 and has excellent diagnostic accuracy. 21 RDW measures circulating erythrocyte size variation that is frequently recorded as part of a routine automated complete blood count. 22 RDW has been linked to rise in inflammatory markers such as CRP, interleukin-6, and erythrocyte sedimentation rate.…”

Childhood Mesenteric Adenitis -The Spectrum of Findings

“…[2][3][4] Often considered, the most frequent clinical mask of acute appendicitis, mesenteric adenitis can mimic a variety of conditions including intussusceptions and gastroenteritis. [5][6][7] From earliest considerations that included tuberculosis as an etiological factor to a routinely recommended appendectomy, much seems to have evolved in its management now that a definitive pre-operative diagnosis is possible in most situations. 6,8 Even the nodal size used earlier has been largely seeded by the current size criteria on ultrasound as a reference guide to diagnosis in order to avoid false positivity of findings.…”

Sonografi destekli yorumlama: Semptomatik çocuklarda insidental bulunan mezenterik lenfadenitin anlamı var mı?

“…Çalışma kapsamındaki çocuk hastaların %38'nde akut appendisit tanısı almıştı. Özdamar ve Karavaş [10], akut appendisit ve ML ayırıcı tanısında US kullandıkları çalışmalarında ML'nın uzun ve kısa akslarının oranının ayırıcı tanıda değerli bir bulgu olduğu bildirilmiştir. Bu oranın ML olan olgularda, appendisit tanısı alan olgulara göre anlamlı derecede yüksek olduğunu saptanmışlardır.…”