CT Analysis of Retropharyngeal Abnormality in Kawasaki Disease

Abstract

ObjectiveTo 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 MethodsAmong 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.ResultsThe thickness of RLD was greater in group A than in group B (group A, 6.0 ± 2.1; group B, 4.6 ± 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 ± 1.3; group B, 0.8 ± 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 ± 1.1; group B, 1.0 ± 1.0, p < 0.01).ConclusionIf 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.

Lymph-Node-First Presentation of Kawasaki Disease Compared with Bacterial Cervical Adenitis and Typical Kawasaki Disease

“…Previous reports have compared NFKD with typical KD. 9, 10 Others have described radiologic features 11 and laboratory values 12 that could distinguish NFKD from BCL. Our KD Research Center’s extensive database afforded the unique opportunity to describe and compare NFKD, typical KD, and BCL from a single center.…”

Unusual manifestations of Kawasaki disease with retropharyngeal edema and shock syndrome in a Taiwanese child

“…Group A had greater thickness of RLD, greater scores of the RLD extent into the deep neck spaces, greater scores of the adjacent soft tissue changes than Group B. 19 Therefore, KD patients with retropharyngeal space changes have stronger inflammatory reactions than non-KD patients.…”

“…11 However, inflammation and edema were considered the main mechanism. 19 Increased microvascular permeability is an initial step of KD, and vascular endothelial growth factor might play a role in the vascular leakage. Increases in vascular leakage cause hypoalbuminemia and noncardiogenic edema.…”

Distinct Distribution of Immunocytes in a Retropharyngeal Lymphadenopathy Associated with Kawasaki Disease: A Case Study Compared with Tonsillitis

“…No KD case was pathologically analyzed according to the database of our university hospital from 2000 to 2016. Previous reports on KD-associated pseudoabscesses suggested that such lesions could originate from systemic vasculitis of microvessels with the tissue edema and inflammation [3,4,10]. The aberrant activation of neutrophils, monocytes/macrophages, CD8 + cells, and IgA-producing plasma cells has been reported to involve the systemic vasculitis in KD patients [1].…”

“…The early-appearing manifestation often challenges us to differentiate KD and deep neck infections because the critical lesions may need urgent interventions. KD is suspected when a retropharyngeal abscess is assessed by computed tomography (CT) [3,4,5]. On the other hand, no aspirate samples have been reported that verify abscess formation or fluid collection at the site, even though contrast imaging has indicated ring-enhancing lesions [3].…”