B-mode sonographic criteria for differential diagnosis of cervicofacial lymphadenopathy in cat-scratch disease and toxoplasmosis

Cat-scratch disease: Otolaryngologic manifestations and management

OBJECTIVE:

The bacteria Bartonella henselae has been known as the principal causative agent of cat-scratch disease (CSD) since 1992. It is an important cause of infectious lymphadenopathies in the head and neck. Nevertheless, CSD often remains unrecognized in cases of cervicofacial lymph node enlargement.

STUDY DESIGN:

Between January 1997 and May 2003, we conducted a prospective clinical study including 721 patients with primarily unclear masses in the head and neck.

RESULTS:

CSD was diagnosed by serology and molecular investigations in 99 patients (13.7%; median age 33 years). Cervicofacial lymphadenopathy was the most common manifestation. Atypical manifestation of CSD including Parinaud's oculoglandular syndrome, swelling of the parotid gland and erythema nodosum were diagnosed in 8.1%, 8.1%, and 2.0% of cases, respectively.

CONCLUSIONS:

Our results demonstrate that CSD is a major cause of enlarged cervicofacial lymph nodes and should therefore be included in the differential diagnosis of lymphadenopathy in the head and neck region.

[Sonographic differential diagnosis of cervical masses]

One of the main indications for the use of ultrasound by the head and neck specialist is the diagnosis of cervical masses. The examination can be easily performed since all structures of interest are located superficially and are not covered by boney or air-filled structures. Further advantages of ultrasound in contrast to other imaging techniques such as MRI or CT include its high resolution and lack of side effects. Even structures of <5 mm in diameter can be interpreted well. Since ultrasound is fast, has no side effects and can be performed as often as necessary, it represents an excellent diagnostic instrument in the follow-up of patients with head and neck cancer. In addition to the conventional B-scan technique, colour duplex sonography is also often performed today to obtain additional information on the nature of cervical masses. Thus, different entities of cervical lymph nodes can be well differentiated by their pattern of vascularization.