Sonographic Features of Bacille Calmette–Guérin (BCG) Lymphadenitis

Full Article

JPK Tsang, OC Li, MK Yuen

Hong Kong J Radiol 2012;15:233-6

Objective: To review the sonographic features of Bacille Calmette–Guérin (BCG) lymphadenitis.

Methods:Records of children less than 18 years old who presented with axillary swelling for sonography from November 2007 to May 2012, in whom with diagnosis of BCG lymphadenitis based on clinical findings (isolated ipsilateral enlarged axillary lymph nodes after BCG vaccination) were retrieved. They were identified from the Cluster Radiology Information System, and had to have no other identifiable cause of lymphadenitis. Those with a lesion situated at the cutaneous layer that was not suggestive of a lymph node were excluded. Age at presentation, site of BCG injection, sonographic features, subsequent management, and clinical outcomes were reviewed.

Results:Twelve patients (9 males, 3 females) were included. The age at presentation ranged from 2 to 20 months. All patients received BCG injection over the left deltoid. The maximum diameters of the axillary lymph nodes ranged from 0.9 cm to 2.5 cm. There were nine cases (75%) with lymph nodes showing multiple internal echogenic specks. Internal anechoic areas and posterior enhancement were observed in three cases (25%). Increase in Doppler flow was noted in five cases (42%). Eight patients were treated conservatively while four had incisions or aspirations performed. All patients ran a benign course with a reduction in size or resolution of the axillary swelling during subsequent clinical follow-up.

Conclusion: Sonographic features of BCG lymphadenitis are variable. Axillary lymph nodes with multiple internal echogenic specks were found in a relatively high proportion of our patients (75%) with this clinical diagnosis, and could be regarded as a sonographic feature of this condition.

 

中文摘要

卡介苗(BCG)淋巴結炎的超聲影像

曾佩琪、李安慈、袁銘強

目的:回顧卡介苗(BCG)淋巴結炎的超聲影像特徵。

方法:收集2007年11月至2012年5月期間,18歲以下因腋窩淋巴結腫大而超聲檢查的病人紀錄。根據 單側(與BCG疫苗注射部位身體同側)腋窩淋巴結腫大的臨床症狀,他們均被診斷為患有BCG淋巴 結炎。病人資料的來源為醫院聯網的放射學資訊系統。研究病人並無淋巴結炎的其他明確病因。但 如果病灶位於皮膚表層而不牽涉淋巴結,這些病例不會被列入研究範圍。本研究會回顧病人病發時的年齡、注射BCG的位置、超聲影像特徵、治療方法及臨床預後。

結果:研究共12名病人(9男3女)的紀錄。病發年齡介乎2至20個月。所有病人均在左三角肌接受 BCG注射,腋下淋巴結的最大直徑介乎0.9 cm至2.5 cm。其中9例(75%)在淋巴結處出現多發內部强 回聲光點。3例(25%)出現內部無回聲區伴後方增強。5例(42%)可見多普勒血流信號增加。8名 病人接受保守療法,另4人進行切除或穿刺。所有病人的病程在其後臨床隨訪中呈良性轉歸、腋窩腫 脹减輕或消退。

結論:BCG淋巴結炎可呈現不同的超聲影像。本研究大部份臨床診斷為該病的病人(75%)在腋下 淋巴結處都出現多發强回聲光點,所以可以作為此症超聲影像的一項特徵。