Pediatr Radiol (2006) 36: 1063–1067 DOI 10.1007/s00247-006-0271-6 ORIGINAL ARTICLE Jerome A. Lindeboom . Anne M. J. B. Smets . Ed J. Kuijper . Rick R. van Rijn . Jan M. Prins The sonographic characteristics of nontuberculous mycobacterial cervicofacial lymphadenitis in children Received: 18 April 2006 / Revised: 15 June 2006 / Accepted: 15 June 2006 / Published online: 12 August 2006 # Springer-Verlag 2006 Abstract Background: Nontuberculous mycobacteria (NTM) are a common cause of chronic cervicofacial lymphadenitis in young children. The differential diagnosis includes other infections, lymphoepithelial cysts and malignancies. Objective: To assess the sonographic findings of NTM cervicofacial lymphadenitis in children. Materials and methods: We analysed the sonograms of cervicofacial lymph nodes of 145 children with microbiologically proven NTM lymphadenitis. Results: The size of the involved lymph nodes ranged from 1.9 cm to 4.4 cm. Most of the NTM patients (85%) presented in a stage of lymph node fluctuation with violaceous skin discoloration. On sonogra- phy, marked decreased echogenicity was seen in all cases. In 133 of the patients (92%) liquefaction with intranodal cystic necrosis, nodal matting and adjacent soft-tissue oedema were present. 66 children received antibiotic treat- ment, and the other children underwent surgical excision of the involved lymph nodes. In 69% of the patients successfully treated with antibiotics, multiple intranodal calcifications were present on sonography after 1 year. Conclusions: Sonographic findings can provide addi- tional diagnostic clues for NTM lymphadenitis in child- hood. A marked decrease of echogenicity in the early stages, with intranodal liquefaction in the advanced stages, are universal features, albeit not entirely specific. Multiple intranodal calcifications are rather characteristic of end- stage mycobacterial infection. Keywords Nontuberculous mycobacteria . Chronic cervical lymphadenitis . Ultrasound . Children Introduction Nontuberculous mycobacterial (NTM) lymphadenitis is a common cause of chronic cervicofacial lymphadenitis in immunocompetent children. The disease manifests itself in young children between the ages of 1 and 5 years, usually without generalized symptoms. Unilaterally enlarged sol- itary or clustered nodal masses occur in the submandibular or preauricular areas, and the nodes suppurate and form a chronic sinus tract [1] The differential diagnosis consists of other infections, e.g. Bartonella henselae lymphadenitis, lymphoepithelial cysts and malignancies. Following histo- ry and physical examination, sonographic evaluation of the head and the neck is one of the first investigations performed in such patients. In adult patients sonography may help to differentiate malignant from benign lymphadenopathy [2], and it provides information on the number, size, site, shape, borders, matting, adjacent soft- tissue oedema, and internal architecture of cervicofacial lymph nodes [3]. On grey-scale sonography, normal and reactive nodes tend to be hypoechoic and oval (short-axis J. A. Lindeboom (*) Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands e-mail: j.a.lindeboom@amc.uva.nl Tel.: +31-20-5664098 Fax: +31-20-5669032 J. M. Prins Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands J. M. Prins Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands A. M. J. B. Smets . R. R. van Rijn Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands J. A. Lindeboom Academic Center for Dentistry (ACTA), University of Amsterdam, Amsterdam, The Netherlands E. J. Kuijper Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands