Diagnostic ultrasound ( PDFDrive )

CHAPTER 48 The Pediatric Head and Neck 1663
A
B
FIG. 48.58 Complicated Lymphadenitis With Abscess. (A) Gray-scale ultrasound image shows multilobulated, hypoechoic area with thick
wall in the left upper cervical region. (B) Color Doppler image shows lack of vessels in the center of the collection but with peripheral
vascularity.
A
B
FIG. 48.59 Fibromatosis Coli. (A) Longitudinal ultrasound shows sternocleidomastoid muscle with enlargement, attenuation of striations, and
mild increase in echotexture. (B) Longitudinal view shows comparison of abnormal left and normal right sternocleidomastoid muscle.
in immunocompromised children. 190 Cat-scratch disease, caused
by the organism Bartonella henselae, manifests typically with a
dominant unilateral node 2 to 4 weeks ater a minor cat scratch,
usually from a kitten. 187 Histoplasmosis, an infection prevalent
in the Mississippi Valley and northeastern United States, manifests
with cervical adenitis and a mediastinal mass and is typically
asymptomatic but may be fatal if acutely disseminated. 190 FNA
for cytopathology and culture may help conirm the diagnosis;
these nodes oten can persist for months, making distinction
from neoplasm diicult. 45,190 Other inlammatory causes of
lymphadenopathy in children include collagen vascular disease,
sarcoid, immunologic deiciencies (HIV and chronic granulomatous
disease), and postvaccination syndrome. 192 Kawasaki
disease, a multisystem vasculitis of unknown origin, causes
cervical adenopathy in 50% to 70% of patients with the disease. 193
Children with Kawasaki disease typically are presented before
5 years of age with enlarged unilateral lymph nodes greater than
1.5 cm in diameter. 193
Fibromatosis Colli
Fibromatosis colli occurs in 0.3% to 1.9% of children. he etiology
is still unclear but may involve intramuscular hemorrhage,
venous occlusion, birth trauma, or in utero torticollis. 82,144,187,194
Pathologically, ibromatosis colli results from ibrosis and
shortening of the sternocleidomastoid muscle, producing a sot
tissue mass. 195 Peak incidence of presentation is 2 to 8 weeks
ater birth. Fibromatosis colli typically afects the irstborn boy
with breech presentation or diicult delivery. Most infants have
ipsilateral head tilt, contralateral chin deviation, and a palpable
sot tissue mass. 196,197 From 6% to 20% of patients have associated
musculoskeletal anomalies, including hip dysplasia and
facial asymmetry. 49
Sonography is the best technique to image the ibromatosis
colli lesion. A normal sternocleidomastoid muscle demonstrates
decreased echogenicity and long, thin, echogenic lines denoting
the muscle fascicles along the length of the muscle. In the presence
of ibromatosis colli, there is a focal or difuse enlargement of
the sternocleidomastoid, which typically shows homogeneous
or heterogeneous increased echogenicity; however, mixed and
hypoechoic lesions have been described 194,195 (Fig. 48.59). Focal
lesions tend to involve the inferior third of the muscle. 194 In
larger masses, there is distorted architecture with disruption of
the normal muscle bundles. 195 Some cases may resolve spontaneously;
however, physical therapy is the irst line of therapy and