Cervical ultrasound and computed tomography of Kawasaki disease: Comparison with lymphadenitis

Taiki Nozaki, Yuka Morita, Daisuke Hasegawa, Akari Makidono, Yuri Yoshimoto, Jay Starkey, Isao Kusakawa, Atsushi Manabe, Yukihisa Saida

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)


Background: Differentiating Kawasaki disease (KD) from cervical lymphadenitis (CL) is clinically difficult but essential given that treatment and outcome differ significantly. Research on differentiation between KD and CL using ultrasound (US) and computed tomography (CT) is limited. The purpose of this study was to identify cervical US and CT findings that may differentiate KD from CL. Methods: We retrospectively reviewed cervical US of 25 KD patients and 25 CL patients, and CT of 14 KD patients, and 14 CL patients. Two radiologists analyzed specific imaging features on US (lymph node size, shape, echogenicity, margins, laterality, necrosis, and presence of normal hilum) and on CT (size and location of enlarged nodes, laterality, perinodal infiltration, and retropharyngeal edema). Results: On US, patients with KD more frequently had lymph nodes with a “cluster of grapes” appearance (KD vs CL: 64% vs 32%, P < 0.05) and less frequently had poorly circumscribed margins (0% vs 36%, P < 0.01), necrosis (0% vs 32%, P < 0.01), or non-visualization of the hilum (4% vs 36%, P < 0.01). On CT, KD patients more frequently had retropharyngeal edema (100% vs 29%, P < 0.001) and less frequently had level 4 lymphadenopathy (14% vs 79%, P < 0.01) than CL patients. Conclusions: Ultrasound is mainly useful for excluding purulent lymphadenopathy while CT is a useful diagnostic tool for differentiating KD from CL, especially in patients with incomplete KD, who present with prominent cervical lymphadenopathy and other equivocal principal findings.

Original languageEnglish
Pages (from-to)1146-1152
Number of pages7
JournalPediatrics International
Issue number11
Publication statusPublished - 2016 Nov 1
Externally publishedYes


  • cervical lymphadenitis
  • computed tomography
  • Kawasaki disease
  • ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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