J Korean Soc Radiol.  2014 Jul;71(1):6-13. 10.3348/jksr.2014.71.1.6.

Comparative Analysis of Tuberculous Lymphadenitis and Kikuchi Disease of the Neck

• Yoon YS
• Han JK
• Shin HC
• Kim YT
• Bae SB
• Jou SS

• KMID: 1709014
• DOI: http://doi.org/10.3348/jksr.2014.71.1.6

Abstract

PURPOSE
To compare the clinical and CT manifestations of Kikuchi disease (KD) and tuberculous lymphadenitis (TL).
MATERIALS AND METHODS
111 patients with TL (55 men, 56 women, mean age 38.6 years, range 13-80 years) and 73 patients with KD (24 men, 49 women, mean age 26.8 years, range 8-61 years) were included in the study. Two observers independently compared sex, age, peripheral white blood cells, erythrocyte sedimentation rate (ESR), nodal distribution, nodal bilaterality, perinodal fat infiltration, muscle abscess, nodal conglomeration, necrotic and non-necrotic lymph nodes in the patients with TL and KD.
RESULTS
KD patients showed a female predominance (67.1%). Patients with TL were older. Leukocytopenia and increased ESR were more frequent in patients with KD. KD more commonly affected lymph nodes in level II, III, and V, while TL more commonly involved lymph nodes in the upper paratracheal area. Perinodal fat infiltration was more frequent in KD. Muscle abscess was seen in patients with TL only (14%). Necrotic lymph nodes were more frequent in TL. A thin type was more frequent in TL.
CONCLUSION
KD showed female predominance, leukocytopenia, increased ESR, involvement of levels II, III, and V and frequent perinodal fat infiltration. TL patients were older than KD patients, were commonly affected in the upper paratracheal area, abscesses were shown only in this group and thin type necrotic lymph nodes were more frequent.

MeSH Terms

Abscess
Blood Sedimentation
Female
Histiocytic Necrotizing Lymphadenitis*
Humans
Leukocytes
Leukopenia
Lymph Nodes
Male
Neck*
Tuberculosis, Lymph Node*

Figure

• 

  Fig. 1 Tuberculous lymphadenitis in a 15-year-old girl who presented with palpable right neck mass a few days ago. A-C. Axial CT images show multiple necrotic lymph nodes, bilaterally, in level II, III, IV, and V. The thin type necrotic lymph nodes at level II of left neck (white arrow) shows peripheral enhancing portion less than 2 mm thick and below 25% of the total area of lymph node. D. The necrotic lymph node is at the right paratracheal area (black arrow). Excisional biopsy was performed at level II of the right neck and the histopathologic diagnosis was consistent with tuberculosis.

• 

  Fig. 2 Tuberculous lymphadenitis in a 34-year-old man who presented with painful swelling on the right neck one week ago. Axial image shows a large abscess splitting the right platysma muscle (white arrow), suggesting a muscle abscess. Adjacent subcutaneous fat infiltration (arrowheads) was also noted. Tuberculosis was confirmed by ultrasound guided fine needle aspiration of the abscess.

• 

  Fig. 3 Kikuchi disease in a 23-year-old man who presented with palpable mass in the right neck 3 days ago. Axial images show multiple necrotic and non-necrotic lymph nodes at level II, III, IV, and V bilaterally. A. There are conglomerated homogenous enhancing lymph nodes (white arrow) with perinodal fat infiltration (arrowhead) at level II of left neck. B. The thick type necrotic lymph node at level III of the left neck (black arrow) has peripheral enhancing portion more than 2 mm thick and above 25% of total lymph node area. C, D. There are another non-necrotic lymph nodes at level III, IV, and V which show left side predominancy. Ultrasound-guided fine needle aspiration biopsy was performed on the level II lymph node of the left neck. Histopathologic diagnosis was Kikuchi's lymphadenopathy.

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