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2015 | 15 | 61 | 137–150
Article title

Limfadenopatia węzłów chłonnych wątrobowych u dzieci z przewlekłym wirusowym zapaleniem wątroby

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EN
Perihepatic lymphadenopathy in children with chronic viral hepatitis
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Abstracts
EN
Objective. To assess whether lymph node enlargement in the hepatoduodenal ligament occurs in children with chronic viral hepatitis B and C in comparison to healthy controls. Subject and methods. In 49 patients with chronic viral hepatitis (38 with chronic hepatitis B, 11 with chronic hepatitis C, 31 male, 18 female; age range 1 to 17 years), and in 51 healthy controls (25 male, 26 female; age range 4 to 16 years), the total perihepatic lymph node volume was assessed using transabdominal ultrasonography as previously described in adult patients. Results. Adequate visualization of the liver hilum was achieved in 46/49 (94%) pediatric patients with chronic viral hepatitis and in 46/51 (90%) pediatric healthy controls. In patients with adequate liver hilum visualization, enlarged perihepatic lymph nodes (longitudinal diameter >14 mm) were detected in 32/46 (70%) patients with chronic viral hepatitis and in 5/46 (11%) healthy controls. The total perihepatic lymph nodes volume [mean ± SD] was 1.0 ± 1.2 mL (0.1–5.4 mL) in patients with chronic viral hepatitis and 0.1 ± 0.1 mL (0.0–0.4 mL) in healthy controls (p < 0.05). A maximal lymph node diameter >14 mm identified patients with chronic viral hepatitis with 70% sensitivity and 89% specificity. Conclusion. Transabdominal ultrasound can detect lymph nodes within the hepatoduodenal ligament not only in adults but also in children. Paediatric patients with chronic viral hepatitis have significantly enlarged perihepatic lymph nodes compared to controls. Therefore, sonographic assessment of perihepatic lymphadenopathy might be a non-invasive diagnostic tool to screen paediatric patients for chronic viral hepatitis.
PL
Cel: Celem pracy była ocena występowania powiększonych węzłów chłonnych więzadła wątrobowo-dwunastniczego u dzieci z przewlekłym wirusowym zapaleniem wątroby typu B i C w porównaniu ze zdrową grupą kontrolną. Pacjenci i metoda: Objętość całkowitą węzłów chłonnych wątrobowych zbadano u 49 pacjentów z przewlekłym wirusowym zapaleniem wątroby (38 z przewlekłym wirusowym zapaleniem wątroby typu B, 11 z przewlekłym wirusowym zapaleniem wątroby typu C; 31 chłopców, 18 dziewcząt; wiek pacjentów od 1 do 17 lat) oraz u zdrowych dzieci stanowiących grupę kontrolną (25 chłopców, 26 dziewcząt; wiek od 4 do 16 lat) za pomocą ultrasonografii jamy brzusznej, zgodnie z poprzednim opisem dotyczącym dorosłych pacjentów. Wyniki: Poprawną wizualizację wnęki wątroby uzyskano u 46/49 (94%) dzieci z przewlekłym wirusowym zapaleniem wątroby oraz u 46/51 (90%) zdrowych dzieci z grupy kontrolnej. Wśród tych pacjentów powiększone węzły chłonne wątrobowe (o wymiarze podłużnym >14 mm) wykryto u 32/46 (70%) pacjentów z przewlekłym zapaleniem wątroby oraz 5/46 (11%) zdrowych dzieci z grupy kontrolnej. Objętość całkowita węzłów chłonnych wątrobowych (średnia ± SD) u pacjentów z przewlekłym wirusowym zapaleniem wątroby wynosiła 1,0 ± 1,2 ml (0,1–5,4 ml), natomiast w grupie kontrolnej 0,1 ± 0,1 ml (0,0–0,4 ml) (p < 0,05). Na podstawie maksymalnej średnicy węzłów chłonnych wynoszącej >14 mm zidentyfikowano pacjentów z przewlekłym wirusowym zapaleniem wątroby z czułością 70% i swoistością 89%. Wnioski: Badanie ultrasonograficzne jamy brzusznej pozwala na wykrycie węzłów chłonnych w obrębie więzadła wątrobowo-dwunastniczego nie tylko u osób dorosłych, ale również u dzieci. U dzieci z przewlekłym wirusowym zapaleniem wątroby występują znacznie powiększone węzły chłonne wątrobowe w porównaniu z grupą kontrolną. W związku z tym ocena ultrasonograficzna powiększenia węzłów chłonnych wątroby może stanowić nieinwazyjne narzędzie diagnostyczne do badań przesiewowych dzieci w kierunku przewlekłego wirusowego zapalenia wątroby.
Discipline
Publisher

Year
Volume
15
Issue
61
Pages
137–150
Physical description
Contributors
  • Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany. Medizinische Klinik II, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
author
  • Zentrum der Kinderheilkunde Abteilung für Kindergastroenterologie und Mukoviszidose, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany
author
  • Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
  • Translational Gastroenterology Unit, Oxford University Hospitals, Headley Way, Oxford, UK
  • Innere Medizin 2, Caritas Krankenhaus, Uhlandstr. 7, D-97980 Bad Mergentheim, Germany, tel.: 49 7931 58 2201, fax: 49 7931 58 2290, Bad Mergentheim, Germany. Medizinische Klinik II, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany, christoph.dietrich@ckbm.de
  • Innere Medizin 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany. Département d’imagerie médicale, Clinique des Cévennes, Annonay, France
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