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Mesenteric Lymphadenitis Workup

  • Author: Jennifer Lynn Bonheur, MD; Chief Editor: Julian Katz, MD  more...
 
Updated: Dec 29, 2015
 

Laboratory Studies

The following laboratory studies may aid in the evaluation of patients with suspected mesenteric lymphadenitis:

  • CBC count: Leucocytosis with WBCs exceeding 10,000/µL occurs in at least 50% of cases.
  • Chemistries: - Findings are generally within reference ranges except in patients with severe nausea and vomiting who may present with metabolic alkalosis and azotemia.
  • Serology can be supportive in diagnosis of etiologic agents such as Y enterocolitica. Serological tests tend to be delayed, and several antigens may have to be tested.
  • Urinalysis may be useful to perform when the diagnosis is unclear and to exclude urinary tract infection.
  • In patients who present with diarrheal symptoms, stool cultures should be performed.
  • Blood culture: This is performed prior to prescribing antibiotics and in patients who have features of septicemia. Isolation of the organism from blood, lymph nodes, or other body fluids will help define appropriate therapy and guide further evaluation.

Other studies

Lymph node specimen: In patients subjected to laparotomy, lymph nodes may show evidence of inflammation or suppuration, and culture may yield a causative organism.

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Imaging Studies

Contrast computed tomography (CT) scanning demonstrates enlarged mesenteric lymph nodes, with or without associated ileal or ileocecal wall thickening, and a normal appearing appendix. In mesenteric adenitis, lymph nodes tend to be larger, greater in number, and more widely distributed than in appendicitis. Rao et al specified the criterion of 3 or more nodes with a short-axis diameter of at least 5 clustered in the right lower quadrant. CT scanning is also important to exclude other differential diagnoses, especially acute appendicitis.

Contrast-enhanced magnetic resonance imaging (MRI) can differentiate between acute appendicitis and other causes of pediatric abdominal pain, with good visualization of the appendix.[5]  More information is needed whether contrast enhancement with MRI has an advantage over non-enhanced MRI in this setting.

Abdominal ultrasonographic scanning with Doppler scanning is a useful adjunct for excluding other differential diagnoses.[1, 6] For instance, ultrasonographic demonstration of mural thickening of the terminal ileum plus mesenteric thickening is indicative of regional enteritis. Focal abdominal tenderness in response to transducer pressure is common. Ultrasonography is often the preferred initial diagnostic procedure, especially in children with uncomplicated abdominal pain.

A study by Ja Lim et al supported the use of ultrasonography in the diagnosis of mesenteric lymphadenitis. The retrospective study involved 100 children with clinically suspected intussusception, with abdominal ultrasonography instead demonstrating the presence of mesenteric lymphadenitis in 13 of these patients. Other conditions identified in the study included ileocolitis, terminal ileitis, choledochal cyst, accessory spleen torsion, small bowel ileus, midgut volvulus with bowel ischemia, and hydronephrosis, as well as intussusception (in 37 patients).[7]

Sheridan et al demonstrated the potential utility of ultrasonography to stratify patients with acute appendix into different treatment strategies.[8] They found that (1) a fluid-filled appendix always correlated with a suppurative or mixed pathologic appearance that likely warranted operative intervention, and (2) a lymphoid-predominant pathologic appearance occurred only in cases where appendiceal wall thickening alone was seen on ultrasonography.[8]

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Contributor Information and Disclosures
Author

Jennifer Lynn Bonheur, MD Attending Physician, Division of Gastroenterology, Lenox Hill Hospital

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy, New York Academy of Sciences, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Oluyinka S Adediji, MD, MBBS Consulting Staff, Department of Adult and General Medicine, Health Services Incorporated, Montgomery, Alabama

Oluyinka S Adediji, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association

Disclosure: Nothing to disclose.

Mukul Arya, MD Associate Professor of Internal Medicine, Weill Cornell Medical College; Assistant Director of Therapeutic Endoscopy, Department of Gastroenterology and Internal Medicine, Wyckoff Heights Medical Center

Mukul Arya, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Douglas M Heuman, MD, FACP, FACG, AGAF Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, American Gastroenterological Association

Disclosure: Received grant/research funds from Novartis for other; Received grant/research funds from Bayer for other; Received grant/research funds from Otsuka for none; Received grant/research funds from Bristol Myers Squibb for other; Received none from Scynexis for none; Received grant/research funds from Salix for other; Received grant/research funds from MannKind for other.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Vivek V Gumaste, MD Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association

Disclosure: Nothing to disclose.

References
  1. Toorenvliet B, Vellekoop A, Bakker R, Wiersma F, Mertens B, Merkus J, et al. Clinical differentiation between acute appendicitis and acute mesenteric lymphadenitis in children. Eur J Pediatr Surg. 2011 Mar. 21(2):120-3. [Medline].

  2. Moore MM, Kulaylat AN, Brian JM, et al. Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol. 2015 Aug. 70 (8):881-9. [Medline].

  3. Zinczuk J, Wojskowicz P, Kisluk J, Fil D, Kemona A, Dadan J. Mesenteric lymphadenitis caused by Yersinia enterocolitica. Prz Gastroenterol. 2015. 10 (2):118-21. [Medline].

  4. Frisch M, Pedersen BV, Andersson RE. Appendicitis, mesenteric lymphadenitis, and subsequent risk of ulcerative colitis: cohort studies in Sweden and Denmark. BMJ. 2009 Mar 9. 338:b716. [Medline]. [Full Text].

  5. Koning JL, Naheedy JH, Kruk PG. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol. 2014 Aug. 44 (8):948-55. [Medline].

  6. Ackerman SJ, Irshad A, Anis M. Ultrasound for pelvic pain II: nongynecologic causes. Obstet Gynecol Clin North Am. 2011 Mar. 38(1):69-83, viii. [Medline].

  7. Ja Lim K, Lee K, Yoon DY, et al. The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases. Acta Radiol. 2014 Feb 13. [Medline].

  8. Sheridan AD, Ehrlich L, Morotti RA, Goodman TR. Sonographic distinction between acute suppurative appendicitis and viral appendiceal lymphoid hyperplasia ("pink appendix") with pathological correlation. Ultrasound Q. 2015 Jun. 31 (2):95-8. [Medline].

 
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