Ultrasonic diagnosis of acute mesenteric lymphadenitis in children and etiological analysis of intestinal pathogen infection
Objective To evaluate the sensitivity and specificity of ultrasound diagnosis for acute mesenteric lymphadenitis(AMLA)in children and analyze its association with intestinal pathogen infections.Methods This retrospective study included 108 children diagnosed with AMLA in our hospital between July 2022 and July 2024.All patients underwent ultrasound examination,with the number,size,and related imaging features of mesenteric lymph nodes(e.g.,bowel wall thickening and ascites)recorded.Stool samples were tested using PCR and bacterial cultures to identify the types of intestinal pathogens.Multivariate logistic regression analysis was employed to assess the correlation between ultrasound imaging features and pathogen types,adjusting for confounders such as age,sex,and duration of illness.Results Among the 108 patients,82(75.93％)showed an increased number of mesenteric lymph nodes,with an average lymph node diameter of 1.2 0.3 cm.Bowel wall thickening and ascites were detected in 34 patients(31.48％)and 20 patients(18.51％),respectively.The sensitivity of ultrasound diagnosis was 92.59％(100/108),and the specificity was 85.71％(24/28),indicating high diagnostic accuracy for AMLA.Pathogen detection revealed that 63 cases(58.33％)were viral infections,primarily norovirus(32 cases,29.63％)and rotavirus(18 cases,16.66％);32 cases(29.63％)were bacterial infections,mainly Salmonella(14 cases,12.96％)and Shigella(9 cases,8.33％);the remaining 13 cases(12.04％)were mixed infections.Univariate analysis showed that an increased number of lymph nodes was more common in viral infections,with an incidence of 84.13％and an average lymph node diameter of 1.3±0.4 cm,while 62.48％of bacterial infection cases exhibited bowel wall thickening and 62.52％had ascites.Multivariate logistic regression analysis revealed a significant association between viral infections and enlarged lymph nodes(OR=3.612,95％CI:1.136-11.486,P=0.030),while bacterial infections were significantly associated with bowel wall thickening(OR=6.095,95％CI:1.890-19.656,P=0.002)and ascites(OR=11.398,95％CI:3.377-38.475,P＜0.001).Additionally,age under five years was associated with viral infections(OR=2.774,95％CI:1.047-7.347,P=0.040),and illness duration of more than 7 days was associated with bacterial infections(OR=7.250,95％CI:2.282-23.029,P=0.001).Conclusion Ultrasound has high sensitivity and specificity in diagnosing AMLA in children.Multivariate analysis demonstrated a significant association between viral infections and enlarged lymph nodes,while bacterial infections were frequently accompanied by bowel wall thickening and ascites.Combining ultrasound with pathogen detection can improve diagnostic accuracy and optimize clinical management for acute abdominal pain in children.
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