1. Imaging characteristics of hemophagocytic lymphohistiocytosis
- Author
-
Nancy E. Fitzgerald and Kenneth L. MacClain
- Subjects
Child abuse ,Diagnostic Imaging ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Histiocytosis, Non-Langerhans-Cell ,Skeletal survey ,Gallbladder wall thickening ,Hepatosplenomegaly ,Periosteal reaction ,Hemophagocytic lymphohistiocytosis ,Sensitivity and Specificity ,Severity of Illness Index ,Periportal echogenicity ,Periventricular white matter ,Ultrasound ,Abdomen ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Child ,Neuroradiology ,Retrospective Studies ,medicine.diagnostic_test ,Kawasaki disease ,business.industry ,Infant, Newborn ,Bone-marrow transplant ,Infant ,Ultrasonography, Doppler ,medicine.disease ,Magnetic Resonance Imaging ,Survival Analysis ,Epstein-Barr virus (EBV) ,medicine.anatomical_structure ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Disease Progression ,Original Article ,Female ,Radiography, Thoracic ,medicine.symptom ,Chest radiograph ,business ,Tomography, X-Ray Computed - Abstract
Background Hemophagocytic lymphohistiocytosis (HLH) is a nonmalignant disorder of immune regulation, with overproduction of cytokines and diminished immune surveillance. Symptoms are nonspecific and may affect multiple organs, including the central nervous system. Neuroimaging findings have been described in case reports and small series; body imaging findings have not been described extensively. Objective To summarize findings of the most frequently performed imaging studies of the brain, chest and abdomen in patients with HLH. Materials and methods Retrospective review of chest radiographs and CT, abdominal ultrasound and CT, brain CT and MRI, skeletal surveys, and autopsy data. Results Twenty-five patients were diagnosed and treated for HLH at our institution over an 11-year period; 15 patients (60%) died. Common chest radiograph findings included alveolar-interstitial opacities with pleural effusions, often with rapid evolution and resolution. Hepatosplenomegaly, gallbladder wall thickening, hyperechoic kidneys and ascites were common abdominal findings, which resolved after therapy in some cases. Brain-imaging studies revealed nonspecific periventricular white-matter abnormalities, brain-volume loss and enlargement of extra-axial fluid spaces. Three infant cases, one with intracranial hemorrhage, one with multiple pathologic rib fractures and one with diaphyseal periosteal reaction involving multiple long bones on skeletal survey, raised suspicion of child abuse at presentation. Abuse was not substantiated in any case. Conclusions Clinicians and radiologists should be aware of the radiographic manifestations of HLH, which are nonspecific and overlap with infectious, inflammatory and neoplastic disorders. Findings in the chest (similar to acute respiratory distress syndrome) and abdomen may progress rapidly and then regress with institution of appropriate anti-HLH therapy. CNS findings may be progressive. In some infants, initial imaging findings may mimic nonaccidental trauma.
- Published
- 2002