Ultrasound findings and their utility in paediatric mesenteric adenitis: A scoping review

Abstract

Background:

Mesenteric adenitis is a commonly made diagnosis for children presenting to the Paediatric Emergency Department with acute abdominal pain. Ultrasound is recommended as the first-line imaging modality for children with right-sided abdominal pain owing to its safety and diagnostic value. Unlike appendicitis, however, diagnostic criteria for mesenteric adenitis are not clearly defined.

Objectives:

To synthesise the literature on ultrasound findings for paediatric mesenteric adenitis, including diagnostic criteria, sonographic appearances and techniques. By undertaking this review, we aimed to identify gaps in the literature to inform future research.

Methods:

We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. We searched PubMed, Embase, Scopus and the Cochrane Library for studies involving patients 1–18 years who underwent radiology-performed or point-of-care ultrasound for suspected mesenteric adenitis with findings synthesised thematically.

Results:

Seventeen studies were included. Only one evaluated point-of-care-ultrasound. Definitions of mesenteric adenitis were heterogeneous in terms of the number of lymph nodes visible and lymph node size. Associated features such as bowel wall thickening, periportal cuffing and systemic signs were reported inconsistently. Advanced modalities including Doppler, superb microvascular imaging and elastography were explored in a minority of studies, while few provided longitudinal follow-up data. Sample sizes were generally small, designs were retrospective, and interobserver reliability was rarely assessed.

Conclusion:

Ultrasound is widely used for paediatric mesenteric adenitis, but diagnostic criteria lack consensus. Evidence reporting the use of point-of-care ultrasound is minimal. Prospective studies are needed to establish reliable diagnostic criteria and clarify the clinical utility of point-of-care ultrasound in this setting.