Images in Emergency Medicine
Article Outline
[Ann Emerg Med. 2007;50:90.]
A 5-year-old girl with an unremarkable medical history and a full vaccination course presented with a tender right neck mass first noticed by her parents 5 days prior. The child only complained of pain when the mass was palpated; she had been afebrile and otherwise behaving normally. Her examination was notable for a mildly erythematous, mobile, non-fluctuant neck mass (Figure 1). There were no signs or symptoms of airway or oropharyngeal obstruction. Bedside ultrasound showed heterogenous tissue with small areas fluid collection (Figure 2).
Figure 1.
Right neck mass.
Figure 2.
Bedside ultrasound shows the 1.55 cm by 2.69 cm mass, outlined by the calipers. Note the heterogenous nature of the tissue. Used with permission of Whit Fisher, MD, Bellevue Hospital Center, Emergency Medicine Department, New York, NY.
Diagnosis
Bartonella henselae lymphadenitis. The patient registered positive for B. henselae by serology testing.
“Cat scratch disease” is most common in patients with a history of exposure to cats, especially kittens, which are frequently bacteremic for B. henselae. Fever and other systemic symptoms are often absent, and reactive lymph nodes frequently regress after several weeks. In some cases nodes may suppurate and require aspiration.1, 3
Rare complications can include hepatic granulomatous lesions, splenic abscesses, encephalopathy, osteomyelitis, conjunctivitis, and neuroretinitis.1, 2, 3
Diagnosis is most commonly made by serologic testing and evoking a history of cat exposure. Treatment in symptomatic individuals typically involves a five-day course of azithromycin.1
References
For the diagnosis and teaching points, see page 97.To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com
PII: S0196-0644(06)02622-9
doi:10.1016/j.annemergmed.2006.12.006
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
