Objective  To analyze the ultrasonic features of cervical lymph nodes and related involved sites in children with histiocytic necrotizing lymphadenitis (HNL).

Methods  The clinical data of children with HNL admitted to the First Affiliated Hospital of Henan University of Chinese Medicine between May 2022 to May 2025 were retrospectively analyzed, and the ultrasonic features of lymph nodes in abnormal parts were observed and recorded.

Results  A total of 33 children with HNL were enrolled, all of whom had cervical lym-phadenopathy, mainly unilateral involvement (60.61%). Lymph nodes in 69.70% of the children showed an orderly rounded distribution with round-like shape; increased echo of the perinodal tissue was found in 72.73% of the children; homogeneous hypoechogenicity was observed in the internal echo of lymph nodes in 72.73% of the children; 30.30% of the children had a tendency toward lymph node fusion. Some children were complicated with lymphadenopathy in other parts as well as hepatosplenomegaly. Color Doppler ultrasonography showed that the blood flow signals of lymph nodes in all children presented a hilar distribution, mainly with abundant blood flow signals (69.70%).

Conclusion  Ultrasonography is helpful for the early diagnosis and disease assessment of HNL in children, which can provide more effective imaging evidence for clinical practice, optimize the diagnosis and treatment pathway of HNL in children, and guide decisions regarding puncture biopsy and overall clinical management.

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