深耳下腺リンパ節腫脹がみられた猫ひっかき病の２例

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  • Cat Scratch Disease with Deep Parotid Node Swelling: A Report on Two Cases

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Cat scratch disease (CSD) is a relatively common, benign, self limiting infection with Bartonella species. It is characterized by tender, chronic or subacute lymphadenopathy affecting various parts of the human body. Typically, lymph node swelling in the upper extremity region is seen. However, in most cases of atypical CSD, lymphadenopathy of the preauricular region has been described. We report on two patients with the parotid nodes swelling caused by CSD. In one case, the classic signs of CSD were presented, with Parinaud oculoglandular syndrome, including both conjunctivitis and preauricular lymphadenopathy. The othe case was definitively diagnosed as CSD based on not only contact with cats and imaging features, but also on the more modern and available serological findings (positive titers of antibody to Bartonella henselae) In this paper, we present the appearance of CSD on Ultrasonography, Computed Tomography and Magnetic Resonance images, and consider the lymphatic anatomy of the preauricular and parotid regions. In the preauricular and parotid regions, the preauricular node (not a parotid node), the superficial parotid node, and the deep parotid node are distributed. It is difficult to distinguish the preauricular enlarged lymph nodes from those in the parotid gland by physical examination alone. Furthermore, other infectious disease or a parotid tumor may not de determined by physical examination alone. Surgical procedures are not recommended when CSD is suspected, except for symptomatic relief or to exclude a parotid neoplasm. Even if the patient has not been scratched by a cat, a tentative preoperative diagnosis of CSD can be made by careful questioning for a positive history of fever, a primary skin lesion and/or conjunctivitis, and by confirmation of cat contact within the previous few weeks and/or having cats as pets. Furthermore, when preauricular lymphadenopathy is detected on sectional images, oral radiologists should consider CSD and the available serological analyses should be given in preference to the other invasive examinations.

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  • 歯科放射線

    歯科放射線 43 (2), 70-80, 2003

    特定非営利活動法人 日本歯科放射線学会

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