It's worth a second look: Sonographic identification of lymphoid hyperplasia of the pediatric bowel

Lymphoid hyperplasia is benign, reactive proliferation of lymphatic tissue that can present with similar sonographic findings as appendicitis or intussusception. This pictorial essay explores the sonographic presentation of lymphoid hyperplasia and the way it mimics the pathology of appendicitis and intussusception. Common in pediatric patients, lymphoid hyperplasia occurs in response to systemic infections, including viral gastroenteritis. When lymphoid hyperplasia occurs, it causes enlargement of the lymphatic tissue of the lamina propria found in the terminal ileum, ileocecal valve, and appendix. Differentiating lymphoid hyperplasia from other conditions requires careful assessment of sonographic features, including identification of bowel wall, measurements of bowel wall, free fluid, inflammatory changes, and lymph nodes. The images presented in this pictorial essay show pediatric cases in which lymphoid hyperplasia mimicked pathology. These situations can lead to longer admissions for patients and repeat ultrasound exams. The pictorial essay underscores the importance of a thorough sonographic assessment that maintains a systematic approach when obtaining images to ensure diagnostic accuracy. Without slow and steady investigation, it is possible to mistake lymphoid hyperplasia for its higher acuity counterparts. Sonographers play a crucial role in ensuring accurate diagnosis of lymphoid hyperplasia by taking a second look in cases of focal bowel wall thickening at the terminal ileum, ileocecal valve, and appendix.