{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T15:16:39Z","timestamp":1773760599973,"version":"3.50.1"},"reference-count":72,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Necrotizing (abscessing) lymphadenopathy is a clinically relevant condition with a broad differential diagnosis, including acute bacterial infections, mycobacterial disease, zoonoses, fungal and parasitic infections, autoimmune disorders, and malignancies with central necrosis. Early and reliable differentiation between these causes is important to avoid misdiagnosis and to guide appropriate therapy. This review summarizes the pathophysiological mechanisms, typical imaging features, and diagnostic value of contrast-enhanced ultrasound (CEUS) in necrotizing lymphadenopathy. Representative clinical vignettes illustrate the disease spectrum and correlate CEUS patterns with underlying pathology. The literature review was narrative and based on targeted searches of PubMed\/MEDLINE and Google Scholar focusing on CEUS in necrotizing lymphadenopathy. A brief literature overview highlights current evidence, limitations, and research gaps. Conventional B-mode ultrasound (BMUS) and Doppler typically demonstrate enlarged hypoechoic or heterogeneous nodes with reduced central vascularity but lack specificity for necrosis. CEUS provides real-time visualization of nodal microvascular perfusion, which may support clearer differentiation between viable tissue and necrotic or abscess cavities. Common but non-specific CEUS patterns include central non-enhancement with a peripheral hyperemic rim in abscesses, irregular avascular cores in tuberculous lymphadenopathy, patchy non-enhancing areas in autoimmune conditions, and heterogeneous enhancement with ill-defined necrosis in malignant nodes. CEUS can support biopsy targeting, facilitate drainage procedures, and enable radiation-free follow-up. CEUS may offer diagnostic and interventional advantages in the evaluation of necrotizing lymphadenopathy, offering more consistent characterization of nodal necrosis compared with conventional sonography. While most evidence focuses on tuberculosis and malignancy, growing experience with zoonotic and autoimmune diseases suggests broader utility. Most currently available evidence derives from observational studies and small case series, highlighting the need for prospective multicenter validation. Standardization of CEUS criteria, integration into multiparametric ultrasound protocols, and multicenter validation are needed to establish CEUS as a routine component in the diagnostic work-up of necrotizing lymphadenopathy.<\/jats:p>","DOI":"10.3390\/diagnostics16060888","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:42:16Z","timestamp":1773751336000},"page":"888","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Necrotizing (Abscessing) Lymphadenopathy and the Diagnostic Value of Contrast-Enhanced Ultrasound (CEUS): A Review with Clinical Vignettes"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1900-5149","authenticated-orcid":false,"given":"Christian","family":"G\u00f6rg","sequence":"first","affiliation":[{"name":"Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstra\u00dfe, 35043 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200082, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0356-660X","authenticated-orcid":false,"given":"G\u00f6rg","family":"Friedemann","sequence":"additional","affiliation":[{"name":"Interdisciplinary Center of Ultrasound Diagnostics, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstra\u00dfe, 35043 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7008-6650","authenticated-orcid":false,"given":"Christian","family":"Jenssen","sequence":"additional","affiliation":[{"name":"Department for Internal Medicine, Krankenhaus M\u00e4rkisch Oderland, 15344 Strausberg, Germany"},{"name":"Brandenburg Institute for Clinical Ultrasound (BICUS), Brandenburg Medical University, 16816 Neuruppin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0087-7748","authenticated-orcid":false,"given":"Michael","family":"Kallenbach","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gastroenterologie, Hepatologie und Infektiologie, Universit\u00e4tsklinikum D\u00fcsseldorf, 40225 Dusseldorf, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9492-0141","authenticated-orcid":false,"given":"Kathleen","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Medical Department I\/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-5452","authenticated-orcid":false,"given":"Findeisen","family":"Hajo","sequence":"additional","affiliation":[{"name":"Department for Hematology, Oncology and Immunology, University Hospital Giessen and Marburg, Philipp University of Marburg, 35037 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitin","family":"Chaubal","sequence":"additional","affiliation":[{"name":"Thane Ultrasound Centre, Jaslok Hospital and Research Centre, Mumbai 400026, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6015-6347","authenticated-orcid":false,"given":"Christoph Frank","family":"Dietrich","sequence":"additional","affiliation":[{"name":"University Hospital Frankfurt, Johann-Wolfgang-Goethe University Frankfurt on the Main, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"795","DOI":"10.4103\/1319-2442.185264","article-title":"Hilar and para-aortic necrotizing lymphadenopathy associated with antineutrophil cytoplasmic antibody-negative pauci-immune crescentic glomerulonephritis","volume":"27","author":"Varro","year":"2016","journal-title":"Saudi J. 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