Emergent Pediatric US: What Every Radiologist Should Know

Abstract

Appendicitis, intussusception, and hypertrophic pyloric stenosis (HPS) are three of the most common reasons for emergent abdominal imaging in pediatric patients. Although the use of computed tomography has risen dramatically over the past 2 decades, children are particularly at risk for the adverse effects of ionizing radiation, and even low-dose radiation is associated with a small but significant increase in lifetime risk of fatal cancer. In most emergency departments, the use of magnetic resonance (MR) imaging as a primary modality for the evaluation of a child with abdominal pain remains impractical due to its high cost, its limited availability, and the frequent need for sedation. Ultrasonography (US) does not involve ionizing radiation and, unlike MR imaging, is relatively inexpensive, is widely available, and does not require sedation. Another major advantage of US in abdominal imaging is that it allows dynamic assessment of bowel peristalsis and compressibility. Delayed diagnosis of any of the aforementioned disease processes can lead to serious morbidity and, in some cases, death. The ability to diagnose or exclude disease with US should be part of a core radiology skill set for any practice that includes a pediatric population.

Intussusception in childhood: role of sonography on diagnosis and treatment

“…2), ''intestine-within-intestine'' aspect at longitudinal scans and ''pseudo-kidney'' in the oblique scans (Fig. 3) [14,18]. The location of the suspected intussusception was the right abdomen in 11 patients, left abdomen in 3 and the paraumbilical region in 2.…”

“…In the 12 patients who underwent the plain radiography of the abdomen in addiction to the ultrasound, it was not possible to do a presumptive diagnosis of intussusception, possible only thought the ''crescent-sign'' [14]. In 11/12 patients plain radiography of the abdomen appeared completely negative despite the positive ultrasound examination; only in one patient, with a negative ultrasound examination, presumptive radiographic signs of intussusception were documented, such as altered distribution of gas in the small intestine characterized by gaseous distension of the intestinal loops and almost complete absence of air in the ascending colon [1].…”

“…The ''classic'' clinical triad has been described as consisting of (a) acute colicky abdominal pain, (b) ''currant jelly'' or frankly bloody stools, and (c) either a palpable abdominal mass or vomiting. Many children do not present the complete triad of symptoms and in some cases intussusception may be transient with spontaneously reduction [3,7,13,14].…”

“…The superior performance of US in the diagnosis of intussusception, the high level of patient comfort and safety allowed by US and the ability to arrive at alternative diagnoses with US has led to reserve enemas only for therapeutic purposes. When the symptoms are vague, it would be reasonable to perform also a plain radiography [17], but its sensitivity in detecting intussusception is as low as 45 % [14].…”

Ultrasound-guided reduction of ileocolic intussusception in children

“…Ileocolic intussusception is a common cause of childhood abdominal pain and intestinal obstruction and therefore a common surgical emergency in the pediatric population. The peak incidence is in children from 6 months up to 2 years of age (2), where enlarged mesenteric lymph nodes act as a "leading point", mostly due to acute abdominal infection (3,4). In children younger than 6 months and older than 2 years, associated bowel abnormality should be considered as intussusceptum (Meckel diverticulum, duplication cyst, ectopic pancreas, and tumors) (5).…”