2-year-old with abdominal pain case mrn 6628633 sarah kurian, ms4 diagnostic radiology february 2014
TRANSCRIPT
![Page 1: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/1.jpg)
2-year-old with Abdominal Pain Case MRN 6628633
Sarah Kurian, MS4Diagnostic RadiologyFebruary 2014
![Page 2: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/2.jpg)
History 2 year old female with no significant past medical history who
presents with abdominal pain and non-bloody, non-bilious vomiting x 3 days.
Afebrile, normal WBC count Decreased urine output, last BM 4 days ago Admitted from ED for management of dehydration
![Page 3: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/3.jpg)
KUB
![Page 4: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/4.jpg)
History, continued Abdominal US to assess appendix – normal Surgery consulted - concern for malrotation vs. obstruction Surgery recommended further imaging Upper GI series with small bowel follow-through
![Page 5: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/5.jpg)
KUB
![Page 6: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/6.jpg)
![Page 7: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/7.jpg)
Ultrasound
Target or donut — on transverse view
![Page 8: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/8.jpg)
Lower GI with Fluoroscopy
![Page 9: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/9.jpg)
Intussusception Ileocolic (90%) Mostly idiopathic
Thought to be 2/2 hypertrophied lymphoid tissue in the terminal ileum, induced by a preceding viral illness
Only 2–12% caused by an identifiable lead point Common lead points are Meckel's diverticulum, polyp, or
lymphoma ages 6 months to 2 years
![Page 10: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/10.jpg)
Intussusception Classic triad of symptoms
Pain, vomiting, palpable abdominal mass Plain radiographs are diagnostic in 29–50% of cases Get at least 2 views including supine and prone or left
lateral decubitus views Force air into the cecum
![Page 11: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/11.jpg)
Radiographic findings lack of air-filling of the
cecum on the supine film
Other findings:
Air crescent sign—gas around part of the intussusceptum (although rare, this is highly specific for the diagnosis)
![Page 12: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/12.jpg)
Rim or Target sign—soft-tissue mass containing a faintly visible circle of fat density (the mesenteric fat)
Target or Rim Sign
![Page 13: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/13.jpg)
Ultrasound 98.5–100% sensitive
and 88–100% specific
Able to identify anatomic lead points
Target or donut Crescent or donut—
the entrapped mesentery (often containing nodes) within the intussusception
![Page 14: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/14.jpg)
Treatment Air or barium enema reduction under continuous
observation with fluoroscopy Contraindications = peritonitis, perforation Complication = bowel perforation
Surgery (if enema fails)
Recurrence – in 10% and is highest within the first 2 days following reduction
![Page 15: 2-year-old with Abdominal Pain Case MRN 6628633 Sarah Kurian, MS4 Diagnostic Radiology February 2014](https://reader037.vdocuments.net/reader037/viewer/2022110209/56649e315503460f94b222a2/html5/thumbnails/15.jpg)
Back to our patient Returned with fevers 4 days after discharge Admitted + for Rhino-/Entero- virus Likely caused the intussusception in the first place!