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8/2/2019 12 - Paediatric Abdomen Radiology
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Paediatric Abdomen
Radiology
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Case 1
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Esophageal atresia
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Associated with VACTERL disorders.
Most commonly associated with TEF.
Infants present shortly after birth.
Xray findings:
Coiled NG tube.
If there is bowel gas in the abdomen..Associtated with TEF.
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Tracheo-esophageal fistula
Sx:
Coughing, and choking during feeding.
Recurrent pneumonia.
Respiratory distress.
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Case 2
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Duodenal atresia
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Most common cause of congenital duodenalobstruction is duodenal atresia.
Usually at the region of the ampulla of vater. Associated disorders: Down syndrome.
malrotation., heart disease, renal anomalies,TEF, VACTERL.
Sx: bilious vomiting in the first day of life.
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X-ray findings:
Double bubble sign (dilated stomach and
duodenal bulb)No gas seen distally.
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Case 3
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Differential diagnosis
Meconium ileus.
Meconium plug.
Hirschsprungs disease
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Meconium ileus
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Caused by thick meconium that adheres to the smallbowel wall causing obstruction, usually at the level of theileocecal valve.
Almost all patients with meconium ileus have cysticfibrosis
10-15% of CF patients present with meconium ileus.
Small bowel obstruction, dilated small bowel loops,
soap-bubble pattern of bowel gas (air mixed withmeconium), often in the right lower quadratn.
Microcolon (unused colon).
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Meconium plug
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Meconium is impacted in the colon, thecolon remains normal in caliber.
Often seen in infants of diabetic mothers.
Contrast study shows meconium castfilling defect in the colon.
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Hirschsprungs
disease
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Aganglionosis of the colon with absence ofparasympathetic ganglia in mucosal and
submucosal layers of colon. The most common transition site is the
rectosigmoid colon.
Early presentation with failure to pass meconium
within 24 hours of life, or later presentation withconstipation and paradoxical diarrhea.
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Normally, the rectum is larger than the colon. There is an abnormal rectosigmoid ratio with the rectum
smaller than the sigmoid.
The TRANSITION ZONE is the junction between theproximal normally innervated colon and the distalaganglionic segment, the normally innervated proximalcolon becomes dilated.
33% if cases normal-appearing rectum.
24 hour film in equivocal cases may either show delayedretention of contrast within the colon, contrast mixed withstool, or more obvious transition zone.
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Case 4
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Premature infant, second week of life,presented with bloody stools, diarrhea,
bilious emesis, respiratory distress,abdominal distension.
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Necrotizing
enterocolitis
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* most common acquired GIT emergency ofpremature infants.
* X-ray findings: earliest sign and most commonsign is gaseous bowel distention, pneumatosisintestinalis (diagnostic), linear or cystic airbubbles within the bowel wall. Air fluid levels.free intra peritoneal air if perforation.
* usually affects the distal ileum and theascending colon.
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Case 5
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New born infant presented with non-biliousprojectile vomiting with a palpable mass in
the epigastric region.
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Hypertrophic pyloric
stenosis
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Pyloric stenosis present at the age of 3-6 weeks, usuallyin a first born male.
Most common cause of gastric outlet obstruction.
Pyloric length >14mm Pyloric muscle wall thickness > 4mm (most reliable
criterion).
Exaggerated peristaltic waves.
Delayed or no gastric emptying of fluid into duodenum.
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The string sign, narrowing of andelongated pyloric canal.
The thickened and enlarged muscle masson the doudenal bulb (apple core,mushroom).
The shoulder sign caused by theimpression of the hypertrophied muscle onthe antrum.
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http://images.google.com.au/imgres?imgurl=http://med.plig.org/images/20-2.gif&imgrefurl=http://med.plig.org/20/92.html&h=265&w=300&sz=60&hl=en&start=25&um=1&tbnid=pCIWo-HTwBGSQM:&tbnh=102&tbnw=116&prev=/images%3Fq%3Dpyloric%2Bstenosis%26start%3D20%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DN8/2/2019 12 - Paediatric Abdomen Radiology
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Case 6
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Malrotation
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Malrotation is the failure of the normal rotation ofthe bowel resulting in suspension of the smallbowel on a narrow vascular pedicle.
The duodenal-juejunal junction expectedlocation is to the left of the spine at the level ofthe duodenal bulb.
Malposition of the cecum in the left side of the
abdomen. Complications: obstruction and midgut volvuluswhich is a surgical emergency.
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Midgut volvulus is a twisting of the smallintestine around its vascular pedicle due tomalrotation.
Present within the first month of life with biliousvomiting, abdominal distension and shock.
Complications include intestinal ischemia andnecrosis in the distribution of the SMA.
Radiological findings: spiral course of midgutloops (cork screw appearance).
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Case 7
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Intussusception
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Intussusception occurs when a portion of thedigestive tract becomes telescoped into theadjacent bowel segment. Most common
between 3months and 2 years. The majority ofcases are ileocolic.
X-ray: soft tissue mass which is most seen in theupper quadrant effacing the adjacent hepatic
contour, reduced air in the small intestine or agasless abdomen.
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Ultrasound: target or doughnut sign, withhypoechoic rim and hyperechoic central
area (psuedo-kidney). Idiopathic ( following viral illness with
hypertrophy of peyers pateches interminal ileum) or pathologic leading point
(tumour, inspissated feces CF, lymphoma. Presentation 3-24 months.
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Treatment: reduction under fluoroscopicguidance using air enema (safer) or using
Barium (risk of peritonitis if perforationoccurs).
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Complication of intussusception is bowelischemia and perforation.
Absolute contraindication for reduction:shock not corrected with IV fluids,established perforation with clinical signs
of peritonitis.
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Case 8
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Pneumoperitoneum
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X ray signs include:
1) football sign: central lucency with air outlining
the falciform ligament in the right upperquadrant.
2) Riglers sign (wall sign): air on both sides of
the bowel wall.
3) triangle sign: air between loops of bowel.
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