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Ingested Button Batteries

KEY FACTS Terminology Ingestion of disc-shaped battery, typically by young child Increasingly of more injurious lithium cell type Esophagus particularly susceptible to injury by lodged battery with potentially catastrophic consequences Imaging Frontal radiograph: Margin shows double halo/ring en face Lateral radiograph: Rim of step-off/beveled edge Negative pole (narrower side): Site of anticipated most severe injury North American Society for Pediatric Gastroenterology, Hepatology, & Nutrition imaging guidelines…

Ingested Coins

KEY FACTS Imaging Disc-shaped metallic density without circumferential beveled edge/step-off Most common sites of impaction Upper esophagus at thoracic inlet Midesophagus at aortic arch impression Lower esophageal sphincter at gastroesophageal junction Other sites of impaction include pylorus, duodenum, ileocecal valve Imaging recommendations Screening frontal radiographs of neck through pelvis ± lateral view of upper airway Targeted lateral radiograph if foreign body identified Top Differential Diagnoses Button…

Hypertrophic Pyloric Stenosis

KEY FACTS Terminology Hypertrophic pyloric stenosis (HPS): Idiopathic pyloric muscle thickening in young infants → progressive gastric outlet obstruction Imaging Near complete gastric outlet obstruction due to abnormally elongated & thickened pyloric muscle Pylorus fails to relax/open → minimal gastric emptying → gastric overdistention → emesis Ultrasound shows hypertrophied circumferential hypoechoic muscle & elongated pyloric canal filled with echogenic mucosa Commonly accepted sonographic criteria for HPS…

Necrotizing Enterocolitis

KEY FACTS Terminology Necrotizing enterocolitis (NEC): Life-threatening condition of neonatal GI tract characterized by inflammation, ischemia, & translocation of bacteria into bowel wall Imaging Diagnosis based on clinical & imaging findings Mainstay of imaging for suspected NEC: Radiography Findings range from nonspecific (paucity of bowel gas) to suggestive (thickened, dilated bowel loops) to diagnostic [pneumatosis, portal venous gas (PVG), & free peritoneal gas] Duke Abdominal Assessment Scale…

Hirschsprung Disease

KEY FACTS Terminology Congenital disorder of enteric nervous system: Absence of ganglion cells in intestinal myenteric & submucosal plexus Lack of peristalsis → functional bowel obstruction Aganglionic segment extends retrograde from anus for variable length with gradual transition to normal innervation Imaging Newborn radiograph: Numerous loops of dilated bowel Radiograph outside neonatal period: Large stool burden with variable colonic dilation Contrast enema especially useful in evaluating…

Midgut Volvulus

KEY FACTS Terminology Ligament of Treitz: Suspends duodenojejunal junction (DJJ), defines normal duodenal rotation Malrotation: Abnormal rotation & fixation of small bowel (SB) mesentery that can lead to complications Bowel obstruction by Ladd bands Midgut volvulus (MV) due to short mesenteric base, prone to twisting MV: Twisting of SB about superior mesenteric artery → bowel obstruction, ischemia/necrosis Imaging Radiographs: Most common appearance is normal Distended stomach…

Malrotation

KEY FACTS Terminology Malrotation: Any abnormal rotation of small or large bowel, which rotate separately during development Malfixation: Abnormal position or length of bowel fixation by mesentery, typically associated with malrotation Short mesenteric fixation predisposes to midgut volvulus [twisting of midgut about superior mesenteric artery (SMA) → vascular occlusion & potential bowel ischemia] Imaging Fluoroscopic GI findings 3rd duodenum (D3) never crosses midline, often extends anteriorly…

Kawasaki Disease

KEY FACTS Terminology Inflammatory disease of small- & medium-sized blood vessels of unknown etiology, mainly in young children Widespread but characteristic manifestations Coronary artery aneurysms most feared complication Imaging Chest radiography usually normal Echocardiography has sufficient sensitivity & specificity in detecting proximal coronary artery aneurysms Remains 1st-line modality CTA can demonstrate aneurysms, stenoses, & Ca²⁺ of coronary or other arteries Cardiac MR protocol includes function, coronary…

Heterotaxy Syndromes

KEY FACTS Terminology Disturbance of normal left-right asymmetry in position of thoracic & abdominal organs; typically described in terms of right atrial isomerism vs. left atrial isomerism Imaging Best diagnostic clue: Abnormal symmetry in chest & abdomen Classic radiographic appearance: Transverse midline liver, discrepancy between position of cardiac apex & stomach, bilateral left- or right-sidedness in chest, cardiomegaly or other findings of congenital heart disease Echo:…