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Meckel Diverticulum

KEY FACTS Terminology Most common omphalomesenteric duct remnant Imaging Classic imaging appearance (in patient with GI bleeding): Focal persistent accumulation of radiotracer in right lower quadrant on nuclear pertechnetate scan (Meckel scan) Coincident with & isointense to gastric uptake as ∼ 65% of symptomatic Meckel diverticula contain ectopic gastric mucosa Other modalities (US, CT, MR) Blind-ending tubular structure may be inconspicuous May present as cyst, even…

Ileocolic Intussusception

KEY FACTS Terminology Invagination of distal small bowel (intussusceptum) into colon (intussuscipiens) in telescope-like manner Imaging US: Best diagnostic modality if clinically suspected Round mass with target sign in right abdomen Mean diameter of 2.6 cm (vs. 1.5 cm for purely small bowel intussusceptions) Sweeping transducer proximal & distal shows relationship to small & large intestine May see entrapped lymph nodes, appendix, other pathologic lead points…

Appendicitis

KEY FACTS Terminology Acute obstruction of appendiceal lumen → distention → ↑ intraluminal pressure → venous obstruction → ischemia → superimposed infection of appendiceal wall → eventual perforation Imaging US 1st-line modality in child with RLQ pain Noncompressible, dilated, tubular blind-ending structure (appendix) in RLQ with induration of surrounding fat – ± echogenic, shadowing appendicolith US diameter of appendix ≥ 6 mm (during compression) suggestive of…

Hernias

KEY FACTS Terminology Hernia: Protrusion of contents from normally encasing body cavity through normal or abnormal opening Inguinal hernia: Protrusion of abdominal contents through defect in inguinal region Indirect inguinal hernia: Contents protrude into open deep inguinal ring, extend through patent processus vaginalis, & exit superficial inguinal ring – 15% of inguinal hernias bilateral – In females, ovary may herniate through canal of Nuck Umbilical hernia:…

Ingested Multiple Magnets

KEY FACTS Terminology Ingestion of multiple magnets or single magnet + additional metallic foreign bodies Potential for significant bowel complications Rare-earth magnets 5-10x stronger than traditional magnets Imaging Metallic density foreign bodies; shapes variable Magnets attract through bowel walls Multiple “stacked” magnets may simulate single rectangular or cylindrical foreign body Entrapment of interposed bowel wall suggested with Gap between otherwise closely apposed magnets or magnet &…

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…