Abdomen pediatri

5/24/2018 Abdomen pediatri

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Abd ped


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Normal plain abdominal film of a newborn


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After birth

shows gas in thestomach10-15 minutes

gas in the proximal small bowel30-60 minutes

gas in the distal small bowel within6 hours

and gas in the colon and rectumwithin 24 hours


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. Air in the dilated proximal esophagus (arrows)

S = stomach


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Aspiration pneumonia in right upper lobe and left lower lobe

Note an NG tube in the dilated proximal esophagus


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EsophagealAtresiaand

Tracheoesophageal Fistula When esophageal atresia is suspected in a child, the child should be

intubated using an NG tube and a chest film should be taken.Abnormalities that may be seen are:1. Air in a dilated esophagus proximal to the esophageal

atresia2. The NG tube in the proximal esophagus It cannot be

passed into the stomach.3. No air in the rest of the gastrointestinal tract, if the patient

has esophageal atresia without a tracheoesophageal fistula.If a patient does have esophageal atresia with a

tracheoesophageal fistula, there will be more air in the rest of thegastrointestinal tract than there is in normal children.

4. If the patient has aspiration pneumonia, there will bepulmonary infiltration


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Hypertrophic Pyloric Stenosis

The abnormalities seen in images in thiscondition are

1. In a plain film, dilated stomach and lessgas in the rest of the gastrointestinal tract thannormal.

2. In ultrasonography, thickening of thepylorus muscle.

3. In an upper GI series, string sign,shoulder sign, beak sign, double tract sign, etc.


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Duodenal atresia

The abnormalities seen in a plain

abdomen film of patients with this

condition are dilated stomach and dilated

duodenal bulb with no gas in the rest of

the gastrointestinal tract (double bubble

sign)


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Jejunal atresia

The abnormalities seen in a plain

abdomen film of patients with this

condition are dilated stomach, dilated

duodenal bulb, and dilated proximal

jejunum with no gas in the rest of the

gastrointestinal tract (triple bubble sign).


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Hirschsprung disease = megacolon kongenital

The abnormalities seen in images of patients with this disease are:1. In a plain abdom en f i lm(Figure 1),

- dilated small bowel and large bowel proximal to the aganglionic

segment.

- feces in dilated large bowel sometimes.

- no air or feces in the rectum.

. 2. Bar ium enema- transition zone (Figure 2).

. - hyperspasticity of the aganglionic segment (Figure 3).

. - a rectosigmoid ratio less than 1.

. - the mucosal folds of the large bowel above the aganglionic segment

sometimes similar to mucosal folds of the jejunum (jejunization) (Figure 4).

. - delayed barium evacuation.
http://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig1.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig2.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig3.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig4.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig4.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig3.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig2.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/hdfig1.html


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Figure 1. Dilated small bowel and large bowel without air/feces in the rectum


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Figure 2. Transition zone (arrows)


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Figure 3. Hyperspasticity of the rectum (arrow), transition zone, and

a rectosigmoid ratio less than 1. S = sigmoid, R = rectum


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Figure 4. Jejunization (arrow)


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Necrotizing Enterocolitis

The abnormalities seen in a plain abdomen film of patientswith this condition are:

1. Dilatation of bowel loops, particularly in the right lowerabdomen.

2. Thickening of the bowel wall.

3. Pneumatosis intestinalisIf there is gas in the subserosal layer, there will be linear

or curvilinear radiolucencyin the bowel wall (Figure 1).If there is gas in the submucosal layer, there will be

bubbly or cystic radiolucency in the bowel wall (Figure 2).

4. Gas in the portal vein (Figure 3).5. Pneumoperitoneum when there is perforation of thebowel (Figure 4).
http://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig1.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig2.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig3.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig4.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig4.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig3.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig2.htmlhttp://www.medicine.cmu.ac.th/dept/radiology/pedrad/necfig1.html


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Figure 1. Gas in the subserosal layer (arrows)


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Figure 2. Gas in the submucosal layer (red arrows)

Note thickening of the bowel walls (blue arrows)


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Figure 3. Gas in the portal vein, dilatation of bowel loops,

and Thickening of the bowel walls.


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Figure 4. Pneumoperitoneum. Note falciform ligament (arrow)

and air in the left scrotal sac(S).


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Diaphragmatic hernia

The abnormalities seen in a chest film and a plain

abdomen film of patients with a large diaphragmatic hernia

are:

1. Shift of the heart and mediastinum to

the opposite side.

2. Bowel loops in the hemithorax

3. Fewer bowel loops in the abdomen

than normal.

.


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Intussusception

1. In a plain abdomen film:- a soft tissue mass (Figure 1)- dilated bowel loops or small bowel

obstruction (Figures 2 and 3)- pneumoperitoneum in a patient with

Intussusception and bowel perforation.

Both supine and the upright or the left lateraldecubitus films should be taken in every patientwith suspected intussusception
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2. In ultrasonography:- On a longitudinal scan of the intussusception - a "pseudokidney"

sign (Figure 4) will be seen.. - On a transverse scan of the intussusception - a "target" sign

(Figure 5) or "donut" sign will be seen.

3. Barium enema:- Contraindications1. peritonitis2. pneumoperitoneum when seen in a plain abdomen film.

- A barium enema helps in diagnosis and treatment (reduction ofthe intussusception) in these patients.

- The abnormalities seen in a barium enema (Figure 6) are:1. obstruction of the barium at the site of intussusception2. a cup-shaped filling defect at the site of obstruction3. coiled spring appearance
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Figure 1. Soft tissue mass (arrows)


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Figure 3. Small bowel

obstruction and a soft tissue

mass (M)


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Figure 4. Pseudokidney sign (arrows), RK = right kidney


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Figure 5. Target sign (arrows)


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Figure 6. A cup-shaped

filling defect (arrow) andcoiled spring appearance


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Imaging of Children with Abdominal Masses

Types of imaging:1. Plain abdomen film: In most cases we see only a soft tissue mass

where the mass palpated on physical examination is, and displacement ofbowel loops by the mass. However in some patients a plain abdomen filmmay show more information such as fat or calcifications in patients withteratomas, coarse calcifications in patients with hepatoblastomas, andstippled calcifications in patients with neuroblastomas.

2. Ultrasonography: This can tell us whether the mass is solidorcystic, and where the mass originated. However the complete mass maynot be seen because bowel gas may obscure some portion of it.

3. Computed Tomography: This can show how far the mass hasextended. However some tumors that often extend into the spinal canalsuch as neuroblastomas may not be seen.

4. Magnetic Resonance Imaging: This is more expensive than

computed tomography and it takes longer time. It shows the extension ofthe tumor completely, including extension into the spinal canal. It alsoshows metastases to bone marrow.

5. Barium study: This is helpful in patients where it is suspected thatthe mass originated in the gastrointestinal tact.
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Abdomen pediatri