Category: Visual Diagnosis
Keywords: Intussusception, pediatric, ultrasound (PubMed Search)
A 15 months old male with no past medical history, presenting with two days of decreased oral intake and decreased urine output. The exam was notable for minimal tenderness of abdomen. During an oral fluid challenge in the ED, the patient had a single episode of bilious vomiting. The ED physician ordered an ultrasound study and the results are shown below. What is the diagnosis?
- The use of point of care ultrasound in the ED shortens the time to diagnosis and to definitive treatment. It has a sensitivity of 98-100% even if done by an inexperienced sonographer.
- To diagnose intussusception in the pediatric population, use the High-frequency linear probe for a better image quality. Start with scanning the right upper quadrant, and then move down to scan all four quadrants.
- Classic ultrasound findings include either a Donut-shaped or a Pseudo-kidney appearance, seen as a hypoechoic outer ring and a hyperechoic center. Other variants include; Mesenteric Crescent, where the inner loop will have a crescent hyperechoic appearance with few hypoechoic areas representing lymph nodes, or Central Limb of the Intussusceptum, where a fluid collection is present in the central limb of the intussusceptum instead of a collapsed limb.
- Utilize the US doppler to check for blood flow to the intestinal loops. Diminished blood flow correlates with irreducibility.
Del-Pozo, Gloria, et al. "Intussusception in children: current concepts in diagnosis and enema reduction." Radiographics 19.2 (1999): 299-319.