CChhaalllleennggeess ooff IImmaaggiinngg PPeeddiiaattrriicc AAbbddoommiinnaall EEmmeerrggeenncciieess Susan D. John, M.D. RSNA 2013 CChhaalllleennggeess ooff IImmaaggiinngg CChhiillddrreenn • History and physical exam less reliable – Site of pain may be very misleading • Choosing the best initial modality – Organ of interest – Age of the patient • Differing pathology • Patient cooperation • Safety issues LLeeaarrnniinngg OObbjjeeccttiivveess • Understand the variations of pathology that cause abdominal pain and vomiting in infants and children • Plan safe and effective imaging protocols using US, CT, and MRI • Recognize pitfalls in the diagnosis of pediatric abdominal emergencies with imaging www.uth.tmc.edu/radiology 1 WWhhaatt ppeerrcceennttaaggee ooff ppaattiieennttss iinn yyoouurr pprraaccttiiccee aarree << 1155 yyeeaarrss ooff aaggee?? • 80 - 100% • 50 – 79% • 25 – 49% • 5 – 25% • < 5% AAbbddoommiinnaall PPaaiinn iinn IInnffaannttss aanndd CChhiillddrreenn • History and physical findings overlap – Diarrhea – Blood in stool – Episodic crying – Poorly localized pain • Pathologies cluster in specific age groups – Newborn – 1 week – 2 months – 2 - 5 months – 5 months – 2 years – 2 yrs - adolescence 11 ttoo 88 WWeeeekkss ooff AAggee • Gastroesophageal reflux • Gastric outlet obstruction – Pyloric muscle • Spasm • Hypertrophy HHyyppeerrttrroopphhiicc PPyylloorriicc SStteennoossiiss • Infants 3-6 weeks of age – Younger patients increasing • Projectile vomiting – Non-specfic • US is best modality – 7-12 mHz transducer – Fluid-filled stomach NNoorrmmaall PPyylloorruuss • 1-2 mm muscle • Length negligible • Opens frequently Hypertrophic Pyloric Stenosis TTrraannssvveerrssee Longitudinal • 3 mm + muscle • 1.5 cm + length • Little or no emptying PPiittffaallll –– tthhee eemmppttyy ssttoommaacchh!! • Administer fluid (sugar water), if needed • Oblique patient to right