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Elsayed Y, Soylu H. Point-of-care abdominal ultrasound in pediatric and neonatal intensive care units. Eur J Pediatr 2024; 183:2059-2069. [PMID: 38459132 DOI: 10.1007/s00431-024-05443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/10/2024]
Abstract
A spectrum of critical abdominal pathological conditions that might occur in neonates and children warrants real-time point-of-care abdominal ultrasound (abdominal POCUS) assessment. Abdominal radiographs have limited value with low sensitivity and specificity in many cases and have no value in assessing abdominal organ perfusion and microcirculation (Rehan et al. in Clin Pediatr (Phila) 38(11):637-643, 1999). The advantages of abdominal POCUS include that it is non-invasive, easily available, can provide information in real-time, and can guide therapeutic intervention (such as paracentesis and urinary bladder catheterization), making it a crucial tool for use in pediatric and neonatal abdominal emergencies (Martínez Biarge et al. in J Perinat Med 32(2):190-194, 2004) and (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). Conclusion: Abdominal POCUS is a dynamic assessment with many ultrasound markers of gut injury by two dimensions (2-D) and color Doppler (CD) compared to the abdominal X-ray; the current evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency situations. However, it should still be considered an adjunct rather than replacing abdominal X-rays due to its limitations and operator constraints (Alexander et al. in Arch Dis Child Fetal Neonatal Ed 106(1):F96-103, 2021). What is Known: • Ultrasound is an important modality for the assessment of abdominal pathologies. What is New: • The evidence supports the superiority of abdominal POCUS over an abdominal X-ray in emergency abdominal situations in the neonatal and pediatric intensive care units.
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Affiliation(s)
- Yasser Elsayed
- Section of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
- Women's Hospital, 820 Sherbrook Street, Winnipeg, MB, R2016, R3A0L8, Canada.
| | - Hanifi Soylu
- Section of Neonatology, Department of Pediatrics, Selcuk University, Konya, Turkey
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Limantoro I, Lee AF, Rosenbaum DG. Spectrum of bowel wall thickening on ultrasound with pathological correlation in children. Pediatr Radiol 2022; 52:1786-1798. [PMID: 35513727 PMCID: PMC9072154 DOI: 10.1007/s00247-022-05376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/04/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Applications for bowel US in children have been well described; however, less focus has been placed on patterns of bowel wall architectural change in specific disease states. This pictorial essay reviews normal bowel wall architecture and covers a variety of inflammatory, infectious, vascular and neoplastic disorders outside the neonatal period as seen on US, with illustrative pathological correlation. A thorough understanding of normal and abnormal bowel wall architecture can enrich sonographic interpretation and provide a valuable adjunct to appropriate clinical investigation.
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Affiliation(s)
- Ione Limantoro
- Department of Radiology, British Columbia Children’s Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
| | - Anna F. Lee
- Department of Pathology and Laboratory Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC Canada
| | - Daniel G. Rosenbaum
- Department of Radiology, British Columbia Children’s Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC V6H 3N1 Canada
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Wang S, Tang H, Du W, Ding Y. Massive gastrointestinal hemorrhage caused by Henoch-Schoenlein purpura: A case report. Medicine (Baltimore) 2021; 100:e28240. [PMID: 34918691 PMCID: PMC8677960 DOI: 10.1097/md.0000000000028240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Henoch-Schoenlein purpura (HSP) is a systemic small-vessel vasculitis that commonly occurs in children. Gastrointestinal HSP can rarely progress to gastrointestinal perforation, followed by massive gastrointestinal bleeding. PATIENT CONCERNS An 8-year-old Chinese boy was transferred to the pediatric intensive care unit of our hospital with an emergency occurrence of purpura, severe hematemesis, large bloody stools, and sharp abdominal pain, and complained of abdominal pain and rash 2 weeks prior. DIAGNOSIS The patient had purpura with lower limb predominance, abdominal pain, and gastrointestinal bleeding. Immunofluorescence microscopy of histological sections showed granular and lumpy IgA focal deposition in the blood vessel walls. He was diagnosed with HSP. INTERVENTIONS Initially, he was treated with methylprednisolone, posterior pituitary injection, somatostatin, and hemocoagulase, together with the infusion of large blood products. Postoperatively, he was administered nasal continuous positive airway pressure -assisted ventilation, anti-infection treatment, albumin transfusion, platelet transfusion, abdominal drainage, methylprednisolone, fluconazole anti-fungal treatment, and wound dressing. OUTCOMES There was no evidence of rebleeding, abdominal pain, or purpura at the 2-month follow-up assessment. LESSONS Abdominal HSP should be alert to gastrointestinal perforation when using hormone therapy.
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Zhang M, Lin H, Qin LL. Sonography of pediatric gastrointestinal venous malformations. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:269-273. [PMID: 32954508 DOI: 10.1002/jcu.22924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Gastrointestinal (GI) venous malformations are extremely rare. Such malformations present in the pediatric age group and can occur anywhere in the digestive tract (esophagus, stomach, small or large intestine, anus, and mesentery). We present the sonographic findings of three cases of pediatric GI venous malformation. Sonography is an important diagnostic method in pediatric GI venous malformations.
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Affiliation(s)
- Min Zhang
- Department of Ultrasound, Hainan General Hospital, Haikou, China
| | - Hai Lin
- Department of Pediatric Surgery, Hainan General Hospital, Haikou, China
| | - Ling-Ling Qin
- Department of Ultrasound, Hainan General Hospital, Haikou, China
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Uehara E, Nagata C, Masuda H, Fujimori K, Kobayashi S, Kubota M, Ishiguro A. Risk factors of long hospital stay for immunoglobulin A vasculitis: Single-center study. Pediatr Int 2018; 60:918-922. [PMID: 30129988 DOI: 10.1111/ped.13685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/27/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Immunoglobulin A (IgA) vasculitis is a common, systemic childhood disease that occasionally interferes with oral intake of food and necessitates hospitalization. In Japan, there are no reports on the length of hospitalization or factors related to long-term hospitalization in children with IgA vasculitis. In this study, we investigated the factors related to long-term hospitalization. METHODS We reviewed the medical records of children aged ≤15 years with IgA vasculitis who were admitted to the National Center for Child Health and Development (Tokyo, Japan) between March 2008 and April 2017. We reviewed their gender, age, previous episodes, digestive symptoms, fever, laboratory data, urine analysis, ultrasound, and use of glucocorticoid on admission day. We compared the long-stay (≥10 days) group (L) and the short-stay (≤9 days) group (S) on logistic regression analysis. RESULTS Of the 68 children included in the analysis, 34 were male, and the average age was 71.9 ± 26.4 months. The median period of hospitalization was 10.5 days (range, 0.5-75 days), and 36 children were allocated to group L. In the logistic regression model including age, gender, gastrointestinal (GI) bleeding, and use of glucocorticoid, male sex (OR: 4.2; 95%CI: 1.3-13.5) and GI bleeding (OR: 7.6; 95%CI: 1.4-41.5) were significantly associated with hospitalization ≥10 days. CONCLUSIONS In children with IgA vasculitis, male patients and those with GI bleeding were more likely to have a hospital stay ≥10 days.
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Affiliation(s)
- Erika Uehara
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Chie Nagata
- Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Fujimori
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Shinobu Kobayashi
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.,Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan
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Ultrasound assessment of the bowel: inflammatory bowel disease and conditions beyond. Pediatr Radiol 2017; 47:1082-1090. [PMID: 28779191 DOI: 10.1007/s00247-017-3877-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 04/20/2017] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) is a versatile imaging study for the evaluation of the bowel in children. US imaging of the bowel can be used as the initial examination or in follow-up for many common pediatric diseases. In this article, we highlight our bowel US technique and describe how US can depict the features of a select group of bowel pathologies relevant to pediatric practice.
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Ahn SE, Moon SK, Lee DH, Park SJ, Lim JW, Kim HC, Lee HN. Sonography of Gastrointestinal Tract Diseases: Correlation With Computed Tomographic Findings and Endoscopy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1543-1571. [PMID: 27268998 DOI: 10.7863/ultra.15.09038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/21/2015] [Indexed: 06/06/2023]
Abstract
Sonographic evaluation of the gastrointestinal (GI) tract may be difficult because of overlying intraluminal bowel gas and gas-related artifacts. However, in the absence of these factors and with the development of high-resolution scanners and the technical experience of radiologists, sonography can become a powerful tool for GI tract assessment. This pictorial essay focuses on sonographic findings of GI tract lesions compared with endoscopic, computed tomographic, and magnetic resonance imaging findings. Neoplastic and non-neoplastic diseases and postoperative complications are illustrated, and the distinctive sonographic characteristics of these entities are highlighted.
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Affiliation(s)
- Sung Eun Ahn
- Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul, Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul, Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul, Korea
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Khanna G, Sargar K, Baszis KW. Pediatric vasculitis: recognizing multisystemic manifestations at body imaging. Radiographics 2016; 35:849-65. [PMID: 25969938 DOI: 10.1148/rg.2015140076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pediatric vasculitides are multisystem diseases that can be diagnostic challenges because of variable clinical manifestations. The clinical manifestation is determined by the size of the affected vessels, organs involved, extent of vascular injury, and underlying pathologic characteristics. Henoch-Schönlein purpura and Kawasaki disease are the two most common subtypes of pediatric vasculitis. Diagnosis of pediatric vasculitis can be difficult, and the outcome can be serious or fatal in the absence of timely intervention. Imaging plays a central role in establishing the diagnosis of vasculitis involving large- and medium-sized vessels, visualizing its vascular and extravascular manifestations, and monitoring the disease course and response to treatment. Although imaging cannot depict the vessel changes of small-vessel vasculitis directly, it can be used to detect tissue damage resulting from vessel inflammation. This article discusses the classification and clinical features of the major pediatric vasculitides. The imaging approach to and nonneurologic findings of major pediatric vasculitis subtypes are reviewed for the pediatric body imager.
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Affiliation(s)
- Geetika Khanna
- From the Mallinckrodt Institute of Radiology (G.K., K.S.) and Department of Pediatrics (K.B.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131-MIR, St Louis, MO 63110
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Lau M, Platzer K, Tüshaus L, Kohl M, Stichtenoth G. Verzögerte Diagnose eines akuten Abdomens. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Common and uncommon applications of bowel ultrasound with pathologic correlation in children. AJR Am J Roentgenol 2014; 202:946-59. [PMID: 24758646 DOI: 10.2214/ajr.13.11661] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the indications and techniques for bowel ultrasound for inflammatory bowel disease and other common and uncommon entities and describe and illustrate their imaging appearances, including endoscopic or surgical correlation. CONCLUSION Ultrasound is a useful tool for the evaluation of inflammatory bowel disease and many other bowel diseases. Radiologists must become familiar with the full potential of ultrasound in the evaluation of the bowel in children because the need for alternative radiation-free imaging techniques continues to grow.
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Dabadie A, Bellaiche M, Cardey J, Lachaux A, Michaud L, Morali A. [Current indications of ileocolonoscopy in children in 2012]. Arch Pediatr 2012; 19:1247-51. [PMID: 22995048 PMCID: PMC7133239 DOI: 10.1016/j.arcped.2012.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 07/31/2012] [Accepted: 08/06/2012] [Indexed: 01/29/2023]
Abstract
Les indications de l’iléo-coloscopie chez l’enfant ont été définies en 2002 par le Groupe francophone d’hépatologie gastroentérologie et nutrition. Ces recommandations sont mises à jour sous l’éclairage des nouvelles données et avancées technologiques de la dernière décennie. L’iléo-coloscopie reste essentiellement indiquée devant les hémorragies digestives (méléna ou rectorragies, anémie) et les suspicions de maladie inflammatoire chronique intestinale (MICI). Elle est désormais indiquée pour contrôler l’évolution des MICI, notamment pour contrôler la cicatrisation muqueuse sous traitement et l’absence de récidive postopératoire. Les indications d’iléo-coloscopie itérative sont surtout représentées par les polyposes génétiques avec des recommandations validées pour la polypose adénomateuse familiale. Les contre-indications n’ont pas été modifiées.
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Affiliation(s)
- A Dabadie
- Pôle de pédiatrie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex, France.
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