Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Case 91 - Idiopathic ileocolic intussusception
from Section 8 - Pediatrics
Published online by Cambridge University Press: 05 March 2013
Edited by
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Case 89 Thymus simulating mediastinal hematoma
- Case 90 Foreign body aspiration
- Case 91 Idiopathic ileocolic intussusception
- Case 92 Ligamentous laxity and intestinal malrotation in the infant
- Case 93 Hypertrophic pyloric stenosis and pylorospasm
- Case 94 Retropharyngeal pseudothickening
- Case 95 Cranial sutures simulating fractures
- Case 96 Systematic review of elbow injuries
- Case 97 Pelvic pseudofractures: normal physeal lines
- Case 98 Hip pain in children
- Case 99 Common pitfalls in pediatric fractures: ones not to miss
- Case 100 Non-accidental trauma: neuroimaging
- Case 101 Non-accidental trauma: skeletal injuries
- Index
- References
Summary
Imaging description
“Idiopathic” intussusception refers to distal small bowel lymphoid hyperplasia causing invagination of the ileum into the proximal colon. Such ileocolic intussusceptions without a discrete lead point and comprise the vast majority (>90%) of all pediatric intussusceptions [1].
Ultrasound is the preferred diagnostic modality for intussusception evaluation. An intussusception’s characteristic ultrasound appearance is a right abdominal mass exhibiting a swirled pattern of alternating hyperechogenicity and hypoechogenicity when the bowel is scanned transverse (Figure 91.1). This pattern of concentric rings represents alternating layers of mucosa, muscularis, and serosa. Names given to this appearance include “doughnut sign” and “pseudo-kidney” [2–4]. In longitudinal view, this bowel invagination and its various layers may resemble a sandwich (“sandwich sign”) [5].
Several accompanying sonographic features have been assessed for their ability to predict reducibility and/or bowel necrosis. These include thickness of the peripheral hypoechoic ring, the presence of fluid either trapped in the intussusception or within the peritoneal cavity, and presence of blood flow in the intussusception on Doppler interrogation [6, 7–13]. In aggregate the literature has been controversial regarding their respective prognostic abilities, rendering it difficult to predict which intussusceptions will reduce with enema or progress to bowel inviability [1].
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- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 325 - 330Publisher: Cambridge University PressPrint publication year: 2013
References
, Intussusception. Part 1: a review of diagnostic approaches. Pediatr Radiol. 2003;33(2):79–85.CrossRefGoogle ScholarPubMed
, , Intussusception: US findings with pathologic correlation – the crescent-in-doughnut sign. Radiology. 1996;199:688–92.CrossRefGoogle ScholarPubMed
, Multiple concentric ring sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol. 1978;3(3):307–9.CrossRefGoogle ScholarPubMed
, , Intussusception: indications for ultrasonography and an explanation of the doughnut and pseudokidney signs. Pediatr Radiol. 1985;15(6):388–91.CrossRefGoogle ScholarPubMed
, , , et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19:299–319.CrossRefGoogle ScholarPubMed
, , , et al. Intussusception in children: reliability of US in diagnosis – a prospective study. Radiology. 1992;184:741–4.CrossRefGoogle ScholarPubMed
, Ultrasound features of intussusception predicting outcome of air enema. Pediatr Radiol. 1999;29:705–10.CrossRefGoogle ScholarPubMed
, , , et al. Sonographic features indicative of hydrostatic reducibility of intestinal intussusception in infancy and early childhood. Eur Radiol. 2001;11(12):2576–80.CrossRefGoogle ScholarPubMed
, , , et al. Peritoneal fluid in children with intussusception: its sonographic detection and relationship to successful reduction. Abdom Imaging. 1993;18:277–9.CrossRefGoogle ScholarPubMed
, , , et al. Intussusception: trapped peritoneal fluid detected with US – relationship to reducibility and ischemia. Radiology. 1996;201(2):379–83.CrossRefGoogle ScholarPubMed
, Value of sonography including color Doppler in the diagnosis and management of long standing intussusception. Pediatr Radiol. 1992;22:112–14.CrossRefGoogle ScholarPubMed
, , , et al. Color Doppler ultrasonography in pediatric intussusception. J Ultrasound Med. 1994;13:171–4.CrossRefGoogle ScholarPubMed
, , , et al. Factors related to detection of blood flow by color Doppler ultrasonography in intussusception. J Ultrasound Med. 1997;16:141–4.CrossRefGoogle ScholarPubMed
, , Plain abdominal radiography in suspected intussusception: a reassessment. Pediatr Radiol. 1994;24:293–5.CrossRefGoogle ScholarPubMed
, , , et al. Intussusception: characteristic radiolucencies on the abdominal radiograph. Pediatr Radiol. 1994;24:293–5.CrossRefGoogle ScholarPubMed
, Frequency of right lower quadrant position of the sigmoid colon in infants and young children. Radiology. 2001;219:91–4.CrossRefGoogle ScholarPubMed
, Reliability of the abdominal plain film diagnosis in pediatric patient with suspected intussusception. Pediatr Radiol. 1980;9:199–206.CrossRefGoogle ScholarPubMed
, Intussusception: additional observations on the plain radiograph. AJR Am J Roentgenol. 1982;139:511–13.CrossRefGoogle ScholarPubMed
Diagnosis and treatment of pediatric intussusception: how far should we push our radiologic techniques?Radiology. 1994;191:622–3.CrossRefGoogle ScholarPubMed
, Using color Doppler sonography-guided reduction of intussusception to differentiate edematous ileocecal valve from residual intussusception. AJR Am J Roentgenol. 2004;182(5):1345.CrossRefGoogle ScholarPubMed
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