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Congenital hypertrophic pyloric stenosis. (A) Barium meal study in early phase (frontal view) shows normal contrast-filled esophagus with gas-filled distended stomach. (B, C) Images in later phase acquired in oblique and lateral views show distended contrast-filled stomach with elongated pylorus (white arrow) and narrow lumen (string sign).
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Pediatric stomach and duodenum abnormalities constitute a unique spectrum of conditions unlike adults which are categorized broadly into congenital, inflammatory, neoplastic and miscellaneous conditions. The aim of this article is to describe the role of imaging modalities in gastric and duodenal pathology in children. Some of the entities are uniq...
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... Commonly starts in a supine position, positioning maneuvers helpful (changing to right/left/lateral decubitus); sometimes posterior access may improve assessment, particularly of dorsal parts or if gas impairs access. Preferred high-frequency transducer (pylorus, ventral wall) with highresolution linear (or curved array) [11]. Indications are mostly vomiting (non-bilious) and bloody gastric aspirate, which are also included in the upper abdomen abdominal POCUS assessment. ...
... It typically occurs more in boys aged 2-12 weeks. Treatment is usually by surgery, although medical conservative treatment may be an option in early and mild diseases with high surgical risk [11,13] (Fig. 6). ...
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.
... Abdominal radiographs may appear normal or indicate signs of a proximal blockage. The next diagnostic step usually involves an upper gastrointestinal study, which reveals an abnormal positioning of the duodenojejunal junction, where the duodenum remains to the right of the spine and descends inferiorly (Fig. 13) [10,11]. ...
Trisomy 21, commonly known as Down syndrome (DS), stands as the most prevalent genetic source of intellectual disability worldwide. Individuals with Down syndrome may experience a range of abnormalities affecting multiple organ systems. The distinctive facial features and musculoskeletal characteristics evident at birth often make the diagnosis apparent if it has not been established during pregnancy. Depending on the severity of specific findings, children with Down syndrome may undergo radiological assessments at various stages of their development. The cardiovascular system, the digestive system, the facial look, the morphology of hearing aids, and the central nervous system can all be impacted by Down syndrome. An early diagnosis, especially during prenatal care, allows for better planning and preparation for the child's birth. Therefore, it is essential to have a comprehensive understanding of the radiological characteristics associated with Down syndrome patients. In conclusion, Down syndrome is associated with various radiological features. Indicators of Down syndrome can include the presence of atrioventricular septal abnormalities, tetralogy of Fallot, macroglossia, esophageal atresia, microcephaly, and structural alterations in the musculoskeletal system. During fetal imaging, it is important to assess the volume of amniotic fluid, particularly in the context of nuchal translucency, as well as determine the presence or absence of nasal bones in the fetus.
... Near-field structures such as the pylorus and ventral wall of the stomach can be best visualized using high-resolution linear (or curved array) transducers [11]. The indications for gastric ultrasound include non-bilious vomiting, the assessment of gastric contents, and its inclusion in upper abdominal ultrasound protocols. ...
... The ultrasound appearance of stomach contents varies depending on fluid or food content and the amount of air. The pylorus usually shows a slight thickening of the muscular wall compared to the stomach [11]. ...
... Clinically, pyloric stenosis is characterized by episodic abdominal pain with propulsive nonbilious vomiting and most commonly occurs in boys aged 4-12 weeks of age. Pyloric stenosis is typically treated surgically, though conservative medical management may be an option in early and mild disease as well as in patients with high surgical risk [11,13]. Figure 7 demonstrates ultrasound findings consistent with pyloric stenosis. ...
Abdominal point-of-care ultrasound (POCUS) can be used to evaluate a number of clinical conditions in neonatal and pediatric populations. Similar to other methods of ultrasound assessment, abdominal POCUS allows providers the opportunity to evaluate real-time physiology and, alongside other clinical markers and context, guide diagnostic and therapeutic decisions. This chapter discusses abdominal POCUS applications relevant to neonatal and pediatric intensivists.KeywordsAbdomenPoint-of-care ultrasoundNeonatal necrotizing enterocolitisPerforationIschemia
... Prithviraj et al have presented an extensive review of pediatric gastric and duodenal pathologies, starting from the very common hypertrophic pyloric stenosis to the very rare entities such as malignancies. 5 Rastogi et al have discussed an important clinical condition, gastric outlet obstruction, in light of modern imaging philosophy. The emphasis given CT should prove very useful to our readers, as it reflects their current clinical practice. ...
