MDCT and MRI Protocols in Pediatric Non-traumatic Abdominal Emergencies
Accurate and tempestive diagnosis is essential in pediatric patients with non-traumatic abdominopelvic diseases (Singh et al. Radiographics 27(5):1419–31, 2007). In emergency management of these conditions, ultrasonography (US) and multidetector-row compu
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Michele Scialpi, Maria Elena Latini, Sara Riccioni, Valeria Rondoni, Riccardo Torre, Lucia Mariotti, Alfredo D’Andrea, Raffaele Schiavone, and Lucia Manganaro
22.1
Introduction
Non-traumatic acute abdominal processes include spectrum of medical and surgical conditions in pediatric patient presenting with severe abdominal pain that develops over a period of hours (Stoker et al. 2009). The causes of these abdominal emergencies include inflammation and ischemia of abdominal organs, obstruction and perforation of a hollow organ, and gastrointestinal bleeding. Children with acute abdomen often present with acute abdominal pain, but vomiting, rectal blood loss, and even
M. Scialpi, MD (*) • M.E. Latini, MD S. Riccioni, MD • V. Rondoni, MD • R. Torre, MD L. Mariotti, MD Division of Radiology 2 and Nuclear Medicine, Department of Surgical and Biomedical Sciences, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy e-mail: [email protected]; [email protected] A. D’Andrea, MD Department of Radiology, San Giuseppe Moscati Hospital, Aversa, Caserta, Italy R. Schiavone, MD Department of Radiology, Meyer Children Hospital, Firenze, Italy L. Manganaro, MD Department of Radiological Oncological and Anatomopathological Sciences Policlinico Umberto I, La Sapienza University of Rome, Viale Regina Elena 324, Rome, Italy
sepsis may be the first symptom of severe abdominal pathology. Children are often not able to provide the desired information, which makes recognition of the cause of abdominal complaints more difficult; the consequences of a missed diagnosis may be particularly devastating at a young age (Van Heurn et al. 2014; Carty 2002). Accurate and rapid diagnosis of these conditions helps in reducing related complications (Tseng et al. 2008). Medical and surgical diseases causing abdominal pain in pediatric patients, separate into age groups, are reported in Table 22.1 (Van Heurn et al. 2014; Balachandran et al. 2013). Imaging is an important part in the evaluation of a child with acute abdomen. Plain abdominal X-rays and contrast studies may be useful in many situations. Usually ultrasonography (US) represents firstlevel method of choice (Stoker et al. 2009; Van Heurn et al. 2014). Multidetector-row computed tomography (MDCT) is an imaging technique that provides otherwise unobtainable information in US due to the highest sensitivity and specificity in pediatric patients with acute abdominal pain (Tseng et al. 2008). Specific CT imaging protocols, as splitbolus MDCT technique, are designed for children to reduce radiation exposure significantly in comparison to the conventional bi- or multiphasic CT protocols (Scialpi et al. 2015). Magnetic resonance imaging (MRI) is an attractive modality in patients for whom the risks of
© Springer International Publishing Switzerland 2016 V. Miele, M. Trinci (eds.), Imaging Non-traumatic Abdominal Emergencies in Pediatric Patients, DOI 10.1007/978-3-319-41866-7_22
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366 Table 22.1 Common causes of a
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