Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Case 44 Ruptured appendicitis mimicking an intussusception
- Case 45 Choledochal cyst
- Case 46 Henoch–Schönlein purpura
- Case 47 Biliary atresia
- Case 48 Mesenchymal hamartoma of the liver
- Case 49 Lymphoid follicular hyperplasia
- Case 50 Midgut volvulus
- Case 51 Foveolar hyperplasia: post prostaglandin therapy
- Case 52 Pneumatosis cystoides intestinalis
- Case 53 Desmoplastic small round cell tumor
- Case 54 Post-transplantation lymphoproliferative disorder
- Case 55 Traumatic pancreatic injury
- Case 56 Meconium ileus
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Case 44 - Ruptured appendicitis mimicking an intussusception
from Section 5 - Gastrointestinal imaging
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Case 44 Ruptured appendicitis mimicking an intussusception
- Case 45 Choledochal cyst
- Case 46 Henoch–Schönlein purpura
- Case 47 Biliary atresia
- Case 48 Mesenchymal hamartoma of the liver
- Case 49 Lymphoid follicular hyperplasia
- Case 50 Midgut volvulus
- Case 51 Foveolar hyperplasia: post prostaglandin therapy
- Case 52 Pneumatosis cystoides intestinalis
- Case 53 Desmoplastic small round cell tumor
- Case 54 Post-transplantation lymphoproliferative disorder
- Case 55 Traumatic pancreatic injury
- Case 56 Meconium ileus
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Summary
Imaging description
A six-year-old child presented to the ER with abdominal pain. A ultrasound (US) study (Fig. 44.1a, b) demonstrated a lesion in the right lower quadrant with a pattern of alternating sonolucent and hyperechoic layers, giving an appearance of a bowel loop-within-loop, suggesting intussusception.
A plain radiograph of the abdomen (Fig. 44.1c) revealed blurring of the right flank fat plane, medial displacement of ascending colon gas, and subtle scoliosis of the spine, indicating a right-sided inflammatory process or mass. A contrast enema was obtained to reduce the intussusception diagnosed on US (Fig. 44.1d). The study revealed a possible filling defect at the hepatic flexure which rapidly disappeared (? reduced intussusception) and normal reflux of contrast was noted into the ileum (Fig. 44.1d). The child continued to have abdominal pain, fever, and high white blood cell count. Repeat US the following morning demonstrated a similar, slightly more complex layered pattern and marked surrounding echogenic inflammation was noted (Fig. 44.1e). Taking into account the clinical and laboratory findings as well as the child’s age (old for typical idiopathic intussusception), perforated appendicitis with phlegmon/abscess was suggested as a more likely diagnosis. CT examination confirmed ruptured acute appendicitis with an appendicolith and periappendiceal fluid collection/abscess (Fig. 44.1f, g).
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 196 - 200Publisher: Cambridge University PressPrint publication year: 2014