Intussusception ultrasound
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American Roentgen Ray Society Images of Intussusception |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
An ultrasound may be helpful in the diagnosis of intussusception. Findings on an ultrasound suggestive of/diagnostic of Intussusception include target sign or doughnut sign and pseudokidney sign. If the ultrasonographer is experienced then sensitivity, specificity and negative predictive value can be close to 100%.
Ultrasound
- Ultrasound is the gold standard imaging modality used to diagnose intussusception[1]
- If the ultrasonographer is experienced then [2]
- Sensitivity - 100%
- Specificity - 100%
- Negative predictive value - 100%
- Target or doughnut sign[3]
- Edematous intussuscipien forms an external ring around the centrally located intussusceptum
- Target sign is usually seen in right lower quadrant
- Layers of intussusception forms pseudo-kidney appearance on the transverse view
- Ultrasound in adults:
- Less accurate than in children
- Target sign or doughnut sign
- Concentric alternating echogenic and hypoechogenic bands
- Echogenic bands are formed by mucosa and muscularis
- Hypoechoic bands - formed by the submucosa
- Can be visualized in transverse view
- Pseudo-kidney sign - It can be visualized in longitudinal view
- The intussuscepted segment of bowel mimics a kidney
- Ultrasound can be used to diagnose ileo-ileal intussusception which is a rare form. Fluoroscopy can miss this form of intussusception
- Ultrasound can detect the pathology in 2/3rd of cases.[4]
- Color duplex can detect ischemia of intussusception. It detects lack of perfusion
- Small bowel intussusception:
- Jejuno-jejunal or jejuno-ileal, rather than ileocolic intussusception :
- If the intussusception is outside of the right lower quadrant - paraumbilical or left abdominal region
- Lesion size ≤3 cm
- In children if small bowel intussusception is suspected and the symptoms are mild
- Repeat the ultrasound to see if the finding persists as small bowel intussusceptions mostly reduce spontaneously
- If the finding persist then next step is to evaluate using a CT scan. CT scan can detect if there is a lead point
- The length of the intussusceptum is measured using ultrasound or CT scan. It helps to determine the prognosis so that management is started accordingly
- Jejuno-jejunal or jejuno-ileal, rather than ileocolic intussusception :
- Limitations of ultrasound:[5]
References
- ↑ Ko HS, Schenk JP, Tröger J, Rohrschneider WK (2007). "Current radiological management of intussusception in children". Eur Radiol. 17 (9): 2411–21. doi:10.1007/s00330-007-0589-y. PMID 17308922.
- ↑ Hryhorczuk AL, Strouse PJ (2009). "Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception". Pediatr Radiol. 39 (10): 1075–9. doi:10.1007/s00247-009-1353-z. PMID 19657636.
- ↑ Boyle MJ, Arkell LJ, Williams JT (1993). "Ultrasonic diagnosis of adult intussusception". Am. J. Gastroenterol. 88 (4): 617–8. PMID 8470658.
- ↑ Navarro O, Dugougeat F, Kornecki A, Shuckett B, Alton DJ, Daneman A (2000). "The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases". Pediatr Radiol. 30 (9): 594–603. doi:10.1007/s002470000261. PMID 11009295.
- ↑ Mrak K (2014). "Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception". J Gastrointest Oncol. 5 (4): E75–9. doi:10.3978/j.issn.2078-6891.2014.044. PMC 4110501. PMID 25083311.