Intussusception x ray: Difference between revisions

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==Overview==
==Overview==
An x-ray may be helpful in the diagnosis of intussusception. Plain x-ray abdomen of patient are done in supine and upright position.  Findings on an x-ray suggestive of/diagnostic of intussusception include absence of air in right lower quadrant and right upper quadrant, soft tissue density in right upper quadrant in 25-60% of patients, and normal in 60% of cases.
An [[x-ray]] may be helpful in the [[diagnosis]] of intussusception. Plain abdominal [[X-rays|xray]] of patient is done in [[supine]] and upright position.  Findings on an [[x-ray]] suggestive of/[[Diagnosis|diagnostic]] of intussusception include absence of air in [[Right lower quadrant abdominal pain resident survival guide|right lower quadrant]] and right upper quadrant, [[soft tissue]] density in [[RUQ|right upper quadrant]] in 25-60% of patients, and normal in 60% of cases.


==X Ray Images==
==X Ray Images==
===Plain film===
===Plain film===
* An x-ray may be helpful in the diagnosis of intussusception. Findings on an x-ray suggestive of/diagnostic of intussusception include:
* An [[x-ray]] may be helpful in the [[diagnosis]] of intussusception. Findings on an [[x-ray]] suggestive of/[[Diagnosis|diagnostic]] of intussusception include:
** Normal in 60% of cases.
** Normal in 60% of cases  
** Absence of air in right lower quadrant and right upper quadrant.
** Absence of air in right lower quadrant and right upper quadrant
** Soft tissue density in right upper quadrant in 25-60% of patients.
** [[Soft tissue]] density in right upper quadrant in 25-60% of patients  
** Distended loops of bowel with absence of colonic gas (sign of intestinal obstruction).
** Distended loops of [[bowel]] with absence of [[Colon|colonic]] gas (sign of [[Bowel obstruction|intestinal obstruction]])  
** Target sign   
** Target sign<ref name="pmid17390062">{{cite journal |vauthors=Ratcliffe JF, Fong S, Cheong I, O'Connell P |title=Plain film diagnosis of intussusception: prevalence of the target sign |journal=AJR Am J Roentgenol |volume=158 |issue=3 |pages=619–21 |year=1992 |pmid=1739006 |doi=10.2214/ajr.158.3.1739006 |url=}}</ref>  
*** Two concentric radiolucent circles superimposed on the right kidney.  
*** Two concentric radiolucent circles superimposed on the right [[kidney]]  
*** This signifies peritoneal fat around the intussusception.  
*** This signifies [[peritoneal]] [[fat]] around the intussusception   
*** A study shows target sign is present in 26% of patients.<ref name="pmid1739006">{{cite journal |vauthors=Ratcliffe JF, Fong S, Cheong I, O'Connell P |title=Plain film diagnosis of intussusception: prevalence of the target sign |journal=AJR Am J Roentgenol |volume=158 |issue=3 |pages=619–21 |year=1992 |pmid=1739006 |doi=10.2214/ajr.158.3.1739006 |url=}}</ref>   
*** A study shows target sign is present in 26% of patients<ref name="pmid1739006">{{cite journal |vauthors=Ratcliffe JF, Fong S, Cheong I, O'Connell P |title=Plain film diagnosis of intussusception: prevalence of the target sign |journal=AJR Am J Roentgenol |volume=158 |issue=3 |pages=619–21 |year=1992 |pmid=1739006 |doi=10.2214/ajr.158.3.1739006 |url=}}</ref>   
** Crescent sign
** Crescent sign
*** A soft tissue density projecting into the gas of the large bowel.    
*** A [[soft tissue]] density projecting into the gas of the [[large bowel]]    
** Concealed liver margin.<ref name="pmid20401973">{{cite journal |vauthors=Saverino BP, Lava C, Lowe LH, Rivard DC |title=Radiographic findings in the diagnosis of pediatric ileocolic intussusception: comparison to a control population |journal=Pediatr Emerg Care |volume=26 |issue=4 |pages=281–4 |year=2010 |pmid=20401973 |doi= |url=}}</ref>     
** Concealed liver margin<ref name="pmid20401973">{{cite journal |vauthors=Saverino BP, Lava C, Lowe LH, Rivard DC |title=Radiographic findings in the diagnosis of pediatric ileocolic intussusception: comparison to a control population |journal=Pediatr Emerg Care |volume=26 |issue=4 |pages=281–4 |year=2010 |pmid=20401973 |doi= |url=}}</ref>     
** Xrays cannot be used to exclude intussusception in patients where suspicion of intussusception is very high.<ref name="pmid28268146">{{cite journal |vauthors=Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE |title=Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic |journal=Acad Radiol |volume=24 |issue=5 |pages=521–529 |year=2017 |pmid=28268146 |doi=10.1016/j.acra.2017.01.002 |url=}}</ref>  
** [[X-rays|Xrays]] cannot be used to exclude intussusception in patients where suspicion of intussusception is very high<ref name="pmid28268146">{{cite journal |vauthors=Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE |title=Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic |journal=Acad Radiol |volume=24 |issue=5 |pages=521–529 |year=2017 |pmid=28268146 |doi=10.1016/j.acra.2017.01.002 |url=}}</ref>  
*** Sensitivity is 48%     
*** [[Sensitivity (tests)|Sensitivity]] is 48%     
*** Specificity is 21%     
*** [[Specificity (tests)|Specificity]] is 21%     
** A study conducted on patients of intussusception showed negative [[X-rays|x-ray]] findings in 20%<ref name="pmid21242220">{{cite journal |vauthors=Weihmiller SN, Buonomo C, Bachur R |title=Risk stratification of children being evaluated for intussusception |journal=Pediatrics |volume=127 |issue=2 |pages=e296–303 |year=2011 |pmid=21242220 |doi=10.1542/peds.2010-2432 |url=}}</ref>   
** If suspicion of intussusception is low in a patient. [[X-rays|X-ray]] showing air in the [[cecum]] or terminal [[ileum]] can exclude intussusception<ref name="pmid22929143">{{cite journal |vauthors=Roskind CG, Kamdar G, Ruzal-Shapiro CB, Bennett JE, Dayan PS |title=Accuracy of plain radiographs to exclude the diagnosis of intussusception |journal=Pediatr Emerg Care |volume=28 |issue=9 |pages=855–8 |year=2012 |pmid=22929143 |doi=10.1097/PEC.0b013e318267ea38 |url=}}</ref>   
* An [[x-ray]] can be used in cases of low suspicion. But, [[ultrasound]] is superior in diagnosing and excluding intussusception   


'''Patient #1'''
[[File:Intussusception 1.jpg|thumb|Soft tissue mass projects over the right lower abdomen. No bowel dilation.
[[File:Intussusception 1.jpg|thumb|Soft tissue mass projects over the right lower abdomen. No bowel dilation.
Source: Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>
Source: Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>

Latest revision as of 17:28, 9 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

Overview

An x-ray may be helpful in the diagnosis of intussusception. Plain abdominal xray of patient is done in supine and upright position. Findings on an x-ray suggestive of/diagnostic of intussusception include absence of air in right lower quadrant and right upper quadrant, soft tissue density in right upper quadrant in 25-60% of patients, and normal in 60% of cases.

X Ray Images

Plain film

  • An x-ray may be helpful in the diagnosis of intussusception. Findings on an x-ray suggestive of/diagnostic of intussusception include:
    • Normal in 60% of cases
    • Absence of air in right lower quadrant and right upper quadrant
    • Soft tissue density in right upper quadrant in 25-60% of patients
    • Distended loops of bowel with absence of colonic gas (sign of intestinal obstruction)
    • Target sign[1]
      • Two concentric radiolucent circles superimposed on the right kidney
      • This signifies peritoneal fat around the intussusception
      • A study shows target sign is present in 26% of patients[2]
    • Crescent sign
    • Concealed liver margin[3]
    • Xrays cannot be used to exclude intussusception in patients where suspicion of intussusception is very high[4]
    • A study conducted on patients of intussusception showed negative x-ray findings in 20%[5]
    • If suspicion of intussusception is low in a patient. X-ray showing air in the cecum or terminal ileum can exclude intussusception[6]
  • An x-ray can be used in cases of low suspicion. But, ultrasound is superior in diagnosing and excluding intussusception
Soft tissue mass projects over the right lower abdomen. No bowel dilation. Source: Case courtesy of Dr Eric F Greif, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/29373">rID: 29373</a>

References

  1. Ratcliffe JF, Fong S, Cheong I, O'Connell P (1992). "Plain film diagnosis of intussusception: prevalence of the target sign". AJR Am J Roentgenol. 158 (3): 619–21. doi:10.2214/ajr.158.3.1739006. PMID 1739006.
  2. Ratcliffe JF, Fong S, Cheong I, O'Connell P (1992). "Plain film diagnosis of intussusception: prevalence of the target sign". AJR Am J Roentgenol. 158 (3): 619–21. doi:10.2214/ajr.158.3.1739006. PMID 1739006.
  3. Saverino BP, Lava C, Lowe LH, Rivard DC (2010). "Radiographic findings in the diagnosis of pediatric ileocolic intussusception: comparison to a control population". Pediatr Emerg Care. 26 (4): 281–4. PMID 20401973.
  4. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE (2017). "Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic". Acad Radiol. 24 (5): 521–529. doi:10.1016/j.acra.2017.01.002. PMID 28268146.
  5. Weihmiller SN, Buonomo C, Bachur R (2011). "Risk stratification of children being evaluated for intussusception". Pediatrics. 127 (2): e296–303. doi:10.1542/peds.2010-2432. PMID 21242220.
  6. Roskind CG, Kamdar G, Ruzal-Shapiro CB, Bennett JE, Dayan PS (2012). "Accuracy of plain radiographs to exclude the diagnosis of intussusception". Pediatr Emerg Care. 28 (9): 855–8. doi:10.1097/PEC.0b013e318267ea38. PMID 22929143.

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