Intussusception x ray: Difference between revisions
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==Overview== | ==Overview== | ||
An x-ray may be helpful in the diagnosis of intussusception. Plain | 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 | *** 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 | ** 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 | ** [[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 | |||
[[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
- A soft tissue density projecting into the gas of the large bowel
- Concealed liver margin[3]
- Xrays cannot be used to exclude intussusception in patients where suspicion of intussusception is very high[4]
- Sensitivity is 48%
- Specificity is 21%
- 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
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.