Intussusception ultrasound: Difference between revisions
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==Overview== | ==Overview== | ||
An | 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 (tests)|sensitivity]], [[Specificity (tests)|specificity]] and [[negative predictive value]] can be close to 100%. | ||
==Ultrasound== | ==Ultrasound== | ||
* Ultrasound is the gold standard imaging modality used to diagnose | * [[Ultrasound]] is the [[Gold standard (test)|gold standard]] imaging modality used to diagnose intussusception<ref name="pmid17308922">{{cite journal |vauthors=Ko HS, Schenk JP, Tröger J, Rohrschneider WK |title=Current radiological management of intussusception in children |journal=Eur Radiol |volume=17 |issue=9 |pages=2411–21 |year=2007 |pmid=17308922 |doi=10.1007/s00330-007-0589-y |url=}}</ref> | ||
* If the ultrasonographer is experienced then <ref name="pmid19657636">{{cite journal |vauthors=Hryhorczuk AL, Strouse PJ |title=Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception |journal=Pediatr Radiol |volume=39 |issue=10 |pages=1075–9 |year=2009 |pmid=19657636 |doi=10.1007/s00247-009-1353-z |url=}}</ref> | * If the ultrasonographer is experienced then <ref name="pmid19657636">{{cite journal |vauthors=Hryhorczuk AL, Strouse PJ |title=Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception |journal=Pediatr Radiol |volume=39 |issue=10 |pages=1075–9 |year=2009 |pmid=19657636 |doi=10.1007/s00247-009-1353-z |url=}}</ref> | ||
** [[Sensitivity]] - 100% | ** [[Sensitivity]] - 100% | ||
** [[Specificity]] - 100% | ** [[Specificity]] - 100% | ||
** Negative predictive value - 100% | ** [[Negative predictive value]] - 100% | ||
* Target or doughnut sign<ref name="pmid8470658">{{cite journal |vauthors=Boyle MJ, Arkell LJ, Williams JT |title=Ultrasonic diagnosis of adult intussusception |journal=Am. J. Gastroenterol. |volume=88 |issue=4 |pages=617–8 |year=1993 |pmid=8470658 |doi= |url=}}</ref> | * Target or doughnut sign<ref name="pmid8470658">{{cite journal |vauthors=Boyle MJ, Arkell LJ, Williams JT |title=Ultrasonic diagnosis of adult intussusception |journal=Am. J. Gastroenterol. |volume=88 |issue=4 |pages=617–8 |year=1993 |pmid=8470658 |doi= |url=}}</ref> | ||
** Edematous | ** Edematous intussuscipien forms an external ring around the centrally located intussusceptum | ||
** Target sign is usually seen in right lower quadrant | ** Target sign is usually seen in right lower quadrant | ||
* Layers of intussusception forms pseudo-kidney appearance on the transverse view | * Layers of intussusception forms pseudo-kidney appearance on the transverse view | ||
* [[Ultrasound]] in adults | * [[Ultrasound]] in adults: | ||
** Less accurate than in children | ** Less accurate than in children | ||
** [[Target sign]] or doughnut sign | ** [[Target sign]] or doughnut sign | ||
*** Concentric alternating echogenic and hypoechogenic bands | *** Concentric alternating [[Echogenicity|echogenic]] and hypoechogenic bands | ||
*** Echogenic bands are formed by mucosa and muscularis | *** [[Echogenic]] bands are formed by [[mucosa]] and [[Muscularis mucosae|muscularis]] | ||
*** Hypoechoic bands - formed by the submucosa | *** Hypoechoic bands - formed by the [[submucosa]] | ||
*** Can be visualized in transverse view | *** Can be visualized in transverse view | ||
** Pseudo-kidney sign - It can be visualized in longitudinal view | ** Pseudo-kidney sign - It can be visualized in longitudinal view | ||
** The intussuscepted segment of bowel | ** 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 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 | * [[Ultrasound]] can detect the [[pathology]] in 2/3rd of cases.<ref name="pmid11009295">{{cite journal |vauthors=Navarro O, Dugougeat F, Kornecki A, Shuckett B, Alton DJ, Daneman A |title=The impact of imaging in the management of intussusception owing to pathologic lead points in children. A review of 43 cases |journal=Pediatr Radiol |volume=30 |issue=9 |pages=594–603 |year=2000 |pmid=11009295 |doi=10.1007/s002470000261 |url=}}</ref> | ||
* Color duplex can detect ischemia of intussusception. It detects lack of perfusion | * Color duplex can detect [[ischemia]] of intussusception. It detects lack of [[perfusion]] | ||
* Small bowel intussusception | * [[Small bowel]] intussusception: | ||
** Jejuno-jejunal or jejuno-ileal, rather than ileocolic 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 | *** If the intussusception is outside of the right lower quadrant - paraumbilical or left [[abdominal]] region | ||
*** Lesion size ≤3 cm | *** Lesion size ≤3 cm | ||
** In children | ** 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 | *** 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 | *** If the finding persist then next step is to evaluate using a [[Computed tomography|CT scan]]. [[Computed tomography|CT scan]] can detect if there is a lead point | ||
** The length of the intussusceptum is measured using ultrasound or CT. It helps to determine the prognosis so that management is started accordingly | ** The length of the intussusceptum is measured using [[ultrasound]] or [[Computed tomography|CT scan]]. It helps to determine the [[prognosis]] so that management is started accordingly | ||
* Limitations of ultrasound | * Limitations of [[ultrasound]]:<ref name="pmid25083311">{{cite journal |vauthors=Mrak K |title=Uncommon conditions in surgical oncology: acute abdomen caused by ileocolic intussusception |journal=J Gastrointest Oncol |volume=5 |issue=4 |pages=E75–9 |year=2014 |pmid=25083311 |pmc=4110501 |doi=10.3978/j.issn.2078-6891.2014.044 |url=}}</ref> | ||
** In cases of bowel distension and morbid obesity, massive air can result in reduced rate of detection and diagnosis of intussusception. | ** In cases of [[bowel]] distension and morbid [[obesity]], massive air can result in reduced rate of detection and [[diagnosis]] of intussusception. | ||
[[File:Intussusception - Target Sign .jpg|Target Sign . Source: Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/6502">rID: 6502</a> |thumb|300x300px|none]] | [[File:Intussusception - Target Sign .jpg|Target Sign . Source: Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/6502">rID: 6502</a> |thumb|300x300px|none]] | ||
Latest revision as of 17:50, 9 January 2018
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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.