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Ultrasound findings of acute pancreatitis in children
Andrew T Trout1,2,3, Rupesh Patel4, Jaimie D Nathan5
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. andrew.trout@cchmc.org.
Insights
Peripancreatic edema is the most common ultrasound finding in pediatric acute pancreatitis, observed in up to 63% of cases. Pancreas duct dilation, a previously reliable indicator, was rarely seen in children.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Diagnostic Ultrasound
Background:
- Systematic documentation of ultrasound (US) findings in pediatric acute pancreatitis is limited.
- Pancreas duct dilation is considered a reliable indicator of acute pancreatitis but lacks rigorous examination in children.
Purpose of the Study:
- To systematically document US findings in children diagnosed with acute pancreatitis.
- To determine the interobserver agreement on these US findings.
Main Methods:
- Retrospective cross-sectional study of pediatric patients (<18 years) enrolled in an acute pancreatitis registry (March 2013 - July 2020).
- Two blinded observers reviewed the initial transabdominal US examination within two weeks of pancreatitis onset.
- Analysis of US findings and interobserver agreement using kappa statistics.
Main Results:
- Ultrasound was performed at a median of 1 day post-attack in 141 children.
- Peripancreatic edema was the most frequent finding (54-63%), with substantial interobserver agreement.
- Pancreatic duct dilation was rare (12-14%), and the duct was visible in only 35% of patients.
Conclusions:
- Peripancreatic edema is the most common US finding in pediatric acute pancreatitis, showing high interobserver agreement.
- Pancreas duct dilation, though cited as reliable, is infrequently identified in children with acute pancreatitis on ultrasound.
Background:
Studies systematically documenting US findings in children with acute pancreatitis are limited. Pancreas duct dilation is described as the most reliable finding of acute pancreatitis but this has not been rigorously examined in children.
Objective:
To systematically document US findings in children with acute pancreatitis and to define interobserver agreement on those findings.
Materials And Methods:
In this cross-sectional study we retrospectively reviewed images for all pediatric patients <18 years of age who had been prospectively enrolled in a registry of patients with index admissions for acute pancreatitis between March 2013 and July 2020. Two blinded observers (R1, R2) reviewed the first transabdominal US examination performed within 2 weeks of the pancreatitis attack for each patient.
Results:
In 141 children, US was performed at a median of 1 day (interquartile range [IQR]: 0, 1) following acute attack. Thirty-three (23%, R1) and 38 (27%, R2) children had no abnormal findings on US. Peripancreatic edema was the most frequent finding documented by both reviewers (63% R1, 54% R2). The pancreatic duct was visible in only 35% of the children and was dilated in only 12% (R1) and 14% (R2). There was substantial to almost-perfect agreement between reviewers on findings of acute pancreatitis (κ=0.62-1), including duct visibility.
Conclusion:
Peripancreatic edema was the most frequently identified finding in children with acute pancreatitis, present in up to 63%, with almost perfect interobserver agreement. Duct dilation, cited in the literature as a reliable finding of acute pancreatitis, was rarely identified in our sample.
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