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Published on: September 8, 2023
Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric
Lichun Hua1, Yaqing Huang2, Hui Liu1
1Department of Ultrasound, Children's Hospital of Nanjing Medical University, No. 88, Jiangdong East Road, Jianye District, Nanjing, Jiangsu, P.R. China.
Insights
High-resolution ultrasound and multi-slice computed tomography (MSCT) significantly improve the diagnosis of pediatric intra-abdominal hernias (IAHs). This combined imaging approach enhances accuracy and helps identify causes of missed diagnoses in children.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Radiology
Background:
- Intra-abdominal hernias (IAHs) in children pose diagnostic challenges.
- Missed or misdiagnosed IAHs can lead to serious complications like strangulated intestinal obstruction.
Purpose of the Study:
- To evaluate the diagnostic value of combining high-resolution ultrasound with multi-slice computed tomography (MSCT) for pediatric IAHs.
- To identify reasons for missed diagnoses and misdiagnoses of IAHs in children.
Main Methods:
- Retrospective analysis of 45 surgically confirmed pediatric IAH cases.
- Comparison of diagnostic rates between combined imaging (ultrasound + MSCT) and intraoperative findings.
- Analysis of factors contributing to diagnostic errors.
Main Results:
- Combined ultrasound and MSCT achieved an 88.9% diagnostic rate for pediatric IAHs.
- High-resolution ultrasound alone had a 77.8% diagnostic rate, with the "cross sign" as a key feature.
- MSCT aided in diagnosing 5 of 10 initially missed or misdiagnosed cases.
Conclusions:
- Combined high-resolution ultrasound and MSCT significantly improve diagnostic accuracy for pediatric IAHs.
- Mesenteric defects are a common type of primary IAH and are prone to complications.
- Understanding diagnostic pitfalls is crucial for timely intervention in pediatric IAHs.
Introduction:
To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children.
Methods:
A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed.
Results:
Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%.
Discussion:
IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.
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