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Initial Ultrasound for Meckel's Diverticulum and Duplication Cyst in Pediatric Patients: Diagnostic Performance,
Takahiro Hosokawa1, Yumiko Sato1, Yutaka Tanami1
1Department of Radiology, Saitama Children's Medical Center, Saitama, Japan.
Purpose:
To evaluate the diagnostic performance of ultrasound in detecting Meckel's diverticulum (MD) and duplication cysts (DC) and to identify factors influencing diagnostic accuracy.
Methods:
Among 66 patients with MD or DCs, we assessed the effect of symptom presence, atypical complications (hemoperitoneum, perforation, or acute pancreatitis), and lesion shape (tubular or cystic) on initial sonographic diagnostic accuracy using Fisher's exact test.
Results:
Initial ultrasound correctly diagnosed 49.9% (27/66) of cases. Correct diagnosis rates differed significantly between MD and DC (11/17 vs. 33/5, p < 0.001) and between tubular and cystic lesions (13/15 vs. 36/2, p < 0.001). No significant differences were observed for symptomatic versus asymptomatic cases (22/6 vs. 34/4, p = 0.302) or for cases with versus without atypical complications (1/27 vs. 5/33, p = 0.230). However, all DC cases with atypical complications were misdiagnosed on ultrasound.
Conclusion:
Ultrasound demonstrated reliable diagnostic performance for DCs; however, MDs were more challenging to identify. Consequently, when MDs are suspected on clinical grounds, additional imaging, such as Tc-99m scintigraphy, should be considered. In patients with DCs, atypical complications, such as hemoperitoneum or acute pancreatitis, may obscure sonographic diagnosis. Sonographers should therefore include DCs in the differential diagnosis when these complications arise without an apparent etiology.
Insights
Ultrasound accurately diagnosed duplication cysts (DCs) but struggled with Meckel's diverticulum (MD). Additional imaging is recommended for suspected MD, and sonographers should consider DCs in atypical complications.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Pediatric Surgery
Background:
- Meckel's diverticulum (MD) and duplication cysts (DCs) are congenital gastrointestinal anomalies.
- Accurate and timely diagnosis is crucial for effective management and preventing complications.
Purpose of the Study:
- To assess the diagnostic accuracy of ultrasound for Meckel's diverticulum (MD) and duplication cysts (DCs).
- To identify factors influencing the sonographic diagnostic performance for these conditions.
Main Methods:
- Retrospective analysis of 66 patients with confirmed MD or DCs.
- Evaluation of ultrasound diagnostic accuracy based on symptom presence, atypical complications, and lesion morphology (tubular vs. cystic).
- Statistical analysis using Fisher's exact test to determine significant factors.
Main Results:
- Overall ultrasound diagnostic accuracy was 49.9% (27/66).
- Higher accuracy for duplication cysts (DCs) compared to Meckel's diverticulum (MD) (33/5 vs. 11/17).
- Cystic lesions were diagnosed more accurately than tubular lesions; atypical complications in DCs led to misdiagnosis.
Conclusions:
- Ultrasound is reliable for diagnosing duplication cysts (DCs) but less so for Meckel's diverticulum (MD).
- Consider Tc-99m scintigraphy for suspected Meckel's diverticulum (MD) when clinical suspicion is high.
- Atypical complications in duplication cysts (DCs) can obscure sonographic findings, necessitating their inclusion in the differential diagnosis.
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