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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Ultrasound findings and their utility in paediatric mesenteric adenitis: A scoping review
Rashed Chowdhury1, David McCreary1, Cameron Hamilton1
1Paediatric Emergency Department, Sunderland Royal Hospital, Sunderland and South Tyneside NHS Foundation Trust, South Shields, SR4 7TP, UK.
Insights
Ultrasound is a common tool for diagnosing pediatric mesenteric adenitis, but clear diagnostic criteria are lacking. More research is needed to establish reliable ultrasound criteria and assess point-of-care ultrasound
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Diagnostic Ultrasound
Background:
- Mesenteric adenitis is a frequent diagnosis in children with acute abdominal pain.
- Ultrasound is the preferred imaging modality for right-sided abdominal pain in children.
- Unlike appendicitis, clear diagnostic criteria for mesenteric adenitis are not well-established.
Purpose of the Study:
- To review ultrasound findings for pediatric mesenteric adenitis.
- To synthesize diagnostic criteria, sonographic appearances, and techniques.
- To identify research gaps for future studies on pediatric mesenteric adenitis.
Main Methods:
- A scoping review was conducted following PRISMA-ScR guidelines.
- Searched major databases (PubMed, Embase, Scopus, Cochrane Library).
- Included studies on patients aged 1-18 years undergoing ultrasound for suspected mesenteric adenitis.
Main Results:
- Seventeen studies were included; only one focused on point-of-care ultrasound.
- Heterogeneous definitions of mesenteric adenitis and inconsistent reporting of associated features were noted.
- Small sample sizes, retrospective designs, and limited assessment of interobserver reliability were common.
Conclusions:
- Consensus on ultrasound diagnostic criteria for pediatric mesenteric adenitis is lacking.
- Evidence for point-of-care ultrasound in this context is minimal.
- Prospective studies are required to establish reliable criteria and evaluate point-of-care ultrasound utility.
Background:
Mesenteric adenitis is a commonly made diagnosis for children presenting to the Paediatric Emergency Department with acute abdominal pain. Ultrasound is recommended as the first-line imaging modality for children with right-sided abdominal pain owing to its safety and diagnostic value. Unlike appendicitis, however, diagnostic criteria for mesenteric adenitis are not clearly defined.
Objectives:
To synthesise the literature on ultrasound findings for paediatric mesenteric adenitis, including diagnostic criteria, sonographic appearances and techniques. By undertaking this review, we aimed to identify gaps in the literature to inform future research.
Methods:
We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. We searched PubMed, Embase, Scopus and the Cochrane Library for studies involving patients 1-18 years who underwent radiology-performed or point-of-care ultrasound for suspected mesenteric adenitis with findings synthesised thematically.
Results:
Seventeen studies were included. Only one evaluated point-of-care-ultrasound. Definitions of mesenteric adenitis were heterogeneous in terms of the number of lymph nodes visible and lymph node size. Associated features such as bowel wall thickening, periportal cuffing and systemic signs were reported inconsistently. Advanced modalities including Doppler, superb microvascular imaging and elastography were explored in a minority of studies, while few provided longitudinal follow-up data. Sample sizes were generally small, designs were retrospective, and interobserver reliability was rarely assessed.
Conclusion:
Ultrasound is widely used for paediatric mesenteric adenitis, but diagnostic criteria lack consensus. Evidence reporting the use of point-of-care ultrasound is minimal. Prospective studies are needed to establish reliable diagnostic criteria and clarify the clinical utility of point-of-care ultrasound in this setting.
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