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CT of intussusception in the pediatric patient: diagnosis and pitfalls
T D Cox1, W D Winters, E Weinberger
1Department of Radiology, University of Washington School of Medicine and Children's Hospital and Medical Center, CH-69, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
Insights
Computed tomography (CT) effectively identifies intussusception in children, revealing intraluminal masses and characteristic signs like the target sign. However, atypical presentations can mimic intussusception on CT scans.
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Gastrointestinal Diseases
Background:
- Pediatric intussusception presents variably based on location, lead point, and systemic factors.
- Computed tomography (CT) aids in evaluating complex pediatric intussusception cases.
Purpose of the Study:
- To review computed tomography (CT) imaging findings in pediatric patients diagnosed with intussusception.
Main Methods:
- Retrospective review of CT scans from five pediatric patients diagnosed with intussusception between 1989 and 1994.
- Analysis of imaging features including intraluminal masses, fat, target sign, and signs of bowel compromise.
Main Results:
- All five patients demonstrated intraluminal masses on CT.
- The 'target sign' and intraluminal fat were common findings.
- Long-standing cases showed fluid distension, inflammation, and tissue plane loss, correlating with surgical findings of necrosis.
Conclusions:
- CT is valuable for diagnosing pediatric intussusception, identifying key features.
- Awareness of potential pitfalls, such as other conditions mimicking the 'target sign,' is crucial for accurate diagnosis.
Abstract:
Intussusception in the pediatric patient may have a varied clinical presentation depending on its location, presence of lead point, intermittent occurrence, or underlying systemic disease. Computed tomography (CT) may be used at times in the evaluation of children with complicated presentations. The purpose of this investigation was to review the findings of CT images obtained in children with intussusception. Five patients with intussusception were diagnosed by CT at our institution between 1989 and 1994. An intraluminal mass was found in all patients. Intraluminal eccentrically located fat, as well as the target sign of alternating layers of high and low attenuation, was seen in most patients. In patients with a more long-standing process, fluid-distended loops, inflammation, and loss of tissue planes were seen and corresponded with necrosis and areas of nonviable bowel found at surgery. Finally, potential pitfalls with the layered or target appearance are discussed in the form of two patients who were initially felt to have intussusception at CT, but in whom the target appearance was later found to be due to other processes.