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Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus
Y Shimanuki1, T Aihara, H Takano
1Department of Radiology, Saitama Children's Medical Center, Japan.
Insights
The clockwise whirlpool sign on color Doppler ultrasound is highly accurate for diagnosing midgut volvulus in children. This imaging technique should be the first step for suspected cases.
Area of Science:
- Pediatric radiology
- Gastrointestinal diagnostics
- Medical imaging technology
Background:
- Midgut volvulus is a surgical emergency in pediatric patients.
- Early diagnosis is crucial for preventing intestinal ischemia and necrosis.
- Conventional imaging methods may have limitations in diagnosing midgut volvulus.
Purpose of the Study:
- To assess the diagnostic utility of the clockwise whirlpool sign.
- To evaluate color Doppler ultrasound (US) for midgut volvulus detection.
- To determine the accuracy of the whirlpool sign in pediatric patients.
Main Methods:
- A study involving pediatric patients with suspected midgut volvulus.
- Abdominal grayscale and color Doppler US were performed.
- The whirlpool sign, defined as the mesenteric vessels wrapping around the superior mesenteric artery, was analyzed for its rotational direction.
Main Results:
- The clockwise whirlpool sign was observed in 12 out of 13 surgically confirmed midgut volvulus cases.
- The sign was absent in patients without midgut volvulus.
- Sensitivity, specificity, and positive predictive value for the clockwise whirlpool sign were 92%, 100%, and 100%, respectively.
Conclusions:
- The clockwise whirlpool sign is a reliable indicator of midgut volvulus.
- Color Doppler US is recommended as an initial diagnostic tool for suspected midgut volvulus in children.
- This imaging modality offers high accuracy in identifying this critical condition.
Purpose:
To evaluate the clockwise whirlpool sign at color Doppler ultrasound (US) in the diagnosis of midgut volvulus.
Materials And Methods:
Pediatric patients (160 boys, 76 girls; age range, 0 day to 14 years) with possible midgut volvulus underwent abdominal gray-scale US and color Doppler US. Midgut volvulus was diagnosed by recognition of the whirlpool sign (wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery). If the whirlpool rotated clockwise with caudal movement of the transducer, the direction of the whirlpool was defined as clockwise.
Results:
Color Doppler US showed a whirlpool sign that was clockwise in 12 of 13 patients with surgically confirmed midgut volvulus and counterclockwise in three patients without midgut volvulus. Sensitivity, specificity, and positive predictive value of clockwise whirlpool sign for midgut volvulus were 92%, 100%, and 100%.
Conclusion:
The clockwise whirlpool sign is diagnostic of midgut volvulus. Color Doppler US should be performed as an initial imaging study in children suspected of having midgut volvulus.