Point-of-care ultrasound identification of pneumatosis intestinalis in pediatric abdominal pain: a case report

James, Vigil; Warier, Aswin; Lee, Khai Pin; Ong, Yong-Kwang Gene

doi:10.1186/s13089-017-0057-0

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Moreover, US is the first-choice diagnostic test in the evaluation of children with suspected intussusception and pyloric stenosis with an overlap sensitivity and specificity when performed by imaging specialists, junior residents or pediatric emergency physicians [ 29 ]. POCUS can rule in the diagnosis of intussusception and could be useful in the estimation of blood flow, in the identification of free fluid or echogenic foci that could suggest a failure in intussusception reduction or complications [ 17 , 30 ]. Concerning pyloric stenosis, frequently suspected in projectile vomiting, there is no currently definitive consensus regarding absolute measurements [ 29 ] and ulterior research is needed in this field.…”

Section: Resultsmentioning

confidence: 99%

Point of care ultrasonography in the pediatric emergency department

et al. 2018

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ImportancePoint-of-care ultrasonography (POCUS) allows to obtain real-time images to correlate with the patient’s presenting signs and symptoms. It can be used by various specialties and may be broadly divided into diagnostic and procedural applications.ObjectiveWe aimed at reviewing current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs).FindingsUS diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited. Similarly, Focused Assessment with Sonography for Trauma (FAST) has become a standard procedure in adult emergency medicine but it is still not well codified in the pediatric practice. Concerning procedural applications of POCUS we identified 4 main groups: peripheral vascular access, bladder catheterizations, identification and drainage of abnormal fluid collections and foreign body identification.Conclusions and relevanceBedside emergency ultrasound is routinely used by adult emergency physicians and in the last 10 years its application is recognized and applied in PED. Pediatric emergency physicians are encouraged to familiarize with POCUS as it is a safe technology and can be extremely helpful in performing diagnosis, managing critical situations and guiding procedures, which results in globally improving pediatric patients care.

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Section: Resultsmentioning

confidence: 99%

Point of care ultrasonography in the pediatric emergency department

et al. 2018

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“…Many studies have shown that bedside ultrasound imaging is successful abdominal organs pathologies within adults and children. [11][12][13][14] A study that investigated the role of US performed by EPs in detecting the various causes of AAP found a 76% rate of accurate diagnosis. 3 In another study in patients with nonspecific abdominal pain, the accurate diagnosis of EPs was found a 45%.…”

Section: Discussionmentioning

confidence: 99%

Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

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et al. 2020

Hong Kong j. emerg. med.

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Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

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“…POCUS abdomen has been shown to aid and expedite the diagnosis in patients with abdominal trauma with hemoperitoneum, characterize systemic hypoperfusion and shock, detect gallstones, acute cholecystitis, and diagnose ureterolithiasis and assess for pyelonephritis [7][8][9][10]. It can be a useful adjunct for bedside diagnosis of digestive tract diseases such as intussusception, appendicitis, small bowel obstruction, and bowel perforation [3,[11][12][13]. POCUS can be a valuable imaging tool for assessing a pediatric patient with abdominal pain, in whom stringent adherence to the principle of ALARA is paramount [14].…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

et al. 2020

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Background The presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department. Case presentation We describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality. Conclusions In a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.

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Point-of-care ultrasound identification of pneumatosis intestinalis in pediatric abdominal pain: a case report

Cited by 9 publications

References 19 publications

Point of care ultrasonography in the pediatric emergency department

Point of care ultrasonography in the pediatric emergency department

Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

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