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Tuesday, November 12, 2019
Home Specialties Emergency Medicine Non-Invasive Approaches to Emergency Pediatric Diagnostic Imaging

Non-Invasive Approaches to Emergency Pediatric Diagnostic Imaging

Radiologic imaging, including computed tomography (CT), continues to be a standard approach to diagnosing pediatric conditions in the emergency department. In a number of settings, ultrasound (US) offers a non-invasive alternative to exposing the pediatric patient to the ionizing radiation of other techniques. US is low-cost and can be done at the bedside.

A study from the National Institutes of Health showed that children are susceptible to a variety of forms of cancer due to exposure to ionizing radiation.[1] These malignancies include those involving the skin, breast, and brain as well as leukemia.

In an article in Applied Radiology, Saigal and colleagues[2] provide a detailed review of the many clinical applications for US. A brief summary follows. 

Pediatric Trauma
US can quickly detect the presence of abdominal fluid. Four areas in particular can be examined: right and left upper quadrants, pericardium and pelvis. This is an especially useful diagnostic technique with the unstable child patient because of its speed and availability. Saigal and colleagues note that for an unstable patient who has sustained blunt trauma, US is significantly quicker and less expensive than CT or diagnostic peritoneal lavage.[2]

Gastrointestinal Pathology
US can verify suspected anomalies, such as malrotation and volvulus. US can be a useful adjunct to an upper GI contrast study, still the diagnostic gold standard, when volvulus is suspected. 

Pyloric stenosis
When the pyloric muscle causes a narrowing of the esophageal entrance into the stomach, US can show the shape and size of the deformity.

Intussusception
Early diagnosis improves the patient’s prognosis and US is an option to gain quick insight into the condition.

Appendicitis
This continues to be one of the most common childhood emergencies. Again, rapid diagnosis at the bedside with an US study can confirm your suspicions. 

Scrotal abnormalities
US is the primary imaging modality for evaluating the acute scrotum, including testicular torsion, testicular appendage torsion, epididymitis, orchitis, hernia, hematocele, and abscess.[2]

Ovarian conditions
Such conditions as abscesses, ectopic pregnancy, and ovarian torsion can be detected by US.

Pancreatitis and cholecystisis
Cysts, abscesses, necrosis, and hemorrhage can be identified by a US examination of the pancreas and pancreatic duct. 

Renal conditions
Pyelonephritis and ureteropelvic junction obstruction cause severe abdominal pain in the pediatric patient. US is less capable of detecting pyelonephritis, but it does disclose complications such as abscesses and pyonephrosis.

Head trauma
US studies can detect the presence of subdural hematomas by showing the displacement of blood vessels in relation to the surface of the child’s brain.

Hip effusion
US is used to guide the aspiration of fluid from the affected joint when septic arthritis is suspected. 

Foreign bodies
US can help determine the position and composition of a foreign body. Metal and plastic are easily distinguishable.

Bottom Line
In specific settings, US can help minimize the exposure of pediatric patients to ionizing radiation. The procedure is relatively low-cost, and can be done at the bedside. Preparation time is minimal. 

Last updated on 9/25/19.

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