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Pediatric Imaging

E2939. Don’t Throw the Baby Out with the Bathwater: Avoiding Pitfalls of the Pediatric Acute Abdomen

Gill H1,  Covelli J2,  Haug J1,  May L1,  Zarka A.1 1. Brooke Army Medical Center, Ft. Sm Houston, TX; 2. San Antonio Military Medical Center, San Antonio, TX

Address correspondence to J. Haug (james.c.haug2.mil@mail.mil)

Background Information: Accurate diagnosis of acute pathology in the pediatric abdomen can be a challenging diagnostic dilemma in pediatrics that frequently relies on the appropriate use of radiography, fluoroscopy, ultrasound, CT and occasionally MRI to make the correct diagnosis. Knowledge of normal anatomy, anatomic variants, and the inherent limitations of each imaging modality is important to avoid unnecessary potentially invasive interventions and/or delay in diagnosis and management. The objective of this exhibit is to raise awareness among general radiologists, pediatric radiologists, and clinicians of the appropriate utilization of imaging in this clinical setting as well as frequently associated imaging pitfalls.

Educational Goals/Teaching Points: We understand how the appropriate and timely use of multiple imaging modalities is critical to the accurate diagnosis of acute pediatric abdominal pathology. We identify important anatomical relationships, anatomical variants, and image modality limitations that may predispose to imaging pitfalls and result in incorrect or delayed diagnosis. We highlight and review common pediatric abdominal emergency findings.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We review the ACR appropriateness criteria and Imaging Gently guidelines for imaging in the pediatric patient with acute abdominal pain. We present a staged imaging algorithm based on common clinical presentations that takes into account the benefits, disadvantage and limitations of each modality. We review common etiologies of acute pain in the pediatric patient and common pitfalls that illustrate the importance of appropriate imaging technique and potential challenges to accurate interpretation.

Conclusion: Utilizing appropriate and timely imaging is critical to the diagnosis of pediatrics patients presenting with acute abdominal pain. Failure to utilize appropriate imaging modalities or failing to recognize anatomic variations and limitations of each modality can result in incorrect or delayed diagnoses that can have significant adverse clinical results.