Medico General

12.Contemporary imaging of the child with abdominal pain or distress
David Manson
Paediatr Child Health. 2004 February; 9(2): 93–97.
PMCID: PMC2720470
Contemporary imaging of the child with abdominal pain or distress
David Manson, MD FRCPC FAAP
Department of Diagnostic Imaging, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario
Correspondence: Dr David Manson,Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8. Telephone 416-813-6031, fax 416-813-6043, e-maildavid.manson@sickkids.ca
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Abstract
As technological advances in the field of diagnostic imaging progress rapidly, there is increasing confusion as to how to utilize these resources efficiently in the evaluation ofthe child with acute abdominal pain. The history and physical examination become extremely important to help guide the subsequent imaging protocol. Plain films have limited value. Sonographic technology is particularly well suited to the child for the initial imaging investigation because the sonographic examination can demonstrate excellent sensitivity and specificity for some disease entities.Computed tomography is a useful adjunctive imaging modality, while magnetic resonance imaging for abdominal pain is still in its infancy. Nuclear medicine isotope studies will not be addressed in this review.
Keywords: Abdominal pain, Appendicitis, Imaging, Intussusception, Ultrasound
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Résumé
Avec la progression rapide des technologies dans le domaine de l’imageriediagnostique, le mode d’utilisation efficace de ces ressources dans l’évaluation de l’enfant atteint de douleurs abdominales aiguës devient de plus en plus déroutant. L’anamnèse et l’examen physique prennent une importance capitale pour orienter les protocoles d’imagerie subséquents. Les films simples ont une valeur limitée. La technologie échographique convient particulièrement bien à l’enfant dans lecadre d’une première exploration par imagerie, car l’échographie peut démontrer une sensibilité et une spécificité excellentes dans le dépistage de certaines entités pathologiques. La tomodensitométrie est une modalité d’imagerie auxiliaire utile, tandis que l’imagerie par résonance magnétique des douleurs abdominales en est encore à ses balbutiements. Les études isotopiques en médecine nucléaire nesont pas abordées dans la présente analyse.
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The clinical evaluation of the child with abdominal pain is a common, yet potentially frustrating, problem for the primary care provider. The child’s appropriate evaluation relies heavily on the initial history, the signs and symptoms, and the skillfully performed physical examination. The experienced physician will use theseto differentiate organic from functional causes of pain. It is here where the art and science of paediatrics become interwoven, screening the common, nonorganic causes of abdominal pain from those that require either further testing or immediate therapeutic intervention (eg, the obvious case of appendicitis). Subsequent testing may involve simple screening procedures such as a complete blood countand urinalysis, or the use of one or more of the various imaging modalities. As rapid technological improvements change the capabilities of each imaging modality to perform diagnostic tasks, it has become increasingly confusing to construct appropriate diagnostic algorithms in the evaluation of the child with abdominal pain.
The appropriate use of imaging relies on a careful initial history andphysical examination. These will help guide the subsequent diagnostic imaging examination to use techniques that will be most efficient at evaluating the region of interest. Unfortunately, the history, symptom complex and physical examination are, at times, difficult or nonspecific. This review of imaging modalities is primarily directed toward the previously well child with acute abdominal...