Limits...
Diagnostic accuracy of ultrasound in determining the cause of bilious vomiting in neonates.

Alehossein M, Abdi S, Pourgholami M, Naseri M, Salamati P - Iran J Radiol (2012)

Bottom Line: The results were compared with clinical and radiological data and the final diagnosis.All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%].This study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Department of Radiology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Plain radiography and contrast radiologic studies are traditionally the main options in evaluating neonates presenting with bilious vomiting. While ultrasonography (US) is more available, its diagnostic accuracy is in question.

Objectives: The purpose of this study is to determine the diagnostic accuracy of US in evaluating these patients with bilious vomiting.

Patients and methods: All neonates with bilious vomiting or bilious nasogastric tube drainage presented to a children's hospital in a 1.5-year period were included. US were performed in all patients. The results were compared with clinical and radiological data and the final diagnosis. We used chi-square and Fisher's exact tests for analysis.

Results: The cause of bilious vomiting for 18 of the 23 included patients was surgical. All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%]. The sensitivity and specificity of US in diagnosing intestinal atresia (n = 9) was 89% [CI 95%: (68% - 100%)] and 100%. In cases with malrotation (n = 4) and midgut volvulus (n = 2), sonographic diagnosis was in concordance with final surgical diagnosis.

Conclusion: This study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

No MeSH data available.


Related in: MedlinePlus

A 5-day male neonate with bilious vomitingTransverse color Doppler sonogram of the upper abdomen shows a whirlpool sign with a clockwise direction. Capital letter A indicates SMA and V indicate SMV.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3569550&req=5

fig486: A 5-day male neonate with bilious vomitingTransverse color Doppler sonogram of the upper abdomen shows a whirlpool sign with a clockwise direction. Capital letter A indicates SMA and V indicate SMV.

Mentions: Abdominal US were performed with a real time US unit (Siemens G50 with 7.5 convex and 10MHz linear transducers). Routine gray scale US was done by a pediatric radiologist. From the technical point of view, the baby was first located in the right lateral decubitus to displace gastric secretions toward the antropyloric portion and duodenum. In some stable cases, few milliliters of water were instilled via the nasogastric (NG) tube. We first characterized the antropyloric portion. The duodenal bulb was visualized as an arrowhead. Then we followed the descending portion of the duodenum lateral to the pancreatic head, the third horizontal portion (between the aorta and the superior mesenteric artery) and finally the fourth portion (cephalad and to the left). More distal bowel loops were followed by keeping the graded compression technique. Small and large bowels could be differentiated according to anatomic landmarks and their locations. The level of bowel obstruction may be determined by change in the caliber of the bowel loop or direct visualization of pathology (Figure 1). We reported details with clarification anatomy of the duodenum, distention or collapse of bowel loops, free fluid or other abnormalities. Color Doppler US was also conducted with attention to vascularization of the wall of the gastrointestinal tract, superior mesenteric vein/superior mesenteric artery (SMV/SMA) orientation and whirlpool sign (Figure 2).The whirlpool sign was recognized as a representative for midgut volvulus on transverse sonograms of the upper abdomen. The direction of the whirlpool was determined as clockwise or counterclockwise viewed from below the patient. When the transducer was moved in a craniocaudal direction on the abdomen, the whirlpool on the monitor whirled clockwise or counterclockwise according to the direction of the volvulus and the direction of the transducer motion. Surgical cases were implied in the sonographic report as well as inconclusive cases. Routine clinical care remained unchanged during the study period and some patients had UGI series too. A chart review was performed to document clinical information including the outcome that was obtained in the operating room or follow up in the neonatal ward.


Diagnostic accuracy of ultrasound in determining the cause of bilious vomiting in neonates.

Alehossein M, Abdi S, Pourgholami M, Naseri M, Salamati P - Iran J Radiol (2012)

A 5-day male neonate with bilious vomitingTransverse color Doppler sonogram of the upper abdomen shows a whirlpool sign with a clockwise direction. Capital letter A indicates SMA and V indicate SMV.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3569550&req=5

fig486: A 5-day male neonate with bilious vomitingTransverse color Doppler sonogram of the upper abdomen shows a whirlpool sign with a clockwise direction. Capital letter A indicates SMA and V indicate SMV.
Mentions: Abdominal US were performed with a real time US unit (Siemens G50 with 7.5 convex and 10MHz linear transducers). Routine gray scale US was done by a pediatric radiologist. From the technical point of view, the baby was first located in the right lateral decubitus to displace gastric secretions toward the antropyloric portion and duodenum. In some stable cases, few milliliters of water were instilled via the nasogastric (NG) tube. We first characterized the antropyloric portion. The duodenal bulb was visualized as an arrowhead. Then we followed the descending portion of the duodenum lateral to the pancreatic head, the third horizontal portion (between the aorta and the superior mesenteric artery) and finally the fourth portion (cephalad and to the left). More distal bowel loops were followed by keeping the graded compression technique. Small and large bowels could be differentiated according to anatomic landmarks and their locations. The level of bowel obstruction may be determined by change in the caliber of the bowel loop or direct visualization of pathology (Figure 1). We reported details with clarification anatomy of the duodenum, distention or collapse of bowel loops, free fluid or other abnormalities. Color Doppler US was also conducted with attention to vascularization of the wall of the gastrointestinal tract, superior mesenteric vein/superior mesenteric artery (SMV/SMA) orientation and whirlpool sign (Figure 2).The whirlpool sign was recognized as a representative for midgut volvulus on transverse sonograms of the upper abdomen. The direction of the whirlpool was determined as clockwise or counterclockwise viewed from below the patient. When the transducer was moved in a craniocaudal direction on the abdomen, the whirlpool on the monitor whirled clockwise or counterclockwise according to the direction of the volvulus and the direction of the transducer motion. Surgical cases were implied in the sonographic report as well as inconclusive cases. Routine clinical care remained unchanged during the study period and some patients had UGI series too. A chart review was performed to document clinical information including the outcome that was obtained in the operating room or follow up in the neonatal ward.

Bottom Line: The results were compared with clinical and radiological data and the final diagnosis.All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%].This study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran ; Department of Radiology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.

ABSTRACT

Background: Plain radiography and contrast radiologic studies are traditionally the main options in evaluating neonates presenting with bilious vomiting. While ultrasonography (US) is more available, its diagnostic accuracy is in question.

Objectives: The purpose of this study is to determine the diagnostic accuracy of US in evaluating these patients with bilious vomiting.

Patients and methods: All neonates with bilious vomiting or bilious nasogastric tube drainage presented to a children's hospital in a 1.5-year period were included. US were performed in all patients. The results were compared with clinical and radiological data and the final diagnosis. We used chi-square and Fisher's exact tests for analysis.

Results: The cause of bilious vomiting for 18 of the 23 included patients was surgical. All patients labeled as surgical candidates by US ended in surgery [positive predictive value (PPV) = 100%], while only 50% of the patients with inconclusive US were operated [negative predictive value (NPV) = 50%, Confidence Interval (CI) 95%: 29%-71%]. The sensitivity and specificity of US in diagnosing intestinal atresia (n = 9) was 89% [CI 95%: (68% - 100%)] and 100%. In cases with malrotation (n = 4) and midgut volvulus (n = 2), sonographic diagnosis was in concordance with final surgical diagnosis.

Conclusion: This study suggested that in cases in which US makes a certain diagnosis, its accuracy eliminates the need for further diagnostic tests, but if it is inconclusive, further radiological contrast studies should be tried to make the final diagnosis.

No MeSH data available.


Related in: MedlinePlus