E1916. Pediatric Fluoroscopic Follies: An Adventure Through the Pediatric Gastrointestinal Tract With Twists and Turns!
University of Florida
University of Florida
Fluoroscopy is a key modality for investigation of congenital abnormalities of the gastrointestinal tract in the neonatal period. The fluoroscopic upper gastrointestinal series is the reference standard for evaluation of malrotation with or without midgut volvulus. Bilious emesis in the neonate is the most common indication for the emergent fluoroscopic UGI. Though malrotation occurs in up to 1% of the population asymptomatically, the presence of midgut volvulus requires emergent surgery. The fluoroscopic UGI is also useful in the diagnosis of pathologies that may result in unexplained weight loss or failure to thrive and in the pre/post-operative settings. The lower gastrointestinal series is integral in the diagnosis of distal bowel obstruction and can be used therapeutically as well in the neonatal period. Recognition of these abnormal findings on gastrointestinal fluoroscopic examinations is critical for radiologists who perform and interpret pediatric fluoroscopy.
Educational Goals / Teaching Points
This educational exhibit will provide an overview of the pediatric upper and lower gastrointestinal series for radiology residents and general radiologists. Normal anatomy, abnormal and critical findings, and techniques for further evaluation of equivocal results will be examined in detail. Through review of these images, radiologists will improve their familiarity with critical results and have an increased awareness of techniques to improve their diagnostic accuracy.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal duodenal anatomy will be demonstrated with a labeled image of the passage of contrast through the duodenum. This will be contrasted with findings of malrotation, malrotation with midgut volvulus, heterotaxy, duodenal web, annular pancreas, wandering duodenum, and jejunal atresia. Troubleshooting and techniques for eliciting duodenal passage of contrast in equivocal cases will be discussed. The lower gastrointestinal study will then be explained with a similar sequential labeled diagram. Imaging findings associated with abnormal pathologies such as microcolon, meconium ileus, meconium plug syndrome, small left colon, strictures and Hirschsprung’s disease will be compared to normal examinations. Techniques used in difficult cases will also be discussed to conclude the presentation.
Recognition of gastrointestinal pathology identified on fluoroscopic examinations can be lifesaving. Familiarity with critical findings and with fluoroscopic techniques is integral to successful diagnosis.