Purpose or Case Report: Meckel’s diverticulum is the most common congenital gastrointestinal tract abnormality, with a small minority of patients presenting with symptoms related to complications. The aim of this educational exhibit is to provide a pictorial overview of the common and uncommon imaging manifestations of symptomatic Meckel’s diverticulum, with an emphasis on CT findings, though scintigraphic, sonographic, radiographic, and fluoroscopic features will also be detailed.
Methods & Materials: A report search was performed for pediatric (ages 0-18 years) studies between 2008-2016 with reports including the word “Meckel”. Of these cases, those without pathologically confirmed Meckel’s diverticulum were excluded. The remaining cases were reviewed and analyzed.
Results: A pictorial essay of the various appearances of pathologically proven Meckel’s diverticulum will be provided, including the following:
Computed tomography - dilated tubular structure; exophytic soft tissue mass; closed loop small bowel obstruction; inverted diverticulum
Scintigraphy - positive Tc-99m scan; initial negative studies found positive on repeat evaluation
Ultrasound - hyperemic dilated tubular structure
Fluoroscopy and plain radiography - small bowel obstruction; ileoileal intussusception
Conclusions: Meckel’s diverticulum, though infrequently symptomatic, is a known cause of acute abdomen in the pediatric population, and knowledge of its variable appearances on different modalities is imperative in raising the diagnostic possibility of Meckel’s. While scintigraphy is often considered the gold standard, it is only diagnostic if gastric mucosa is present (20-50%). The diagnostic pitfalls of the Meckel's scan should be kept in mind, particularly when there is high clinical suspicion of Meckel’s diverticulum. As a result, it is important to recognize its CT manifestations, as well as the appearance on other modalities such as ultrasound, radiography, and fluoroscopy.