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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-036
Don't be fooled by the lateral view of the duodenum in suspected malrotation and midgut volvulus
Purpose or Case Report: Background:
Malrotation is an important diagnosis that needs to be identified on routine imaging and in the emergency setting. In our institution it is always surgically corrected and therefore accurate diagnosis is essential. Current teaching, supported by research, states that a lateral view on an upper gastrointestinal contrast study (UGIS) can satisfactorily demonstrate normal anatomy and a diagnosis of malrotation. The diagnosis must be made with confidence in this position because any delay in turning the patient into the AP plane can result in contrast progressing into the jejunum with overlapping bowel loops compromising the diagnosis.
Methods & Materials: Method:
We present three cases saved from our regular clinical practice where the lateral component of the UGIS is misleading or confusing and diagnosis relied on adequate AP imaging.
Results: Results:
In the first patient we show that despite normal appearances on the lateral view, the AP imaging demonstrated malrotation which was referred for surgery.
The two other cases demonstrate ‘duodenum redundum’ on AP imaging, a normal variant. The lateral view in both cases demonstrates a meandering path of the second and third part of the duodenum as it courses towards the retroperitoneum. The lateral view was not diagnostic in these cases although we acknowledge that the appearances of a duodenum redundum on the lateral view may be a consistent finding.
Conclusions: Conclusion:
We recognize that in the majority of circumstances the lateral view can be used for diagnosis but as cases of malrotation can be missed, AP imaging should remain as the standard for diagnosis.
Malrotation is an important diagnosis that needs to be identified on routine imaging and in the emergency setting. In our institution it is always surgically corrected and therefore accurate diagnosis is essential. Current teaching, supported by research, states that a lateral view on an upper gastrointestinal contrast study (UGIS) can satisfactorily demonstrate normal anatomy and a diagnosis of malrotation. The diagnosis must be made with confidence in this position because any delay in turning the patient into the AP plane can result in contrast progressing into the jejunum with overlapping bowel loops compromising the diagnosis.
Methods & Materials: Method:
We present three cases saved from our regular clinical practice where the lateral component of the UGIS is misleading or confusing and diagnosis relied on adequate AP imaging.
Results: Results:
In the first patient we show that despite normal appearances on the lateral view, the AP imaging demonstrated malrotation which was referred for surgery.
The two other cases demonstrate ‘duodenum redundum’ on AP imaging, a normal variant. The lateral view in both cases demonstrates a meandering path of the second and third part of the duodenum as it courses towards the retroperitoneum. The lateral view was not diagnostic in these cases although we acknowledge that the appearances of a duodenum redundum on the lateral view may be a consistent finding.
Conclusions: Conclusion:
We recognize that in the majority of circumstances the lateral view can be used for diagnosis but as cases of malrotation can be missed, AP imaging should remain as the standard for diagnosis.
More abstracts on this topic:
Diagnostic Accuracy of Abdominal Ultrasound for Midgut Volvulus
Nguyen Haithuy, Guillerman R, Orth Robert, Seghers Victor, Bales Brandy, Sammer Marla
Overview of the Imaging Manifestations of Megacystis Microcolon Hypoperistalsis SyndromeMaria Anthony Rayer Dhilip Andrew, Snyder Elizabeth, Singh Sudha, Johnstone Lindsey, Sarma Asha, Krishnasarma Rekha
Poster____EDU-036.pdf
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