Imaging in Abdominal Infections

In this special issue of the Journal of Pediatric Infectious Diseases, we have compiled a series of articles addressing the imaging and management of abdominal infections in children. The edition brings together experts from two continents and different regions—North America and Africa with articles covering infections typical of both developed and underdeveloped regions.

Diagnostic imaging plays a universally vital role in the evaluation and management of the pediatric patient with suspected intra-abdominal infection since early and accurate diagnosis and treatment decreases morbidity and limits long-term complications. Ionizing radiation is of particular concern in children and incurred with plain radiography, fluoroscopy, computed tomography (CT), angiography, and nuclear scintigraphy. Ultrasound is widely available, cheap, and an excellent imaging modality in children and does not use radiation. The cost and availability of the alternative, magnetic resonance imaging may limit its use. Imaging is a significant contributor to the global cost of health care, particularly in the developed world. This not only challenges physicians to choose imaging studies based on evidence but also takes into account the cost to parents/guardians and the ability of a pediatric patient to tolerate the procedure. The first article reviews the advantages and disadvantages of available imaging modalities with reference to the American College of Radiology Appropriateness Criteria and discusses current imaging recommendations in suspected abdominal infection.

Urinary tract infection (UTI) and appendicitis are addressed. UTIs are common and invariably result in imaging to look for correctable causes that may have predisposed the child to infection. The ideal imaging algorithm has been extensively debated in the pediatric literature owing to the lack of evidence-based data and evolving theories on the pathophysiology of UTI and vesicoureteric reflux. The authors comprehensively cover this often difficult topic and provide guidelines for best-practice imaging.

Acute appendicitis is a common cause of abdominal pain and resultant surgery in children. The article details the typical imaging findings on ultrasound, CT, and magnetic resonance imaging and describes the indications for image-guided intervention in complicated cases.

Infections prevalent in the developing world and increasing in developed countries as a consequence of immigration and social deprivation are covered in four separate articles. Children with abdominal tuberculosis, ascariasis, hydatidosis, and amoebic liver abscess often present with nonspecific clinical symptoms leading to diagnostic delay. Imaging plays an important role in the early diagnosis and identifies complications. The role of interventional radiology and surgery are also described.

Infectious complications are one of the most significant causes of morbidity and mortality not only in the pediatric cancer patient but also in those undergoing bone marrow or solid organ transplantation. Development of infection in these patients can be related to a variety of factors including compromised mechanical barriers, neutrophil dysfunction, impaired cell-mediated and humoral immunities, and splenic dysfunction. Infections in the pediatric cancer patient, bone marrow, or solid organ transplant recipient typically occur in classic time increments. The infectious complications that occur as a result of these conditions is reviewed in a dedicated article that not only depicts the imaging findings of entities such as neutropenic colitis, infectious enterocolitis, and fungal infections among others but also discusses the pathophysiology leading to their development.

The compilation of articles in this issue of the Journal of Pediatric Infectious Diseases provides an important overview of the imaging options available to clinicians faced with a patient with potential abdominal infection. Guidelines, differential diagnoses, and potential interventions are discussed. As guest editors, we express our gratitude to the authors for their excellent contributions and hope this issue will be informative and educational.