Pediatric Abdominal Infection and Inflammation: Choosing the Appropriate Diagnostic Imaging Study

Abstract

Diagnostic imaging for the evaluation of abdominal infection or inflammation in the child may be required to identify a source of infection, guide percutaneous biopsy for a tissue diagnosis, or determine length of medical therapy. Several anatomic and functional imaging techniques are available, and determining which of these examinations is appropriate can be confusing. Criteria published by the American College of Radiology serve to guide clinicians and radiologists in making these decisions appropriately. In this review, current imaging recommendations relevant to abdominal infection in the child are discussed.

Keywords

pediatric - diagnostic imaging - abdominal - infection - inflammation

• References

• 1 American Board of Internal Medicine. The Choosing Wisely Initiative. Available at: http://www.choosingwisely.org/clinician-lists/#keyword=radiology . Accessed July 13, 2016
• 2 Zhang H, Du L, Du Z, Jiang H, Han D, Li Q. Association between childhood exposure to single general anesthesia and neurodevelopment: a systematic review and meta-analysis of cohort study. J Anesth 2015; 29 (05) 749-757
• 3 American College of Radiology. Appropriateness Criteria®. Available at: https://acsearch.acr.org/list . Accessed July 13, 2016
• 4 Goske MJ, Applegate KE, Boylan J , et al. The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol 2008; 38 (03) 265-269
• 5 Goske MJ. Image gently: child-sizing radiation dose for children. JAMA Pediatr 2013; 167 (11) 1083
• 6 Applegate KE, Cost NG. Image Gently: a campaign to reduce children's and adolescents' risk for cancer during adulthood. J Adolesc Health 2013; 52 (5, Suppl): S93-S97
• 7 Cohen MD. Point: should the ALARA concept and image gently campaign be terminated?. J Am Coll Radiol 2016; 13 (10) 1195-1198
• 8 Bansal GJ. Digital radiography. A comparison with modern conventional imaging. Postgrad Med J 2006; 82 (969) 425-428
• 9 Shuman WP, Ralls PW, Balfe DM , et al. Imaging evaluation of patients with acute abdominal pain and fever. American College of Radiology. ACR Appropriateness Criteria. Radiology 2000; 215 (Suppl): 209-212
• 10 Kosloske AM, Musemeche CA, Ball Jr WS, Ablin DS, Bhattacharyya N. Necrotizing enterocolitis: value of radiographic findings to predict outcome. AJR Am J Roentgenol 1988; 151 (04) 771-774
• 11 Galandiuk S, Fazio VW. Pneumatosis cystoides intestinalis. A review of the literature. Dis Colon Rectum 1986; 29 (05) 358-363
• 12 Cunnion KM. Pneumatosis intestinalis in pediatric acquired immunodeficiency syndrome. Pediatr Infect Dis J 1998; 17 (04) 355-356
• 13 Tang ML, Williams LW. Pneumatosis intestinale in children with primary combined immunodeficiency. J Pediatr 1998; 132 (3 Pt 1): 546-549
• 14 Takanashi M, Hibi S, Todo S, Sawada T, Tsunamoto K, Imashuku S. Pneumatosis cystoides intestinalis with abdominal free air in a 2-year-old girl after allogeneic bone marrow transplantation. Pediatr Hematol Oncol 1998; 15 (01) 81-84
• 15 Duncan B, Barton LL, Eicher ML, Chmielarczyk VT, Erdman SH, Hulett RL. Medication-induced pneumatosis intestinalis. Pediatrics 1997; 99 (04) 633-636
• 16 Lowe LH, Penney MW, Scheker LE , et al. Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis?. AJR Am J Roentgenol 2000; 175 (04) 981-984
• 17 Rollins MD, Andolsek W, Scaife ER , et al. Prophylactic appendectomy: unnecessary in children with incidental appendicoliths detected by computed tomographic scan. J Pediatr Surg 2010; 45 (12) 2377-2380
• 18 Merritt CRB. Physics of ultrasound. In: Rumack CM, Wilson SR, Charboneau JW, , eds. Diagnostic Ultrasound, 3rd ed. St. Louis, MO: Elsevier Mosby; 2005: 3-34
• 19 Smith MP, Katz DS, Lalani T , et al. ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis. Ultrasound Q 2015; 31 (02) 85-91
• 20 Kotagal M, Richards MK, Chapman T , et al; Safe and Sound Campaign. Improving ultrasound quality to reduce computed tomography use in pediatric appendicitis: the Safe and Sound Campaign. Am J Surg 2015; 209 (05) 896-900 , discussion 900
• 21 Saito JM, Yan Y, Evashwick TW, Warner BW, Tarr PI. Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics 2013; 131 (01) e37-e44
• 22 Carroll AE. Doing less is sometimes enough. JAMA 2015; 314 (19) 2069-2070
• 23 Menoch M, Simon HK, Hirsh D , et al. Imaging for suspected appendicitis: variation between academic and private practice models. Pediatr Emerg Care 2016 . PMID: 27050738
• 24 Rosen MP, Ding A, Blake MA , et al. ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis. J Am Coll Radiol 2011; 8 (11) 749-755
• 25 John SD, Hollingsworth C. The pediatric gastrointestinal tract. In: Rumack CM, Wilson SR, Charboneau JW, , eds. Diagnostic Ultrasound, 3rd ed. St. Louis, MO: Elsevier Mosby; 2005: 1941-1976
• 26 McCarville MB, Adelman CS, Li C , et al. Typhlitis in childhood cancer. Cancer 2005; 104 (02) 380-387
• 27 McCarville MB. Evaluation of typhlitis in children: CT versus US. Pediatr Radiol 2006; 36 (08) 890-891
• 28 Yarmish GM, Smith MP, Rosen MP , et al. ACR appropriateness criteria right upper quadrant pain. J Am Coll Radiol 2014; 11 (03) 316-322
• 29 McNitt-Gray MF. AAPM/RSNA physics tutorial for residents: topics in CT. Radiation dose in CT. Radiographics 2002; 22 (06) 1541-1553
• 30 Stoker J, van Randen A, Laméris W, Boermeester MA. Imaging patients with acute abdominal pain. Radiology 2009; 253 (01) 31-46
• 31 Baker ME, Nelson RC, Rosen MP , et al. ACR Appropriateness Criteria® acute pancreatitis. Ultrasound Q 2014; 30 (04) 267-273
• 32 Lee SS, Kim AY, Yang SK , et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 2009; 251 (03) 751-761
• 33 Westbrook C, Roth CK, Talbot J. MRI in Practice, 4th ed. West Sussex, United Kingdom: Wiley-Blackwell; 2011
• 34 Yang WJ, Im SA, Lim GY , et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol 2006; 36 (11) 1154-1158
• 35 Karmazyn B, Coley BD, Dempsey-Robertson ME , et al. Sinusitis – Child. American College of Radiology ACR Appropriateness Criteria®. Available at: https://acsearch.acr.org/list . Accessed July 19, 2016
• 36 Beaman FD, von Herrmann PF, Kransdorf MJ , et al. 2016 Suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). ACR Appropriateness Criteria, Available at: https://acsearch.acr.org/list . Accessed July 19, 2016
• 37 Yaghmai V, Rosen MP, Lalani T , et al. Acute (nonlocalized) abdominal pain and fever or suspected abdominal abscess. 2012. ACR Appropriateness Criteria, Available at: https://acsearch.acr.org/list . Accessed July 19, 2016
• 38 Moore MM, Kulaylat AN, Hollenbeak CS, Engbrecht BW, Dillman JR, Methratta ST. Magnetic resonance imaging in pediatric appendicitis: a systematic review. Pediatr Radiol 2016; 46 (06) 928-939
• 39 Kim DH, Carucci LR, Baker ME , et al. ACR Appropriateness Criteria Crohn disease. J Am Coll Radiol 2015; 12 (10) 1048-57.e4
• 40 Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiographics 2010; 30 (02) 367-384
• 41 Park SH. DWI at MR Enterography for Evaluating Bowel Inflammation in Crohn Disease. AJR Am J Roentgenol 2016; 207 (01) 40-48
• 42 Mettler FA, Guiberteau MJ. Radioactivity, radionuclides, and radiopharmaceuticals. In: Essentials of Nuclear Medicine Imaging: Expert Consult, 6th ed. Philadelphia, PA: Saunders; 2012. :1–21
• 43 Lassmann M, Biassoni L, Monsieurs M, Franzius C, Jacobs F ; EANM Dosimetry and Paediatrics Committees. The new EANM paediatric dosage card. Eur J Nucl Med Mol Imaging 2007; 34 (05) 796-798
• 44 Gelfand MJ, Parisi MT, Treves ST ; Pediatric Nuclear Medicine Dose Reduction Workgroup. Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. J Nucl Med 2011; 52 (02) 318-322
• 45 Lassmann M, Treves ST ; EANM/SNMMI Paediatric Dosage Harmonization Working Group. Paediatric radiopharmaceutical administration: harmonization of the 2007 EANM paediatric dosage card (version 1.5.2008) and the 2010 North American consensus guidelines. Eur J Nucl Med Mol Imaging 2014; 41 (05) 1036-1041
• 46 Westra SJ, Karmazyn BK, Alazraki AL , et al; Expert Panel on Pediatric Imaging. ACR Appropriateness Criteria fever without source or unknown origin-child. J Am Coll Radiol 2016; 13 (08) 922-930
• 47 Parisi MT. Functional imaging of infection: conventional nuclear medicine agents and the expanding role of 18-F-FDG PET. Pediatr Radiol 2011; 41 (07) 803-810
• 48 Skaggs DL, Kim SK, Greene NW, Harris D, Miller JH. Differentiation between bone infarction and acute osteomyelitis in children with sickle-cell disease with use of sequential radionuclide bone-marrow and bone scans. J Bone Joint Surg Am 2001; 83-A (12) 1810-1813
• 49 Ziessman HA. Nuclear medicine hepatobiliary imaging. Clin Gastroenterol Hepatol 2010; 8 (02) 111-116
• 50 Karmazyn B, Alazraki AL, Anupindi SA , et al. 2016 Urinary tract infection – child. ACR Appropriateness Criteria. Available at: https://acsearch.acr.org/list . Accessed March 7, 2017
• 51 Gartner Jr JC. Fever of unknown origin. Adv Pediatr Infect Dis 1992; 7: 1-24
• 52 Tolan Jr RW. Fever of unknown origin: a diagnostic approach to this vexing problem. Clin Pediatr (Phila) 2010; 49 (03) 207-213
• 53 Sturm E, Rings EHHM, Schölvinck EH, Gouw AS, Porte RJ, Pruim J. Fluordeoxyglucose positron emission tomography contributes to management of pediatric liver transplantation candidates with fever of unknown origin. Liver Transpl 2006; 12 (11) 1698-1704
• 54 Jasper N, Däbritz J, Frosch M, Loeffler M, Weckesser M, Foell D. Diagnostic value of [(18)F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation. Eur J Nucl Med Mol Imaging 2010; 37 (01) 136-145
• 55 Simons KS, Pickkers P, Bleeker-Rovers CP, Oyen WJ, van der Hoeven JG. F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with suspected infection. Intensive Care Med 2010; 36 (03) 504-511
• 56 del Rosal T, Goycochea WA, Méndez-Echevarría A , et al. ¹⁸F-FDG PET/CT in the diagnosis of occult bacterial infections in children. Eur J Pediatr 2013; 172 (08) 1111-1115
• 57 Blokhuis GJ, Bleeker-Rovers CP, Diender MG, Oyen WJ, Draaisma JM, de Geus-Oei LF. Diagnostic value of FDG-PET/(CT) in children with fever of unknown origin and unexplained fever during immune suppression. Eur J Nucl Med Mol Imaging 2014; 41 (10) 1916-1923