Enhancing pediatric abdominal pain diagnosis: the role of ultrasound layered scanning technique

Abstract

Background: Pediatric abdominal pain is a common yet diagnostically challenging symptom, particularly in young children who struggle to articulate their discomfort. With obesity increasingly affecting ultrasound accuracy, this study aimed to find the cause of pediatric abdominal pain by seeking new approaches and methods in ultrasound examination, especially in the application among obese or overweight pediatric patients.

Methods: A retrospective analysis was conducted on pediatric patients hospitalized between July 2016 and November 2017 for abdominal pain. Patients were categorized into normal weight, overweight, and obese groups. Conventional and layer-by-layer scanning methods were used by attending physicians to examine abdominal organs, including the liver, gallbladder, spleen, pancreas, kidneys, and bladder. An abdominal probe was employed for rapid screening, followed by a high-frequency probe for detailed three-layer scanning. Ultrasound images were analyzed alongside the children's symptoms and physical signs to provide diagnostic insights.

Results: When comparing the conventional and stratified screening groups, several key differences were noted. The stratified group had higher detection rates for mesenteric lymphadenopathy (100% vs. 86%) and peritonitis (94% vs. 27%). Improved detection in the stratified group was due to the identification of peritoneal thickening, leading to higher detection rates for mesenteric fat inflammation (100% vs. 46%), appendicitis (94% vs. 63%), and urachal inflammation (100% vs. 0%). Detection rates for substantial lesions, such as gallstones and ovarian torsion, were similar in both groups (100%). The stratified group also showed significantly better detection of gastrointestinal conditions like gastroenteritis (97% vs. 32%), inguinal hernia (100% vs. 0%), and intestinal ascariasis (100% vs. 47%). Differences in detection rates were observed when abdominal fat layer thickness was between 0.8 and 1.7 cm, with more significant differences when thickness exceeded 1.7 cm.

Conclusions: Real-time ultrasound with stratified screening effectively detects abdominal and pelvic masses, solid organ lesions, and bowel wall thickening, improving disease detection in children, including individuals with increased body mass index. This method is valuable and recommended for wider use.

Keywords: Abdominal pain; high resolution; layered scanning; pediatrics; real-time ultrasound.

Figure 1

The patient presented with acute migrating lower right abdominal pain. Ultrasound examination revealed a normal appendix with an echo, measuring 0.4 cm in diameter and showing no wall thickening. Utilizing a three-layer technique, an abnormal lesion was detected in the second layer. The surrounding intestinal wall exhibited hypoechoic thickening with bright spots in the center. Diagnosis: cecal diverticulum with fecolith entrapment. Postoperative diagnosis: cecal diverticulum. A slight thickening of the peritoneum was marked in the figure.

Figure 2

The patient presented with acute left abdominal pain lasting for half a day. A history of trauma was noted during investigation. Conventional ultrasound did not reveal remarkable findings. However, subsequent use of a high-frequency probe near the anterior abdominal cavity revealed a plaque-like area with high echogenicity, distinct tenderness and unclear boundaries. No other abnormalities were observed. The provisional ultrasound provisional diagnosis was panniculitis. The patient received anti-inflammatory and analgesic therapy and showed normal findings during a follow-up visit after one week. Abnormality was marked by the white arrow.

Figure 3

A child with panniculitis presented with left lower abdominal pain lasting for one day, accompanied by noticeable tenderness in the left lower abdomen. Ultrasound examination revealed a plaque-like high echo with unclear boundaries between the skin and the peritoneum (A). The patient’s condition improved following symptomatic anti-inflammatory treatment and localized physical therapy (B). The measurements were taken at the lipid membrane thickening.

Figure 4

The child presented with lower abdominal distension and positive abdominal tenderness. Ultrasound examination of the superficial umbilical urachus revealed cystic enlargement characterized by hypoechoic features (white arrow) and minimal blood flow signals. Diagnosis: uracholitis.

Figure 5

The patient experienced frequent vomiting for one month and underwent a medical examination. Notably, a significant thickening of the muscular layer at the pylorus was observed, resembling a cervical-like change. Diagnosis: pyloric hypertrophy. The diagnosis was missed here because the stomach is not examined by conventional ultrasound.

Figure 6

Clinically diagnosed with infectious mononucleosis, the abdominal scan initially revealed no obvious abnormalities. However, a subsequent examination using a high-frequency probe detected increased splenic echogenicity with multiple hypoechoic areas. Notably, solid organs such as the liver and spleen exhibited lymphocyte infiltration, emphasizing the need for early anti-inflammatory treatment.