Intussusception vs. Obstructive Ileus, Renal Trauma, Renal Calculus
Left picture: The diagnosis is an ileo-colic or ileo-cecal intestinal invagination reaching up to the transverse colon. In the US literature, the findings on the longitudinal ultrasound are called ´pseudokidney sign´, and those on the transversal ultrasound of the right upper belly, ´target sign´. Right picture: The toddler with the picture at the top had an obstructive ileus of the small intestine due to a perforated Meckel´s diverticulum, which is visible in the second picture from the top. The toddler with the third picture from the top did not have an intussusception; here, a grade 3 renal trauma was present with fracture and distortion of the normal structure of the upper pole on the left side in the picture. The toddler with the fourth picture from the top had an upper urinary tract infection due to a renal calculus in the middle of the dilated pyelocaliceal system. These case reports illustrate that the important role of the clinician is to provide the radiologist with precise data about the patient´s history and clinical findings, and with a precise formulation of the question.
Left picture: 3.1-year-old boy with surgical abdomen. Plain abdominal x-ray in standing position: The right half of the abdomen is strikingly poor in air; in the middle area there are stool masses and indicated formation of liquid-air levels. Longitudinal ultrasound of the midabdomen (second picture from the top): It shows an oblong mass in a visceral organ. Transverse ultrasound of the right upper belly (third picture from the top): Cross section of a visceral organ with a mass within the lumen. Right picture: The four pictures from the top to the bottom are from three different toddlers with surgical abdomen. The patient with plain abdominal x-ray in upright position (first and second picture from the top) had a sudden onset of crampy abdominal pain. In his left hemiabdomen there are overdistended intestinal loops, the right hemiabdomen has much less air and only one distinct fluid-air level. The patient with an abdominal ultrasound in longitudinal direction (third picture from the top) had also abdominal pain, and was pale. A small longitudinal anechogenic structure in the centre is surrounded by a zone of echos which in turn is surrounded by a larger anechogenic area. The patient with an abdominal ultrasound in a transverse direction (fourth picture from the top) had also abdominal pain, and, in addition, fever, leucocyturia and microscopical hematuria. hematuria.