Diagnostic ultrasound ( PDFDrive )

1852 PART V Pediatric Sonography
A
B
FIG. 53.33 Inlammatory Disease: Transmural Thickening. (A) Hypoechoic thickening of the wall of the ileum (arrows) in a 13-year-old child
with regional enteritis. (B) Colitis. Note greatly thickened colonic wall (arrows).
A
B
FIG. 53.34 Hyperemia With Bowel Inlammation. (A) Note the increased blood low in the intestinal wall (arrows) in a child with nonspeciic
enteritis, demonstrated with color Doppler imaging. (B) Colonic wall thickening and hyperemia caused by Shiga toxin–positive colitis.
and loss of haustration are important indicators of wall
inlammation.
Infectious colitis is a common cause of acute abdominal pain
in children, primarily diagnosed by stool culture. However,
ultrasound is helpful in distinguishing infectious bowel pathology
from other causes such as intussusception and appendicitis in
the young child and appendicitis or Crohn disease in the older
child. Viral infections and gram-negative bacterial infections
such as Shigella, Salmonella, Campylobacter, Escherichia coli,
and Yersinia are common causes of enteritis. 105 Enterohemorrhagic
E. coli can cause hemorrhagic colitis ater ingestion of contaminated
foods.
Lymphoid hyperplasia can be detected within the small bowel,
and mesenteric lymph node enlargement may also be seen,
especially with Yersinia and Salmonella (Fig. 53.35). History and
immune status are important in creating a diferential diagnosis,
with ultrasound primarily used to exclude appendicitis, intussusception,
and Crohn disease while conirming that there is
an underlying enteritis present. Pneumatosis intestinalis can
FIG. 53.35 Hypertrophied Lymphoid Tissue. A cluster of enlarged
mesenteric lymph nodes in a child with Yersinia colitis.