Ultrasound for the Win! 3-year-old with abdominal pain #US4TW

A 3-year-old Hispanic female with no significant past medical or surgical history presents to the Emergency Department with her mother for a 3 day history of crampy abdominal pain, intermittent bloody diarrhea and fever. There has been no recent travel, admissions, or antibiotic use. Her older sister reports similar symptoms, which have resolved. The patient saw her pediatrician the day prior, who recommended supportive care including oral rehydration. This Ultrasound For The Win!” (#US4TW) Case Series focuses on a real clinical cases where point-of-care ultrasound changed the management of a patient’s care or aided in the diagnosis. Learning Objectives Compile a differential diagnosis for pediatric abdominal pain. Discuss the role point-of-care ultrasound (POCUS) plays in differentiating various etiologies of pediatric abdominal pain. Discuss the epidemiology, presentation, diagnosis (including common sonographic findings), and management of intussusception. Vitals P 124 bpm RR 24 breaths/min O2 98% room air T 36.8 C Differential Diagnosis Appendicitis Clostridium difficile Constipation Gastroenteritis Hemolytic uremic syndrome  Henoch-Schönlein purpura Intussusception Meckel’s diverticulum Mesenteric lymphadenitis Obstruction Peritonitis Volvulus On physical examination, the patient is afebrile and nontoxic appearing but visibly uncomfortable. Her abdomen is mildly distended and diffusely tender without peritoneal findings. Genitourinary exam is unremarkable. A severe diaper rash is present on her buttocks, but no stool was noted initially. A point-of-care ultrasound (POCUS) is performed at the bedside: Point-of-Care Ultrasound Ultrasound is the diagnostic imaging modality of choice in diagnosing intussusception in pediatric patients. While a curvilinear probe is required in adult patients, a linear probe is often ideal in the pediatric population. Sonographic findings of intussusception include:  A target or pseudokidney sign (Figures 1-2),​1​ which has a reported sensitivity of 98–100%,​1,2​ specificity of 88–100%,1-2 and negative predictive value of 100%​3​ High-risk … Continue reading Ultrasound for the Win! 3-year-old with abdominal pain #US4TW