CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period.

PURPOSE: To determine whether computed tomographic (CT) findings can help differentiate between benign and clinically worrisome causes of pneumatosis intestinalis (PI) in children. MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and requirement for informed consent was waived. Data were stored in a secured and HIPAA-compliant fashion. CT reports from an 8-year period (July 2000-July 2008) were reviewed to determine all cases with a diagnosis of PI. In these cases, demographic information, clinical presentation, underlying medical condition, and CT findings were reviewed. The cases were grouped into one of two final diagnostic groups: clinically worrisome versus benign PI (diagnosis of exclusion, resolution documented at serial imaging without therapeutic intervention). In each case, the CT findings reviewed included distribution (small bowel, large bowel), extent (mild, moderate, extensive), and morphologic characteristics (linear, cystic, both) of the PI and associated findings such as soft-tissue bowel wall thickening, periintestinal soft-tissue stranding, free air, free fluid, portal venous gas, small-bowel obstruction, and bowel dilatation. Associations between CT findings and benign or clinically worrisome PI were assessed with logistic regression models. RESULTS: There were 44 cases identified. Final diagnostic categories for PI included benign (n = 15) and associated underlying bowel disease (n = 29; definitive in 26 and suspected but not defined in three). The following findings were significant (expressed as percentage of clinically worrisome PI vs percentage of benign): soft-tissue bowel wall thickening (51.2% vs 13.3%, P = .0167), free peritoneal fluid (82.8% vs 33.3%, P = .002), extent of PI (extensive 17.2% vs 69%, P < .001), and periintestinal soft-tissue stranding (55.2% vs 20.0%, P = .0228). Distribution, free peritoneal air, and characteristic morphology (linear vs cystic) were not associated with clinically worrisome PI (all P > .05). CONCLUSION: The cystic or linear pattern of pneumatosis in children is not a useful CT sign to differentiate benign from clinically worrisome PI. CT findings that include soft-tissue thickening of the bowel wall, free fluid, periintestinal soft-tissue stranding, and the extent of PI can be useful in differentiating these entities.

CT findings in children with Meckel diverticulum.

BACKGROUND: Approximately 0.04% of the general population will present with a complication related to Meckel diverticulum. The classic teaching is that symptomatic children with Meckel diverticulum present with painless rectal bleeding and are evaluated with a radionuclide scan. Our subjective experience is that we see children with Meckel diverticulum who present with abdominal pain and are evaluated by CT. OBJECTIVE: We reviewed the findings on CT in children with pathologically proven Meckel diverticulum to identify characteristic patterns of presentation. MATERIALS AND METHODS: Databases were searched (2004-2008) for all children who had a pathologic diagnosis of Meckel diverticulum and a CT scan performed prior to surgery. Demographics, pathology, and CT features were reviewed. CT features reviewed included: soft-tissue stranding, abnormal calcifications, bowel obstruction, free air, free peritoneal fluid, cystic mass, intussusception, obvious lead point, location, and whether a normal appendix was identified. The frequency of Meckel diverticulum encountered on CT scans was compared to that found during the same period of time on technetium pertechnetate studies. RESULTS: The review identified 16 subjects (mean age 9.5 years, M:F 9:7). CT findings included: soft-tissue stranding in nine (56%), small-bowel obstruction (SBO) in nine (56%), intussusception in three (19%), free fluid in ten (63%), cystic mass in four (25%), calcification in none (0%), free air in one (6%), and no abnormalities in two (13%). A normal appendix was identified in only five children (31%). There were three basic patterns of presentation of abnormalities: SBO only in five, intussusception with SBO in three, or cystic mass with inflammatory stranding in four (one with SBO). Also, 2.3 times more Meckel diverticulum was encountered on CT than on technetium pertechnetate studies. CONCLUSION: Meckel diverticulum is currently more commonly encountered in children on CT performed for abdominal pain than on technetium pertechnetate studies. There are three categories of appearance on CT: SBO only, intussusception, or a cystic inflammatory mass.