Multimodality Imaging of Congenital Variants in the Gallbladder: Pictorial Essay.

Congenital variants of the gallbladder development are infrequent and sometimes represent an asymptomatic imaging finding. In this case series, we want to present multimodality imaging findings that permit the diagnosis. Ultrasound, multidetector computed tomography, and magnetic resonance images are included.The proper recognition of these infrequent congenital benign entities avoids unnecessary complementary examinations and misdiagnosis. Although ultrasound represents the most commonly used initial diagnostic tool, the increased use of magnetic resonance imaging and the wide use of multidetector computed tomography make it crucial to know how these entities are seen.A retrospective review of cases of congenital variants of gallbladder through different imaging modalities was performed in our computer archives. Representative images were selected. Agenesis, hypoplasia, septated, duplicated, intrahepatic, and left-sided gallbladder are described.Better understanding and recognition of congenital anomalies in gallbladder images will avoid misdiagnosis.

Características de pacientes con pancreatitis aguda en pediatría: hallazgos clínicos e imaginológicos / Characteristics of Pediatric Patients with Acute Pancreatitis: Clinical and Imaging Findings

Introducción: La pancreatitis aguda (PA) es un proceso inflamatorio pancreático que cursa con dolor abdominal y vómito. Es una entidad infrecuente en pediatría, por lo que existen pocos estudios en la literatura. Las principales causas son trauma, infecciones, fármacos y litiasis. En diversos estudios aparece como primera causa la idiopática; la causa litiásica es infrecuente. El estudio imaginológico se inicia con Ultrasonido (US) y se puede complementar con Tomografía computalizada (TC). Objetivo: Describir los hallazgos imaginológicos y las características epidemiológicas de los pacientes pediátricos con PA. Metodología: Análisis retrospectivo de las características clínicas y radiológicas de niños con PA, durante los años 2004-2012. Se obtuvo un total de 11 casos, 5 varones (45%) y 6 mujeres (55%), todos evaluados con algún método imaginológico. Resultados: Las formas de presentación fueron: aguda, 73%; recurrente, 9%; insuficiencia pancreática, 18%. Los principales síntomas fueron: dolor abdominal, 100%; vómito, 72,7%; fiebre, 9%; diarrea, 18%; ictericia, 9%. Las etiologías fueron: litiásica, 36,4%; idiopática, 27,3%; farmacológica, 18,2%; autoinmune, 9%; hipertrigliceridemia, 9%. Los hallazgos imagenológicos fueron: páncreas aumentado de tamaño, 63,6%; líquido libre, 45,5%; colelitiasis, 36,4%; derrame pleural, 18,2%; colecciones, 18,2%; vía biliar dilatada, 9%. Conclusión: A diferencia de otros estudios, la causa más frecuente de PA en esta serie es la litiásica, lo que concuerda con el alto índice de colelitiasis en la población adulta del país. En este contexto se hace relevante el estudio etiológico de las PA con métodos de imágenes para precisar el tratamiento adecuado.

Introduction: Acute pancreatitis (AP) is an inflammatory pancreatic disease that presents with abdominal pain and vomiting. It is a rare entity in the pediatric population, thus, there are few studies reported in literature. The main etiologies are trauma, infection, drugs, and lithiasis among others. In several studies, the main reported cause is idiopathic, and biliary causes are infrequent. Imaging study usually begins with an abdominal ultrasound, which can be complemented with CT. Objective: The objective is to describe the imaging findings and epidemiological characteristics of children with AP. Method: We performed a retrospective analysis of clinical and radiological features of pediatric patients with AP, between the years 2004-2012. We obtained a total of 11 cases, 5 males (45%) and 6 females (55%), all evaluated with an imaging study. Results: The three forms of presentation were acute 73%, recurrent 9% and pancreatic insufficiency 18%. The main symptoms were abdominal pain 100%, vomiting 72.7%, fever 9%, diarrhea 18%, and jaundice 9%. The most frequent etiology was lithiasic (36.4%), idiopathic (27.3%), drugs (18.2%), autoimmune (9%), and hypertriglyceridemia 9%. The imaging findings were enlarged pancreas 63.6%, free fluid 45.5%, cholelithiasis 36.4%, pleural effusion 18.2%, collections 18.2% and dilated bile duct 9%. Conclusion: Unlike other studies, the most common cause of AP in this series is lithiasic, consistent with the high rate of cholelithiasis in the adult population of our country. In this context it is relevant to study the etiology of AP by imaging studies to determine the adequate treatment.

Características de pacientes con colelitiasis en la edad pediátrica: hallazgos ecográficos, experiencia de diez años / Characteristics in Pediatric Patients with Cholelithiasis: Sonographic Findings, 10 years' Experience

Introducción: Las enfermedades de la vía biliar y la litiasis vesicular son una causa poco frecuente de dolor abdominal agudo en niños, a diferencia de lo que ocurre en adultos. Con la masificación del ultrasonido es posible detectar litiasis biliar en pacientes asintomáticos, lo que podría explicar el aumento de su incidencia. Objetivos: Describir los hallazgos ecográficos y las características epidemiológicas de los pacientes pediátricos con diagnóstico de colelitiasis. Metodología: Análisis retrospectivo de las características clínicas y ecográficas de pacientes pediátricos con colelitiasis en el Hospital Padre Hurtado (Santiago de Chile), entre 2002 y 2012. Resultados: 33 casos (13 hombres y 20 mujeres), de 21 días de vida hasta 15 años, todos evaluados con ecografía abdominal. El diagnóstico se realizó como hallazgo incidental en 3 pacientes; en 13 pacientes se indicó el estudio por cólico biliar recurrente; a 4 pacientes, por sospecha de apendicitis aguda; en 9 casos, como dolor abdominal asociado a vómitos; en 2 casos, como hallazgo en estudio renal, y en 2 pacientes, dentro del estudio de una pancreatitis. En la ecografía, la litiasis múltiple se presentó en el 93% de los casos. En 2 casos se observó coledocolitiasis asociada. Un 93% presentó vía biliar normal. El tratamiento de elección fue la colecistectomía laparoscópica. Conclusión: La litiasis biliar en nuestra población pediátrica es más frecuente de lo informado en la literatura. Como principales factores de riesgo se identificaron el sobrepeso y la obesidad. El principal motivo de realización del examen es el dolor abdominal.

Introduction: Biliary tract and gallstone diseases are a rare cause of acute abdominal pain in children, which is not the case in adults. With the widespread use of ultrasound examination, now we can detect gallstones in asymptomatic patients, which could explain the increased incidence. Objective: To describe the sonographic findings and epidemiological characteristics of pediatric patients diagnosed with cholelithiasis. Methodology: We performed a retrospective analysis of the clinical and sonographic characteristics of the pediatric patients with cholelithiasis in the Hospital Padre Hurtado (Santiago de Chile) during the period 2002-2012. Results: There were a total of 33 cases, 13 males and 20 females with an age range from 21 days old up to 15 years old, all of them were evaluated with abdominal ultrasound. In 3 patients the diagnosis was an incidental finding, 13 patients were studied for recurrent biliary colic, 4 patients as suspected acute appendicitis, 9 cases as abdominal pain associated with vomiting, 2 cases as a finding in renal study and 2 patients in the context of pancreatitis study. Ultrasound showed multiple lithiasis in 93%. In 2 cases there was also a choledocholithiasis. Normal biliary duct was seen in 93% of the cases. The treatment of choice was laparoscopic cholecystectomy. Conclusion: Cholecystolithiasis is more in children than is suggested in literature, and ultrasound is an appropriate imaging study for its detection. The main risk factors identified were excess weight and obesity. The main objective of this test is abdominal pain.