Sonographic Detection of Lymph Nodes in the Intussusception of Infants and Young Children
Clinical Evaluation and Hydrostatic Reduction
C. Koumanidou1,
M. Vakaki1,
G. Pitsoulakis1,
K. Kakavakis1 and
P. Mirilas2,3
1
Department of Radiology, "Agia Sofia" Children's Hospital, Thivon
and Mikras Asias Sts., Goudi, 11527 Athens, Greece.
2
First Department of Pediatric Surgery, "Agia Sofia" Children's
Hospital, 11527 Athens, Greece.
3
Department of Anatomy-Embryology, University of Crete Medical School, P.O. Box
1393, Herakleion, 711 10 Crete, Greece.
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Fig. 1. —8-month-old male infant with intussusception and recent
history of gastroenteritis; hydrostatic reduction failed. Transverse sonogram
of right mid abdomen is presented. Intussusception is shown as targetlike
mass, consisting of multiple concentric rings. Five lymph nodes are revealed
in hyperechoic mesentery. Long axis measures 11 mm in two lymph nodes
(arrows), whereas three measure less than 9 mm (arrowheads).
Trapped fluid was not detected.
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Fig. 2. —20-month-old boy with intussusception and recent history of
gastroenteritis; hydrostatic reduction was successful. Transverse sonogram of
right upper abdomen shows targetlike mass, representing intussusception,
consisting of multiple concentric rings surrounding echogenic center. Three
enlarged lymph nodes are present in intussusception (arrows). Largest
lymph node measures 11 mm at its long axis. Trapped fluid is not detected.
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Fig. 3. —16-month-old girl with intussusception and no history of
gastroenteritis; hydrostatic reduction was successful. Typical sonogram of
target appearance of intussusception is shown, in which multiple concentric
rings are clearly visible. No lymph nodes are revealed in intussusception's
echogenic center.
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Fig. 4. —11-month-old male infant with intussusception and current
gastroenteritis history; hydrostatic reduction failed. Transverse sonogram of
right upper abdomen reveals doughnutlike appearance of intussusception.
Intussusception's external hypoechoic ring is thick. Four lymph nodes are seen
in intussusception (arrows). Largest lymph node length was 12 mm.
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Fig. 5. —6-month-old male infant with intussusception and history of
gastroenteritis. Enema reduction was successful. Transverse sonogram of right
mid abdomen shows typical doughnutlike appearance of intussusception.
Hypoechoic outer rim is thick (arrowheads). Encircled by outer rim,
structure consists of hyperechoic crescent-shaped center, which represents
entrapped mesentery, eccentrically surrounded by heterogeneously hypoechoic
area that is formed by central limb of intussusceptum, probably including
cecoappendiceal complex. Hypoechoic dots in hyperechoic mesentery represent
vessels. No lymph nodes are revealed in intussusception.
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Fig. 6. —6-month-old female infant with intussusception and history of
gastroenteritis. Transverse Doppler sonogram of right mid abdomen reveals
small crescent hypoechoic area representing trapped intraperitoneal fluid
(arrow) and three lymph nodes in intussusception (large
arrowheads). Largest lymph node had length of 13 mm. Intussusception was
ileo-ileocolic. Hydrostatic reduction failed because of the following current
characteristics: trapped fluid, enlarged nodes, and ileo-ileocolic nature.
Other two hypoechoic areas correspond to vessels as shown (small
arowheads).
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Copyright © 2002 by the American Roentgen Ray Society.
