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Omental Infarction in Children: Color Doppler Sonography Correlated with Surgery and Pathology Findings

¹ Departamento de Radiologia, Hospital da Criança Conceição, Ministério da Saúde–Brazil, Rua Francisco Trein, 596, Porto Alegre, RS, CEP 91350-200, Brazil.
² Departamento de Patologia, Hospital da Criança Conceição, Ministério da Saúde, Porto Alegre, RS, 91350-200, Brazil.
³ Departamento de Pediatria, Hospital da Criança Conceição, Ministério da Saúde, Porto Alegra, RS, 90035-030, Brazil.

View larger version (76K): [in a new window]   Fig. 1A. —7-year-old girl with abdominal pain for 1 week and leukocytosis. Transverse gray-scale sonogram shows cakelike hyperechoic mass in right upper quadrant (arrows) with poorly defined hypoechoic areas (arrowheads).

View larger version (48K): [in a new window]   Fig. 1B. —7-year-old girl with abdominal pain for 1 week and leukocytosis. Color Doppler sonogram shows a few peripheral vessels (arrows) in mass (arrowheads).

View larger version (65K): [in a new window]   Fig. 1C. —7-year-old girl with abdominal pain for 1 week and leukocytosis. Longitudinal gray-scale sonogram shows normal appendix (arrows), a finding that was useful in ruling out appendicitis.

View larger version (65K): [in a new window]   Fig. 2A. —8-year-old boy with abdominal pain for 3 days and leukocyte count within normal range. Transverse gray-scale sonogram shows poorly defined hyperechoic mass next to anterior abdominal wall in right upper abdominal quadrant (arrows) that contains poorly defined linear hypoechoic structure (arrowheads).

View larger version (28K): [in a new window]   Fig. 2B. —8-year-old boy with abdominal pain for 3 days and leukocyte count within normal range. Transverse color Doppler sonogram shows a few vessels inside mass (arrow) and absence of vessels in poorly defined linear hypoechoic structure (arrowheads).

View larger version (24K): [in a new window]   Fig. 2C. —8-year-old boy with abdominal pain for 3 days and leukocyte count within normal range. Cranial color Doppler sonogram shows large vessels inside cranial region of hyperechoic tissue (arrows).

View larger version (172K): [in a new window]   Fig. 1D. —7-year-old girl with abdominal pain for 1 week and leukocytosis. Photograph of gross pathologic specimen shows streaks of necrosis and hemorrhage crossing omentum (arrows). Preserved tissue can be visualized between areas of necrosis (arrowheads). Scale: centimeters.

View larger version (124K): [in a new window]   Fig. 2D. —8-year-old boy with abdominal pain for 3 days and leukocyte count within normal range. Photograph of gross pathologic specimen from examination of omental tissue removed at surgery reveals that linear structure corresponded to tissue with hemorrhage and necrosis (arrows) within congested omental tissue (arrowheads).

View larger version (85K): [in a new window]   Fig. 3A. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Longitudinal gray-scale sonogram shows blind-ending hypoechoic tubular structure (arrowheads) within hyperechoic mass (arrows).

View larger version (93K): [in a new window]   Fig. 3B. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Transversal gray-scale sonogram shows blind-ending hypoechoic tubular structure (arrowheads) within hyperechoic mass (arrows).

View larger version (68K): [in a new window]   Fig. 3C. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Longitudinal color Doppler sonogram detects blood flow in artery (arrows) around hypoechoic avascular structure (arrowheads).

View larger version (57K): [in a new window]   Fig. 3D. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Transverse color Doppler sonogram shows spiraling artery around hypoechoic structure (arrows). Pathologic examination confirmed presence of large-diameter artery surrounding twisted and infarcted omental tissue.

View larger version (104K): [in a new window]   Fig. 3E. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Photograph of surgical specimen shows central axis of omental torsion with signs suggestive of ischemia (arrows).

View larger version (157K): [in a new window]   Fig. 3F. —7-year-old boy with abdominal pain for 2 days and leukocyte count at upper limit of normal range. Photograph of gross pathologic specimen shows central necrosis and hemorrhage (arrows) surrounded by peripheral rim of well-preserved adipose tissue (arrowheads). Size and form of infarcted tissue conform to color Doppler sonographic measurements of avascular hypoechoic tubular structure. Scale: centimeters.

View larger version (80K): [in a new window]   Fig. 4A. —10-year-old girl with abdominal pain for 3 days and leukocyte count at upper limit of normal range. Transverse gray-scale sonogram shows blind-ending hypoechoic tubular structure composed of layers (arrowheads) separated by small amount of fluid (F) within hyperechoic mass (arrows). Sonographic appearance is difficult to distinguish from that of nonperforative appendicitis.

View larger version (83K): [in a new window]   Fig. 4B. —10-year-old girl with abdominal pain for 3 days and leukocyte count at upper limit of normal range. Longitudinal gray-scale sonogram shows hypoechoic tubular structure (arrowheads) surrounded by hyperechoic tissue (arrows).

View larger version (65K): [in a new window]   Fig. 4C. —10-year-old girl with abdominal pain for 3 days and leukocyte count at upper limit of normal range. Transverse color Doppler sonogram does not detect blood flow in hypoechoic structure (arrows); sonogram shows hyperemia of adjacent hyperechoic tissue (arrowheads).

View larger version (64K): [in a new window]   Fig. 4D. —10-year-old girl with abdominal pain for 3 days and leukocyte count at upper limit of normal range. Longitudinal color Doppler sonogram shows hypoechoic avascular structure corresponds to infarcted omentum (arrows) surrounded by hyperechoic adipose tissue with adjacent hyperemia (arrowheads).

View larger version (124K): [in a new window]   Fig. 4E. —10-year-old girl with abdominal pain for 3 days and leukocyte count at upper limit of normal range. Photograph of gross pathologic specimen shows folds of omentum forming necrotic and hemorrhagic layers in central region (large arrows), surrounded by peripheral rim of well-preserved adipose tissue (arrowheads). Folds are separated from preserved peripheral tissue by thin streak of fibrosis (small arrows). Size and form of folded infarcted omental tissue conformed to color Doppler sonographic measurements of avascular hypoechoic tubular structure. Scale: centimeters.

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