From the Guidelines
Abdominal Ultrasound is the imaging modality of choice for pediatric patients with chronic intermittent vomiting. This is because ultrasound is a non-invasive, radiation-free imaging modality that is well-suited for pediatric patients, and it can help diagnose conditions such as pyloric stenosis, intussusception, and other abdominal pathologies that may cause vomiting 1. Additionally, ultrasound can evaluate the gallbladder, pancreas, and liver, which can be involved in certain causes of chronic vomiting.
- The sensitivity and specificity of ultrasound for diagnosing abdominal pathologies in children are high, with reported values of 86% and 94%, respectively 1.
- Ultrasound is also a relatively low-cost and widely available imaging modality, making it a more accessible diagnostic tool for pediatric patients 1.
- While Upper GI Series can provide a detailed view of the upper digestive tract, it involves radiation exposure and may not be as readily available as ultrasound 1.
- Other imaging modalities, such as CT and MRI, may be used as second-line imaging techniques if ultrasound is inconclusive, but they involve radiation exposure and may require sedation, making them less suitable for initial imaging in pediatric patients 1.
From the Research
Imaging Modalities for Pediatric Patients with Chronic Intermittent Vomiting
The choice of imaging modality for pediatric patients with chronic intermittent vomiting depends on various factors, including age, symptoms, and clinical presentation.
- The American College of Radiology Appropriateness Criteria 2 provide evidence-based guidelines for imaging in infants with vomiting, discussing modalities such as plain radiography, fluoroscopic upper gastrointestinal series, fluoroscopic contrast enema, ultrasound of the abdomen, and nuclear medicine gastroesophageal reflux scan.
- Ultrasound plays a central role in the diagnostic imaging workup for infantile vomiting, particularly in evaluating the major causes of vomiting in the first months of life 3.
- For pediatric patients, imaging modalities that do not involve ionizing radiation, such as ultrasound and magnetic resonance imaging (MRI), are preferred 4.
- The yield of upper GI series in otherwise healthy infants with chronic vomiting is extremely low, suggesting that this modality may not be justified in this specific group of patients 5.
Considerations for Imaging Modalities
- The choice of imaging modality should be based on the patient's age, symptoms, and clinical presentation, as well as the potential risks and benefits of each modality.
- The use of low-osmolality, water-soluble contrast media in the infant's gastrointestinal tract has been discussed in the context of evaluating vomiting in infants 6.
- Emerging imaging applications, such as MR urography and MR enterography, may also be considered in the evaluation of pediatric patients with chronic intermittent vomiting 4.