From the Guidelines
The imaging modality of choice for pediatric patients with chronic intermittent vomiting is fluoroscopy UGI series, as it is usually appropriate for the initial imaging of an infant with suspected malrotation or other underlying obstruction, especially in cases of bilious vomiting 1.
Key Considerations
- The choice of imaging modality depends on the clinical presentation, age of the patient, and suspected underlying cause of vomiting.
- For infants older than 2 weeks and up to 3 months old with new onset nonbilious vomiting, US abdomen (UGI tract) is usually appropriate for the initial imaging, suspected hypertrophic pyloric stenosis (HPS) 1.
- Fluoroscopy contrast enema is usually appropriate for the next imaging study of an infant with radiographs showing a distal bowel obstruction 1.
- In cases of nonbilious vomiting, where gastroesophageal reflux (GER) is suspected, imaging is usually not necessary in otherwise healthy children 1.
Clinical Scenarios
- Bilious vomiting in the first days after birth suggests the possibility of bowel obstruction and may require urgent surgery 1.
- Nonbilious vomiting in infants can be due to various causes, including GER, overfeeding, or pylorospasm, and may not require imaging in otherwise healthy children 1.
- The role of imaging in children with vomiting is to differentiate between temporary functional abnormalities, pathologies that require surgery, or therapeutic interventions 1.
From the Research
Imaging Modalities for Pediatric Patients with Chronic Intermittent Vomiting
- The imaging modality of choice for pediatric patients with chronic intermittent vomiting is not explicitly stated in the provided studies, but some studies suggest the use of ultrasound (US) and upper GI series in certain scenarios 2, 3.
- According to a study published in 2004, ultrasound plays a central role in the diagnostic imaging workup for infantile vomiting, and is used to assess various causes of vomiting in the first months of life 3.
- Another study published in 2002 found that the yield of upper GI series in otherwise healthy infants with chronic vomiting is extremely low, and may not be justified in this specific group of patients 2.
- Other imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) may also be used in certain cases, but are not specifically recommended for chronic intermittent vomiting in pediatric patients 4.
- The choice of imaging modality may depend on the specific clinical scenario and the presence of other symptoms such as bilious vomiting or projectile vomiting 3.
Clinical Scenarios and Imaging Modalities
- Bilious vomiting in the first days of life: ultrasound and other modalities may be used to assess for underlying causes such as intestinal obstruction or other anatomical abnormalities 3.
- Nonbilious vomiting since birth: ultrasound and upper GI series may be used to assess for gastroesophageal reflux and other causes of vomiting 2, 3.
- Projectile vomiting first occurring after several weeks of life: the imaging modality of choice is not explicitly stated, but ultrasound and other modalities may be used to assess for underlying causes such as pyloric stenosis or other anatomical abnormalities 3.