Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED
Received 9 August 2008; received in revised form 4 November 2008; accepted 2 December 2008. published online 26 October 2009.
Abstract
Objective
The diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique and potential utility of point-of-care ultrasound evaluation in a series of pediatric patients with suspected cholecystitis or biliary tract disease.
Methods
We present a nonconsecutive case series of pediatric and adolescent patients with abdominal pain diagnosed with cholecystitis or biliary tract disease using point-of-care ultrasound. The published sonographic criteria is 3 mm or less for the upper limits of normal gallbladder wall thickness and is 3 mm or less for normal common bile duct diameter (measured from inner wall to inner wall) in children. Measurements above these limits were considered abnormal, in addition to the sonographic presence of gallstones, pericholecystic fluid, and a sonographic Murphy's sign.
Results
Point-of care ultrasound screening detected 13 female pediatric patients with cholecystitis or biliary tract disease when the authors were on duty over a 5-year period. Diagnoses were confirmed by radiology imaging or at surgery and surgical pathology.
Conclusions
Point-of-care ultrasound to detect pediatric cholecystitis or biliary tract disease may help avoid misdiagnosis or delays in diagnosis in children with abdominal pain.
aDepartment of Emergency Medicine, Bellevue Hospital Center/NYU School of Medicine, New York, NY 10016, USA
bDepartment of Pediatrics, Bellevue Hospital Center/NYU School of Medicine, New York, NY 10016, USA
cDepartment of Emergency Medicine Northshore University Hospital, Manhasset, NY 11030, USA
dDivision of Pediatric Emergency Medicine, Boston Medical Center, Boston, MA 02118, USA
eDepartment of Emergency Medicine, Northside Hospital-Forsyth, Atlanta, GA 31029, USA
Corresponding author. Bellevue Hospital Center/NYU School of Medicine, Emergency Care Institute, New York, NY 10016, USA. Tel.: +1 212 562 5070; fax: +1 212 562 3001.
ABSTRACT