Match each pediatric patient's clinical presentation with the most likely corresponding imaging finding.
- A 2-week-old previously healthy full-term infant who presents with sudden-onset bilious emesis and hemodynamic instability.Upper gastrointestinal contrast series revealing the duodenojejunal junction failing to cross the midline and a 'corkscrew' appearance of the distal duodenum.
- A 6-month-old infant presenting with episodic, inconsolable crying, drawing up of the legs, and lethargy between episodes.Abdominal ultrasound demonstrating a 'target' or 'pseudokidney' sign in the right upper quadrant.
- A 4-week-old premature infant (born at 28 weeks gestation) who develops temperature instability, feeding intolerance, and bloody stools.Plain abdominal radiograph revealing intramural bowel gas (pneumatosis intestinalis) and portal venous gas.
- A newborn with Down syndrome who develops bilious vomiting within the first 24 hours of life.Plain abdominal radiograph showing a 'double bubble' sign with complete absence of distal bowel gas.
- A newborn with a known diagnosis of cystic fibrosis who fails to pass meconium within the first 48 hours and develops progressive abdominal distension.Plain abdominal radiograph revealing a granular or 'soap bubble' appearance in the right lower quadrant.
Answer
Match sudden bilious emesis in a full-term infant to malrotation (corkscrew sign); episodic crying and lethargy in an infant to intussusception (target sign); bloody stools in a premature infant to necrotizing enterocolitis (pneumatosis intestinalis); early bilious emesis in Down syndrome to duodenal atresia (double bubble sign); and failure to pass meconium in cystic fibrosis to meconium ileus (soap bubble sign).
Each clinical vignette provides classic epidemiological and symptomatic clues for a specific pediatric gastrointestinal disorder. A 2-week-old full-term infant with sudden bilious emesis and instability suggests malrotation with midgut volvulus, diagnosed by a corkscrew sign on an upper GI series. A 6-month-old with episodic crying, leg drawing, and lethargy indicates intussusception, classically showing a target sign on ultrasound. A premature infant with feeding intolerance and bloody stools points to necrotizing enterocolitis, diagnosed by pneumatosis intestinalis on plain radiography. A newborn with Down syndrome and bilious vomiting suggests duodenal atresia, marked by a 'double bubble' sign. Finally, a newborn with cystic fibrosis failing to pass meconium indicates meconium ileus, which presents with a 'soap bubble' appearance on radiography.
Step-by-Step Solution
Key Concept
Classic clinical presentations and pathognomonic imaging findings of pediatric gastrointestinal emergencies.