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Difficulty: MediumPediatric Gastrointestinal Disorders

Match the following classic radiologic findings with the most appropriate pediatric gastrointestinal pathology.

  • IntussusceptionUltrasonography reveals a multi-layered 'target sign' in the right side of the abdomen.
  • Hypertrophic pyloric stenosisUltrasonography demonstrates a thickened muscle wall measuring greater than 4 mm and an elongated canal measuring greater than 14 mm.
  • Midgut volvulusUpper gastrointestinal contrast study reveals a 'corkscrew' appearance of the jejunum.
  • Duodenal atresiaPlain abdominal radiograph shows a 'double-bubble' sign with an absence of distal bowel gas.
  • Necrotizing enterocolitisPlain abdominal radiograph demonstrates intramural bowel gas (pneumatosis intestinalis).

Answer

The correct matches pair each pediatric gastrointestinal pathology with its classic radiologic finding: Intussusception with the ultrasound 'target sign', Hypertrophic pyloric stenosis with specific ultrasound muscle measurements (>4 mm thick, >14 mm long), Midgut volvulus with the 'corkscrew' sign on an upper GI series, Duodenal atresia with the 'double-bubble' sign, and Necrotizing enterocolitis with pneumatosis intestinalis.
Each radiologic finding represents the distinct anatomical and pathological changes characteristic of its respective disease process. Intussusception creates a concentric, multi-layered 'target' appearance as bowel telescopes into itself. Pyloric stenosis is diagnosed by direct measurement of the pathologically hypertrophied pyloric muscle. Midgut volvulus involves the twisting of the mesentery and bowel, radiographically visualized as a 'corkscrew' pattern of contrast flowing through the twisted jejunum. Duodenal atresia is a complete congenital obstruction, causing dilation of the stomach and proximal duodenum ('double-bubble') with no gas passing distally. Necrotizing enterocolitis involves bacterial invasion of the ischemic bowel wall, producing intramural gas seen as pneumatosis intestinalis.

Step-by-Step Solution

1
Analyze the imaging findings for the right lower/upper quadrant ultrasound.
The 'target sign' represents telescoping bowel.
This confirms the diagnosis of intussusception.
2
Identify the significance of muscle thickness > 4 mm and length > 14 mm on ultrasonography.
These measurements indicate hypertrophy of the pyloric muscle.
This is diagnostic of hypertrophic pyloric stenosis.
3
Evaluate the 'corkscrew' sign on the upper gastrointestinal contrast study.
This indicates twisting of the small bowel around the superior mesenteric artery.
This is the classic finding for midgut volvulus.
4
Interpret the 'double-bubble' sign with absent distal gas.
This demonstrates complete proximal obstruction at the level of the duodenum.
This confirms the diagnosis of duodenal atresia.
5
Assess the finding of intramural bowel gas on plain radiography.
This represents pneumatosis intestinalis, caused by gas-producing bacteria invading a compromised bowel wall.
This is the pathognomonic sign for necrotizing enterocolitis.

Key Concept

Recognizing classic radiologic imaging patterns is essential for the timely diagnosis and management of pediatric gastrointestinal emergencies.
Estimated Time:1m 30s
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Topics

Pediatric Gastrointestinal Disorders

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