🏥 Pediatric Acute Abdominal Imaging Guide

Specialized imaging considerations for children with acute abdominal pain

Consideration	Plain Radiography	Ultrasound	CT Scan	MRI
X-RAY ULTRASOUND CT MRI	PLAIN RADIOGRAPHY	ULTRASOUND	CT SCAN	MRI
Age Group Suitability	Neonates Infants Children Adolescents All ages suitable	Neonates Infants Children Adolescents PREFERRED for all ages	Children Adolescents Avoid in neonates/infants when possible	Children Adolescents Limited use, special circumstances
Radiation Considerations	Low dose • Minimal radiation • ALARA principles applied • Age-appropriate protocols	No radiation • Completely safe • No cumulative effects • Repeatable as needed	High concern • Significant radiation burden • Lifetime cancer risk • Requires strong justification • Pediatric protocols mandatory	No radiation • Safe alternative • No ionizing radiation • Preferred when feasible
Sedation Requirements	Not required • Quick acquisition • Minimal cooperation needed • Can be done with crying child	Not required • Real-time imaging • Can adapt to child movement • Distraction techniques sufficient	Rarely needed • Fast acquisition • Motion artifacts less critical • Child life specialist helpful	Often required • Long scan times • Must remain still • Anesthesia team involvement
Common Pediatric Indications	Bowel obstruction Malrotation Foreign body Pneumoperitoneum Constipation Initial screening	Appendicitis Intussusception Pyloric stenosis Ovarian pathology Gallbladder disease Testicular torsion Kidney stones	Complex appendicitis Trauma Inflammatory bowel disease Pancreatitis When US inconclusive	Appendicitis (atypical) Inflammatory bowel disease Complex mass evaluation When CT contraindicated
Pediatric Advantages	• Excellent for bowel gas patterns • Quick and non-threatening • Good for foreign bodies • Widely available • Cost-effective • No IV access needed	• Gold standard for many conditions • No radiation exposure • Real-time evaluation • Better tissue resolution in children • Can guide interventions • Doppler capability • Bedside availability	• Excellent anatomical detail • Fast acquisition • Trauma evaluation • Complex pathology • When diagnosis unclear • Surgical planning	• Superior soft tissue contrast • No radiation • Multiplanar imaging • Functional information • Excellent for complex cases
Pediatric Limitations	• Limited diagnostic yield • Cannot rule out appendicitis • Poor soft tissue detail • May miss early pathology • Overlapping bowel loops	• Operator dependent • Limited by bowel gas • May miss retroperitoneal pathology • Skill requirement high • Body habitus (rare in children)	• Radiation exposure concern • May require IV contrast • Potential for unnecessary surgery • Cost considerations • Not always available	• Long scan times • Often requires sedation • Limited availability • High cost • Motion artifacts • Contraindications
Technical Considerations	• Age-appropriate techniques • Proper immobilization • Optimal positioning • Reduced exposure parameters • Multiple views as needed	• High-frequency transducers • Graded compression technique • Color Doppler assessment • Patient positioning flexibility • Real-time problem solving	• Pediatric protocols mandatory • Weight-based contrast dosing • Reduced radiation dose • Fast acquisition techniques • Child-friendly environment	• Pediatric coils • Fast sequences • Motion compensation • Sedation protocols • Safety screening
Alternative Approaches	• Limited value as standalone • Best as initial screen • May guide further imaging • Useful for follow-up • Emergency triage tool	• First-line imaging • Ultrasound-first protocols • Can reduce CT use • Combine with clinical scores • Consider expert consultation	• Reserved for specific indications • When ultrasound fails • Multidisciplinary decision • Consider MRI alternative • Risk-benefit analysis	• Problem-solving tool • When other methods fail • Specific contraindications to CT • Complex cases • Specialized centers

🎯 Quick Reference Guide

Age Group Coding:

Neonates (0-1 month)

Infants (1-24 months)

Children (2-12 years)

Adolescents (13-18 years)

Content Categories:

Age Considerations

Radiation Safety

Sedation Needs

Common Indications

Advantages

Limitations

Technical Factors

Alternative Approaches

💡 Key Principle: Ultrasound is the preferred first-line imaging modality for pediatric acute abdomen due to its safety profile, diagnostic accuracy, and child-friendly nature. CT should be reserved for specific indications where ultrasound is inadequate or inconclusive.