Paediatric- Necrotizing enterocolitis (NEC)Created OnMay 7, 2020Last Updated OnMay 7, 2020byadmin You are here: Main Radiology Paediatric- Necrotizing enterocolitis (NEC) < All Topics Table of Contents Abdominal X-Ray Supine abdominal x-rays are the first line imaging modality If NEC is suspected clinically, or there is a concern on supine AXR, additional cross-table lateral or left-lateral decubitus view provides increased sensitivity. Findings include: Dilated bowel loops (often asymmetrical in distribution) Loss of the normal polygonal gas shape Bowel wall oedema with thumbprinting Pneumatosis intestinalis Portal venous gas Pneumoperitoneum indicates severe disease: Only 50-75% of patients with proven perforation will have visible free gas Air on both sides of the bowel (Rigler sign) Air outlining the falciform ligament (football sign) Abdominal X-ray Rigler’s Sign – Double wall sign, seen when air present on both side of intestine. Pneumatosis intestinalis – air-filled pockets in intestinal walls. Ultrasound Bowel wall thickening Alteration of the vascular state Hypervascular (viable but engorged in early stage) Hypovascular (infarcted in a later stage) Intramural gas manifesting as hyperechoic foci within the bowel wall The presence of free fluid suggesting of perforation Hyperechoic foci (white) with shadow – Indicating gas within the mural wall. *Some of the image photo is taken from web, we do not own this, it’s for knowledge sharing purpose.
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