title: Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus.
abstract: OBJECTIVE
  To evaluate the clockwise whirlpool sign at color Doppler ultrasound (US) in the diagnosis of midgut volvulus.
  
  
  METHODS
  Pediatric patients (160 boys, 76 girls; age range, 0 day to 14 years) with possible midgut volvulus underwent abdominal gray-scale US and color Doppler US. Midgut volvulus was diagnosed by recognition of the whirlpool sign (wrapping of the superior mesenteric vein and the mesentery around the superior mesenteric artery). If the whirlpool rotated clockwise with caudal movement of the transducer, the direction of the whirlpool was defined as clockwise.
  
  
  RESULTS
  Color Doppler US showed a whirlpool sign that was clockwise in 12 of 13 patients with surgically confirmed midgut volvulus and counterclockwise in three patients without midgut volvulus. Sensitivity, specificity, and positive predictive value of clockwise whirlpool sign for midgut volvulus were 92%, 100%, and 100%.
  
  
  CONCLUSIONS
  The clockwise whirlpool sign is diagnostic of midgut volvulus. Color Doppler US should be performed as an initial imaging study in children suspected of having midgut volvulus.
authors.affiliation: Department of Radiology, Saitama Children's Medical Center, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shimanuki
authors.forename: T
authors.initials: T
authors.lastname: Aihara
authors.forename: H
authors.initials: H
authors.lastname: Takano
authors.forename: T
authors.initials: T
authors.lastname: Moritani
authors.forename: E
authors.initials: E
authors.lastname: Oguma
authors.forename: H
authors.initials: H
authors.lastname: Kuroki
authors.forename: A
authors.initials: A
authors.lastname: Shibata
authors.forename: K
authors.initials: K
authors.lastname: Nozawa
authors.forename: K
authors.initials: K
authors.lastname: Ohkawara
authors.forename: A
authors.initials: A
authors.lastname: Hirata
authors.forename: S
authors.initials: S
authors.lastname: Imaizumi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D007422:Intestines / Q000002:abnormalities / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color