Point-of-care ultrasound diagnosis of pediatric cholecystitis in the ED.
OBJECTIVE
The diagnosis of cholecystitis or biliary tract disease in children and adolescents is an uncommon occurrence in the emergency department and other acute care settings. Misdiagnosis and delays in diagnosing children with cholecystitis or biliary tract disease of up to months and years have been reported in the literature. We discuss the technique and potential utility of point-of-care ultrasound evaluation in a series of pediatric patients with suspected cholecystitis or biliary tract disease.


METHODS
We present a nonconsecutive case series of pediatric and adolescent patients with abdominal pain diagnosed with cholecystitis or biliary tract disease using point-of-care ultrasound. The published sonographic criteria is 3 mm or less for the upper limits of normal gallbladder wall thickness and is 3 mm or less for normal common bile duct diameter (measured from inner wall to inner wall) in children. Measurements above these limits were considered abnormal, in addition to the sonographic presence of gallstones, pericholecystic fluid, and a sonographic Murphy's sign.


RESULTS
Point-of care ultrasound screening detected 13 female pediatric patients with cholecystitis or biliary tract disease when the authors were on duty over a 5-year period. Diagnoses were confirmed by radiology imaging or at surgery and surgical pathology.


CONCLUSIONS
Point-of-care ultrasound to detect pediatric cholecystitis or biliary tract disease may help avoid misdiagnosis or delays in diagnosis in children with abdominal pain.
Tsung
James W
JW
Department of Emergency Medicine, Bellevue Hospital Center/NYU School of Medicine, New York, 10016, USA. jtsung@gmail.com
Raio
Christopher C
CC
Ramirez-Schrempp
Daniela
D
Blaivas
Michael
M
D000293:Adolescent; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D002648:Child; D002764:Cholecystitis / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019095:Point-of-Care Systems; D014463:Ultrasonography