Case of the Month April 2015, Page 4

An abdominal ultrasound can be useful in detecting acute appendicitis, intussusception, or enlarged lymph nodes that could suggest mesenteric adenitis.

For a larger image, please click on Ardestani 5

Transverse ultrasound above level of the umbilicus shows a classic “crescent in a doughnut” or “target” sign.  Alternating bands of echogenicity are formed when layers of bowel mucosa and muscularis stack along side mesentery which has been “pulled” into the bowel lumen.  This highly suggests intussusception.

For a larger image, please click on Ardestani 6 .

A sagittal view of the same structure shows another classic view of intussusception, that of a “pseudokidney.”  Fat-containing mesentery dragged into an edematous colon gives this appearance.

What is the next appropriate step?

1) Emergent surgery
2) Contrast enema
3) Admission and surveillance
4) Colonoscopy

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