Color Doppler Ultrasound's Utility in Detecting Vesicoureteral Reflux Using the Ureteral Jet Angle.

OBJECTIVES: This study hypothesizes using color Doppler ultrasound to measure ureteral jet angles (UJA) as a diagnostic screening tool for reflux. METHODS: The present prospective cohort study included 122 patients and 238 renal unit pediatric patients suspected of VUR who presented to our hospital between 2019 and 2021. All patients underwent ultrasonography and VCUG, and the UJA was measured color Doppler evaluation of the ureteral jet. The UJA was compared with the VCUG findings in patients with and without reflux. SPSS 26 was used to analyze the data. RESULTS: A total of 96 patients and 139 renal units exhibited reflux. The mean ureteral jet angle in refluxing units was 60.47 + 16.66 degrees, whereas, it was 42.59 + 13.26 degrees in non-refluxing units, a significant difference between the two groups (P < .001). The mean ureteral jet angle was 42.59, 45.89, 60.32, 68.23, and 56.16, for reflux grading from 0 to 5 (except grade 1), respectively. The angle value in each reflux grade increased significantly except for grade 5. For reflux detection (grade I-V), a cut-off angle of 50 degrees was associated with sensitivity and specificity of 70 and 79, respectively. Grade IV/V reflux can be diagnosed with a sensitivity of 70% and specificity of 84% using a cut-off angle of 68 degrees or greater. CONCLUSIONS: UJA detection via color Doppler ultrasound demonstrates high accuracy, is non-invasive method can be utilized as an alternative primary diagnostic tool or in follow-up cases of VUR in children.

Risk Factors of Nonsurgical Management Failure in Pediatric Intussusception Patients With Delayed Presentation.

OBJECTIVES: The present study aimed to investigate the time-related predicting factors of the ultrasound-guided hydrostatic reduction (USGHR) failure in pediatric patients with ileocolic intussusception and delayed presentation. METHODS: The present retrospective study included pediatric patients diagnosed with ileocolic intussusception who presented to our hospital with the related symptoms started 48 hours ago or greater duration during 2018-2020. The patients with spontaneous reduction were excluded from the study. Afterward, the participants with failed and successful USGHR were compared in terms of age, sex, symptom duration, and ultrasound findings using the χ 2 and logistic regression tests. RESULTS: A total of 103 children were included in the present study. The mean symptom duration was 4.13 ± 2.39 days, with a range of 2-14 days. Moreover, 47.6% of the patients had a successful reduction. In addition, there was a significant relationship between failed USGHR and the factors of symptom duration, free peritoneal fluid, entrapped fluid between intussuscepted loops, the size of the invaginated segment, and malperfusion of the intussuscepted bowel loops detected using the Doppler ultrasound ( P < 0.05). However, there was no significant relationship between failed USGHR and the factors of the primary location of intussusception and the presence of intussuscepted lymph nodes ( P > 0.05). CONCLUSIONS: The presence of entrapped fluid between the intussuscepted loops, free peritoneal fluid, and the length of the intussuscepted segments were all associated with USGHR failure in our study. Therefore, determining these predictors may help anticipate failure of reduction.

The utility of spectral Doppler evaluation of acute appendicitis.

PURPOSE: The use of spectral Doppler, peak systolic velocity (PSV), and resistive index (RI) imaging criteria to improve the accuracy of acute appendicitis diagnosis is hypothesized. METHODS: Graded compression ultrasound was performed for suspected patients. The spectral Doppler evaluation was conducted while observing the appendix. A total of 152 patients (82 males and 70 females, ages 4-63 years, mean age of 24.5 years) were examined using the spectral Doppler waveform between 2018 and 2019. RI and PSV values of patients with and without appendicitis were compared to histopathologic findings. SPSS 26 was used to analyze the data, including using descriptive statistics and measures of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Appendicitis was confirmed in 95 patients (62.5%) and rejected in 57 patients (37.5%). For the diagnosis of appendicitis, the area under the curve (AUC) of receiver operating characteristic (ROC) for RI (0.92 with 95% confidence interval (CI): 0.88, 0.97; P = 0.001) and PSV (0.96, with 95% CI: 0.93, 1.00; P = 0.001) was calculated. The discriminatory RI ≥ 0.49 demonstrated high sensitivity (90.5%) and low specificity (86%), and the discriminatory PSV ≥ 9.6 cm/s had high specificity (94.7%) and sensitivity (94.7%) for appendicitis. CONCLUSION: By incorporating spectral Doppler criteria into routine graded compression ultrasound, the diagnostic accuracy of acute appendicitis was increased. In comparison, high PSV and RI values of the appendix with a cut-off point of 9.6 cm/s and 0.49 differ significantly between positive and negative appendectomy patients.

Prognostic Value of Porta-Hepatis Lymphadenopathy in Children with Hepatitis A.

Background: The present study aimed to investigate the prognostic value of porta-hepatis lymphadenopathy (PHL) in children with hepatitis A virus. Methods: The present prospective cohort study included 123 pediatric patients with a definite diagnosis of hepatitis A who were divided into two groups based on the presence or absence of PHL in their abdominal ultrasound: Group A included the patients with a porta-hepatis lymph node of >6 mm in diameter, whereas the patients with a porta-hepatis lymph node of <6 mm in diameter were classified in Group B. The patients were also classified based on the presence or absence of para-aortic lymphadenopathy: Group C had bisecting para-aortic lymph nodes, whereas Group D did not have such findings in their ultrasound. Afterward, the groups were compared in laboratory investigation results and hospital stay. Results: According to our results, Group A (n = 57) was significantly higher in aspartate and alanine aminotransferase and alkaline phosphatase levels compared to Group B (P < 0.05), whereas these two groups were not significantly different in the hospital stay. Furthermore, except bilirubin, all laboratory test results were significantly higher in Group C (n = 3) than in Group D. However, there was no significant correlation between the patients' prognosis with the absence or presence of porta-hepatis or para-aortic lymphadenopathy. Conclusion: We concluded that there was no significant relationship between porta-hepatis or para-aortic lymphadenopathy and the prognosis of the children with hepatitis A. However, ultrasound findings can help determine the disease severity in pediatric patients with hepatitis A.

Bowel necrosis associated with COVID-19 pneumonia: A report of two cases.

A novel coronavirus, called as SARS-CoV-2, caused multiple typical and atypical respiratory symptoms with several reported abdominal findings. We have described 2 cases of an unusual presentation of Covid-19. For patient 1, a woman aged 59-year-old had pneumonia and new onset abdominal pain. In patient 2, a 60-year-old man admitted with positive polymerase chain reaction test and abdominal pain from 2 weeks ago. Both lung and abdominal computed tomography (CT) were achieved in a few days. Acute ischemic mesenteritis and other abdominal complications were observed in the CT scan. Bowel necrosis in combination with peritonitis founded by laparotomy. Early diagnosis of abdominal complications in Covid-19 pneumonia can improve patient outcomes.