JOURNAL OF EVIDENCE BASED MEDICINE AND HEALTHCARE

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Year : 2021 Month : January Volume : 8 Issue : 3 Page : 157-161.

A Cross Sectional Study on Imaging of Paediatric Intra-Abdominal Cystic Lesions

Sreelaxmi Aitipamula1, Veena Madireddy2, Vijaya Kumari Mudunoor3, Baranitharan S.4

1, 2, 3, 4 Department of Radiodiagnosis, Osmania Medical College, Hyderabad, Telangana, India.

CORRESPONDING AUTHOR

Dr. Sreelaxmi Aitipamula, H. No. 6-5-470/2, Ngos Colony, Vanasthalipuram - 500070, Hyderabad, Telangana, India.
Email : sreelaxmi.aitipamula@gmail.com

ABSTRACT

Background

Abdominal cystic lesions are not so uncommon in the paediatric age group. Ultrasonography (USG) is the initial investigation of choice for detection of lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) further compliment the findings of USG and help in the final diagnosis of various abdominal lesions in this age group. Because of the overlap in imaging features, histologic analysis is usually necessary to establish a diagnosis. The major role of the radiologist is to document the cystic nature of these abdominal masses and to determine the origin. Our aim was to study the incidence of cystic abdominal lesions in the paediatric age group and role of imaging in the diagnosis of various types of cystic lesions.

 

Methods

This is a cross sectional study of 60 children who have been referred to radiology department with abdominal symptoms, over a period of 18 months (from April 2018 to September 2019) in Niloufer hospital, Hyderabad. Children suspected to have abdominal lesions have been referred to radiology department. USG is the initial investigation done and further CT / MRI has been done according to the findings on USG. Paediatric patients of age day 1 to 12 years, both male and female suspected to have abdominal cystic lesions either clinically or sonologically have been included in the study. Retroperitoneal lesions are excluded from study.

 

Results

Out of the 60 patients studied, 44 patients were females and the rest were males. The most affected age group was between 0 - 1 year which constituted to 50 percent of the total cases studied. The most common pathologies are ovarian cyst and duplication cyst which constituted about 49 % of the cases. Statistical significance has been observed between the gender and incidence of cystic lesions.

 

Conclusions

Imaging plays a key role in the evaluation of various types of cystic lesions in the paediatric age group and arrive at a particular diagnosis based on specific imaging features. The radiologist must consider patient age, clinical parameters and imaging findings to formulate the likely diagnosis of cystic lesions. USG being cost effective, widely available and with no risk of radiation has been chosen as the first modality for investigation.

 

Keywords

Cystic Lesions, USG, CT / MRI, Ovarian Cyst, Enteric Duplication Cyst

BACKGROUND

Abdominal cystic masses are common in children. Their etiopathogenesis, histology, localisation and clinical presentation differ significantly which could lead to diagnostic dilemmas. Patients usually present with mass per abdomen. Other symptoms include abdominal pain, early satiety, bowel obstruction, or fever if the underlying cause of the mass is infection. Various types of cystic lesions occur in this age group of which some of them have specific imaging features sonologically. On the basis of sonographic findings, selection of additional imaging modalities including CT and MRI can be applied more judiciously. CT and MRI provide additional information and help to narrow down the diagnostic possibilities.

 

Objectives

  1. To study the imaging findings of various intraperitoneal cystic lesions that occur in paediatric age group.
  2. To study the incidence of various types of intraperitoneal cystic lesions in paediatric age group.
  3. To evaluate various cystic lesions and differentiate them based on their imaging findings.

METHODS

This is a cross sectional, hospital-based study conducted over a period of 18 months from April 2018 to September 2019 in the Department of Radiodiagnosis, Niloufer Hospital, Hyderabad.

 

Sample Size & Sample Technique

All the paediatric patients suspected to have intra-abdominal cystic lesions clinically, referred to radiology department, Niloufer hospital, Hyderabad between April 2018 - September 2019 were included in the study. Sample size calculation was time bound and sampling technique was whole sample study.

 

Inclusion Criteria

  • The paediatric patients suspected to have abdominal cystic lesions either clinically or sonologically.
  • Patients with antenatally detected intra-abdominal cystic lesions who have been referred for postnatal scan.
  • Patients aged day 1 to 12 years have been included in the study irrespective of sex.

 

Exclusion Criteria

  • Patients with solid intra-abdominal lesions on imaging.
  • Patients with retroperitoneal lesions.
  • Patients who did not give consent to be a part of the study.

 

Clearance was obtained from the institutional ethics committee. After obtaining informed consent, 60 patients were enrolled in the study. Patients initially underwent clinical and biochemical evaluation. Then USG has been done on Esaote Mylab50. Based on USG findings diagnostic possibilities has been arrived at, sonologically. The children were further subjected to CT / MRI if needed accordingly. MRI has been done on Philips 1.5 Tesla for biliopancreatic abnormalities with dedicated magnetic resonance cholangiopancreatography (MRCP) protocol, and CT has been done on Toshibha Aquilion 16. CT scan included plain and contrast study using intravenous iomeprol. Pedicloryl has been used for sedation of the patients. The lesions have been evaluated on CT in their entirety regarding size, extent, mass effect over adjacent organs and any complications if present. A note of any other incidental findings in the study have also been made.

 

Statistical Analysis

Data was entered in Microsoft Excel and analysis was done using SPSS version 20. Results on categorical measurements are presented as percentages. Significance is assessed at 5 % level of significance, P < 0.05 – statistically significant Fisher’s exact test / chi square test was used to find out the significance of study parameters on a categorical scale between two groups.

RESULTS

 

The association between age and incidence of lesions was found to be statistically in-significant (P = 0.621).

The association between sex of the child and incidence of lesions was found statistically significant (P = 0.036)