Intussusception - pseudokidney sign

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 3 years
Gender: Male

A 5.5 cm soft tissue mass is seen in the right abdomen.

There are mildly dilated loops of small bowel seen in the pelvis and right lower quadrant. Little air or stool is seen in the left colon.

No free air identified.

The osseous structures are unremarkable except for mild rightward splinting.

Ultrasound

A 3.1 x 2.7 cm mass of intussuscepted bowel is seen in the right upper quadrant. The intussusception extends at least 4 cm, and appears to have several hypoechoic lymph nodes as its lead point. Mild bowel wall thickening is seen in the region. No gross free fluid is seen. 

Pseudokidney sign (longitudinal image through intussuscepted segment - running down towards the 4 o'clock position) with a number of enlarged adjacent nodes. 

In contrast, on transverse images, the intussusception appears as a concentric target sign

Case Discussion

Air reduction enema was performed in this patient with plain film and ultrasound findings consistent with intussusception

An 18F Foley catheter was placed per rectum. Contrast was injected into the balloon under fluoroscopic guidance. 

Under fluoroscopy, air was introduced by the Foley catheter and outlined the large soft tissue mass within the right upper quadrant. This was then pushed into the region of the ileocecal valve into the small bowel by air reduction. 

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Case information

rID: 6505
Published: 4th Jul 2009
Last edited: 30th Oct 2019
Inclusion in quiz mode: Included

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