What Kind of Sonographic Findings Indicate Intestinal Polyps in Children?

A recent retrospective study set out to emphasize the technical component of polyp evaluation and to illustrate distinctive sonographic appearance of intestinal polyps.

The results indicate that sonographic appearance of intestinal polyps in children of the juvenile or hamartomatous type can be characteristic.

Methodology
Over an 8-year period, children with intestinal polyps identified on sonography were evaluated. The ultrasound machines used, routine protocol, and findings were recorded. Histology was confirmed by colonoscopic and endoscopic pathology results.

Results
16 children were identified, with a mean age of 4 years (range, 5 months to 12 years). Bowel examination was noted to be performed with linear array transducers using graded compression.

Identifying features of the colon included haustra, intraluminal gas or stool, and little peristalsis. Small bowel was recognized using the presence of valvulae conniventes and active peristalsis as criteria.

Colonic juvenile polyps had a typical sonographic appearance that consisted of a solid vascular hypoechoic intraluminal nodule containing small cystic areas.

Small bowel hamartomatous polyps were similar in sonographic appearance.

In 1 child, hyperechoic nodular structures protruding into the lumen were found to be areas of pseudopolyposis in ulcerative colitis.

As this was only an observational study, no statistics for accuracy, specificity, or sensitivity were calculated.

Conclusions
The sonographic appearance of intestinal polyps in children when using a linear array transducer and graded compression was observed to be characteristic.

For the most part, a hypoechoic intraluminal vascular nodule was observed.

Sonographic appearance of intestinal polyps in children of the juvenile or hamartomatous type can be characteristic.

Findings from this study are reported to be consistent with those of other authors, although this is the largest series of children observed.

Reviewer’s Comments
Although not the gold standard for evaluation of intestinal polyps, this article describes a utility in ultrasound often forgotten. The take-home message for the reader is that when performing an abdominal ultrasound in a child for reasons such as abdominal pain, it would benefit the examiner to also evaluate the bowel using the techniques described. A cause of clinical symptoms may be hiding in the bowel, and ultrasound may help to find it.

Author: Basil Hubbi, MD

Reference:
Parra DA, Navarro OM. Sonographic Diagnosis of Intestinal Polyps in Children. Pediatr Radiol; 2008; 38 (June): 680-684