Abdominal pathologies in children encompass a wide spectrum of conditions, ranging from congenital anomalies to acquired diseases. Early and accurate diagnosis is crucial for effective management and improved outcomes. ^[1] Ultrasonography (USG) has emerged as a preferred imaging modality in pediatric patients due to its non-invasive nature, absence of ionizing radiation, and ability to provide real-time imaging. Unlike computed tomography (CT) and magnetic resonance imaging (MRI), USG is widely available, cost-effective, and well-tolerated by children. ^[2] 

The pediatric abdomen presents unique challenges due to the small size of organs, the presence of developmental anomalies, and the variability of clinical presentations. USG is particularly advantageous in this population, as it allows for dynamic assessment of abdominal structures and can be performed without sedation in most cases. ^[3]

Abdominal pain is one of the most common reasons for pediatric emergency department visits, accounting for approximately 5–10% of all cases. ^[4] The differential diagnosis of abdominal pain in children is broad and includes both surgical and non-surgical conditions. Accurate and timely diagnosis is essential to prevent complications and ensure appropriate treatment. Imaging plays a critical role in this process, and USG has become the first-line modality due to its safety and efficacy. ^[5]

USG offers several advantages over other imaging modalities in the pediatric population. First, it does not involve ionizing radiation, which is particularly important in children due to their increased sensitivity to radiation and the potential for long-term effects. Second, USG provides real-time imaging, allowing for dynamic assessment of abdominal structures, such as peristalsis and blood flow. Third, it is a non-invasive and painless procedure, which reduces anxiety and improves compliance in young patients. ^[7] Additionally, USG is portable and can be performed at the bedside, making it ideal for critically ill children who cannot be transported to the radiology department. ^[8]

Despite its advantages, USG has certain limitations in pediatric abdominal imaging. The small size of abdominal organs and the presence of overlying bowel gas can make visualization challenging. ^[9] Additionally, the interpretation of USG findings requires expertise, as normal variants and developmental changes can mimic pathology. ^[10] In some cases, complementary imaging modalities such as CT or MRI may be required to confirm the diagnosis or provide additional information. ^[11]

Given the widespread use of USG in pediatric abdominal imaging, there is a need to evaluate its diagnostic accuracy and limitations in a systematic manner. This study aims to provide a comprehensive assessment of the role of USG in diagnosing common pediatric abdominal pathologies, with a focus on its sensitivity, specificity, and overall diagnostic performance. The findings of this study will help clinicians make informed decisions regarding the use of USG in pediatric patients and guide future research in this field.

This study aims to evaluate the diagnostic performance of USG in identifying common pediatric abdominal pathologies, including appendicitis, intussusception, hydronephrosis, and hepatobiliary disorders.

This prospective observational study was conducted over a period of 18 months at a tertiary care pediatric hospital. The study protocol was approved by the institutional ethics committee, and informed consent was obtained from the parents or guardians of all participants.

Inclusion Criteria: Pediatric patients aged 0–18 years presenting with abdominal pain, distension, vomiting, or other abdominal symptoms. Patients referred for ultrasound (USG) evaluation of suspected abdominal pathology.

Exclusion Criteria: Patients with a history of abdominal surgery within the past 6 weeks. Patients with severe systemic diseases affecting imaging interpretation (e.g., advanced malignancies, congenital anomalies). Cases where parents or guardians refused consent for participation.

A total of 90 pediatric patients (aged 0–18 years) presenting with abdominal pain, distension, vomiting, or other abdominal symptoms were included in the study. Patients with a history of recent abdominal surgery or those requiring emergency intervention without imaging were excluded.

Imaging Technique

USG was performed using high-frequency linear and curvilinear transducers (5–12 MHz) on a state-of-the-art ultrasound machine. The examination included a systematic evaluation of the liver, gallbladder, spleen, pancreas, kidneys, bladder, and gastrointestinal tract. Doppler imaging was used to assess vascular structures and blood flow. All scans were performed by experienced pediatric radiologists.

Statistical Analysis

USG findings were recorded and categorized into normal and abnormal. Abnormal findings were further classified based on the underlying pathology. The diagnostic accuracy of USG was determined by comparing the imaging findings with clinical, laboratory, and surgical outcomes. Statistical analysis was performed using SPSS software (version 25.0), and p-values <0.05 were considered statistically significant.

Table 1: Demographic and Clinical Characteristics of the Study Population

Table 2: Distribution of Abnormal USG Findings

Nearly 40% of cases had normal USG findings, indicating no visible pathology in those patients. The most commonly detected pathology was intestinal (20%), followed by hepatobiliary (16.7%) and renal (13.3%) abnormalities. Other findings (11.1%) were less frequent but still significant.

Table 3: Correlation of USG Findings with Clinical Diagnosis

Hepatobiliary Disorders: Sensitivity is 86.7%, meaning USG correctly identified 86.7% of actual cases. Specificity is 95.5%, indicating a low rate of false positives.

Renal Abnormalities: Sensitivity is 83.3%, which is slightly lower, but specificity is 96.3%, suggesting a strong ability to rule out false positives.

Intestinal Pathologies: The highest sensitivity at 88.9%, meaning USG is very effective at detecting these conditions, and specificity is 94.7%.

Table 4: Comparison of USG Findings with Surgical/Laboratory Outcomes

Table 5: Statistical Analysis of USG Accuracy

The findings of this study underscore the pivotal role of USG in the diagnosis of pediatric abdominal pathologies. USG offers several advantages, including real-time imaging, portability, and the absence of ionizing radiation, making it an ideal modality for children. The high diagnostic accuracy observed in this study is consistent with previous reports, further validating its utility in clinical practice.

Ultrasound (USG) plays a crucial role in the evaluation of pediatric abdominal pathologies due to its non-invasive nature, lack of ionizing radiation, and high diagnostic accuracy. Our study demonstrated that USG had a sensitivity of 86.5% and specificity of 95.2%, making it a reliable imaging modality for detecting hepatobiliary, renal, and intestinal abnormalities in pediatric patients, consistent with previous studies. ^[12]

Among the 90 patients evaluated, 38.9% had normal USG findings, while 61.1% exhibited abnormalities. The most commonly detected pathology was intestinal abnormalities (20%), followed by hepatobiliary disorders (16.7%) and renal abnormalities (13.3%). These findings align with earlier research indicating that gastrointestinal disorders are among the leading causes of abdominal symptoms in children. ^[13]

The correlation between USG findings and clinical outcomes was strong, with the majority of hepatobiliary, renal, and intestinal cases confirmed through surgical or laboratory findings. The positive predictive value (PPV) of USG was 91.7%, suggesting that an abnormal ultrasound finding has a high probability of being clinically relevant. A recent meta-analysis reported a similar PPV range for pediatric abdominal USG, emphasizing its utility in primary and emergency settings. ^[14]

However, despite its high accuracy, USG has limitations. Operator dependency is a key factor influencing diagnostic performance. Experienced pediatric radiologists conducted all scans in this study, which likely contributed to the high diagnostic yield. Studies have shown that USG interpretation varies with the experience of the radiologist, with junior operators demonstrating lower sensitivity. ^[15] Moreover, while Doppler imaging was useful in assessing vascular structures, it had limitations in cases with minimal blood flow, such as ischemic bowel conditions. ^[16]

In cases where USG findings were inconclusive or did not match clinical suspicions, additional imaging modalities like computed tomography (CT) or magnetic resonance imaging (MRI) were required. While CT provides superior anatomical detail, its use in pediatrics is limited due to radiation exposure concerns. ^[17] MRI, although radiation-free, is less commonly used due to longer acquisition times and the need for sedation in younger children. ^[18]

Despite these challenges, USG remains the first-line imaging modality for pediatric abdominal conditions due to its rapid availability, cost-effectiveness, and safety profile. Future research should focus on integrating artificial intelligence-based image interpretation to enhance diagnostic accuracy, particularly in resource-limited settings. ^[19]

Ultrasonography is a highly effective and safe imaging modality for diagnosing pediatric abdominal pathologies. Its high diagnostic accuracy, coupled with the absence of radiation exposure, makes it an indispensable tool in pediatric radiology. This study highlights the importance of USG as a first-line imaging technique for evaluating abdominal conditions in children, enabling timely diagnosis and appropriate management.

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