Pediatric Radiology

Volume 1, Case 2

The Stomach Flu? - The Target, Crescent, and Absent Liver Edge Signs
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 2
Lynette L. Young, MD
Loren G. Yamamoto, MD, MPH

An 11 month old male with history of "stomach flu" symptoms two weeks ago that had resolved, now presents to the ED with emesis five times the night prior, without blood or bilious material. In the morning he had three loose stools with blood but no mucous. There are no URI symptoms, and no history of fever. He cries intermittently in cycles of 10 to 20 minutes. His past medical history is unremarkable.

Exam: Vital signs T36.5Ax, P118, RR40, Wt 50%ile. He is alert, smiling, and not toxic appearing. Skin exam shows good perfusion (capillary refill time 2 seconds). Pupils reactive. Tympanic membranes no erythema. Oral mucosa moist. Heart regular, no murmur. Lungs clear breath sounds, good aeration. Abdomen soft, flat, active bowel sounds, no mass palpated. Testes descended bilaterally, nontender. No anal fissure, stool heme-positive. Pulses were good.

A stool culture was sent and an abdominal series was obtained.

View abdominal series.

Flat

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Upright

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What is your Diagnosis?

Click here for the answers to Case 2

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Loren Yamamoto, MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns School of Medicine loreny@hawaii.edu