Ultrasound evaluation of infantile vomiting: what a general radiologist should be aware of

Ilianna Tsetsou, Nektarios Spanomanolis, Hippocrates Moschouris, Marina Papadaki


Vomiting in infancy is often a diagnostic challenge. A variety of diseases can manifest with vomiting. Gastrointestinal tract disorders, both congenital and acquired, as well as metabolic, neurological, and inflammatory causes may all present with vomiting. Early diagnosis is of utmost importance, in order to rule out possible life-threatening conditions. Imaging plays an important role in the evaluation of an infant who vomits. Ultrasonography is a safe, easy to perform, and radiation-free imaging modality that allows the radiologist to accurately evaluate the gastrointestinal tract, as well as the abdominal organs. Moreover, in more experienced hands, it allows visualization of the infantile brain in suspected neurological causes.


infant; vomiting; ultrasonography; intestinal obstruction; radiology

Full Text:



Alazraki AL, Rigsby CK, Iyer RS, et al. ACR Appropriateness Criteria® Vomiting in Infants. J Am Coll Radiol 2020; 17(11): S505–S515.

Gale HI, Gee MS, Westra SJ, et al. Abdominal ultrasonography of the pediatric gastrointestinal tract. World J Radiol. 2016; 8(7): 656.

Swischuk LE, Fawcett HD, Hayden CK, et al. Gastroesophageal reflux: how much imaging is required? Radiographics. 1988; 8(6): 1137–1145.

Tolia V, Wuerth A, Thomas R. Gastroesophageal reflux disease: Review of presenting symptoms, evaluation, management, and outcome in infants. Dig Dis Sci. 2003; 48(9): 1723–1729.

Vandenplas Y, Badriul H, Verghote M, et al. Oesophageal pH monitoring and reflux oesophagitis in irritable infants. Eur J Pediatr. 2004; 163(6): 300–304.

Minella R, Minelli R, Rossi E, et al. Gastroesophageal and gastric ultrasound in children: the state of the art. J Ultrasound. 2021; 24(1): 11–14.

Catherine Baud, Alain Couture, Jean Louis Ferran, et al. Ultrasonographic Imaging of the Esophago-Gastric Junction. In: Gastrointestinal Tract Sonography in Fetuses and Children. Springer, Berlin Heidelberg, 2008, pp 85-98

Koumanidou C, Vakaki M, Pitsoulakis G, et al. Sonographic Measurement of the Abdominal Esophagus Length in Infancy: A Diagnostic Tool for Gastroesophageal Reflux. Am J Roentgenol 2004; 183(3): 801–807.

Jang HS, Lee JS, Lim GY, et al. Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children. J Clin Ultrasound 2001; 29(4): 212–217.

Hernanz-Schulman M. Infantile Hypertrophic Pyloric Stenosis. Radiology 2003; 227(2): 319–331.

Hiorns MP. Gastrointestinal tract imaging in children: current techniques. Pediatr Radiol 2011; 41(1): 42–54.

Hsu P, Klimek J, Nanan R. Infantile hypertrophic pyloric stenosis: Does size really matter? J Paediatr Child Health. 2014; 50(10): 827–828.

Iqbal CW, Rivard DC, Mortellaro VE, et al. Evaluation of ultrasonographic parameters in the diagnosis of pyloric stenosis relative to patient age and size. J Pediatr Surg. 2012; 47(8): 1542–1547.

Catherine Baud, Alain Couture, Jean Louis Ferran, et al. Antro-Pyloric Abnormalities. In: Gastrointestinal Tract Sonography in Fetuses and Children. Springer, Berlin Heidelberg, 2008, pp 99-129

Cohen HL, Zinn HL, Haller JO, et al. Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis. J Ultrasound Med 1998; 17(11): 705–711.

Taghavi K, Powell E, Patel B, et al. The treatment of pyloric stenosis: Evolution in practice. J Paediatr Child Health 2017; 53(11): 1105–1110.

Stanescu AL, Liszewski MC, Lee EY, et al. Neonatal Gastrointestinal Emergencies: Step-by-Step Approach. Radiol Clin North Am. 2017; 55(4): 717–739.

Azarow K, Connolly B, Babyn P, et al. Multidisciplinary evaluation of the distended abdomen in critically ill infants and children: The role of bedside sonography. Pediatr Surg Int. 1998; 13(5–6): 355–359.

Seashore JH. Midgut Volvulus. Arch Pediatr Adolesc Med 1994; 148(1): 43.

Nguyen HN, Navarro OM, Guillerman RP, et al. Untwisting the complexity of midgut malrotation and volvulus ultrasound. Pediatr Radiol 2021; 51(4): 658–668.

Strouse PJ. Disorders of intestinal rotation and fixation (‘malrotation’). Pediatr Radiol. 2004; 34(11): 837–851.

Patino MO, Munden MM. Utility of the Sonographic Whirlpool Sign in Diagnosing Midgut Volvulus in Patients With Atypical Clinical Presentations. J Ultrasound Med 2004; 23(3): 397–401.

Waldhausen J, Richards M. Meconium Ileus. Clin Colon Rectal Surg 2018; 31(02): 121–126.

Byun J, Han JW, Youn JK, et al. Risk factors of meconium-related ileus in very low birth weight infants: patients-control study. Sci Rep. 2020; 10(1): 4674.

Sathe M, Houwen R. Meconium ileus in Cystic Fibrosis. J Cyst Fibros. 2017; 16: S32–S39.

Leonidas JC, Berdon WE, Baker DH, et al. Meconium ileus and its complications. A reappraisal of plain film roentgen diagnostic criteria. Am J Roentgenol Radium Ther Nucl Med 1970; 108(3): 598–609.

Burke MS, Ragi JM, Karamanoukian HL, et al. New strategies in nonoperative management of meconium ileus. J Pediatr Surg 2002; 37(5): 760–764.

Veyrac C, Baud C, Prodhomme O, et al. US assessment of neonatal bowel (necrotizing enterocolitis excluded). Pediatr Radiol 2012; 42(S1): 107–114.

Henry MC., Moss RL. Current issues in the management of necrotizing enterocolitis. Semin Perinatol 2004; 28(3): 221–233.

Rich BS, Dolgin SE. Necrotizing Enterocolitis. Pediatr Rev 2017; 38(12): 552–559.

D’Angelo G, Impellizzeri P, Marseglia L, et al. Current status of laboratory and imaging diagnosis of neonatal necrotizing enterocolitis. Ital J Pediatr 2018; 44(1): 84.

Kim W-Y, Kim WS, Kim I-O, et al. Sonographic evaluation of neonates with early-stage necrotizing enterocolitis. Pediatr Radiol 2005; 35(11): 1056–1061.

Alexander KM, Chan SS, Opfer E, et al. Implementation of bowel ultrasound practice for the diagnosis and management of necrotising enterocolitis. Arch Dis Child - Fetal Neonatal Ed 2021; 106(1): 96–103.

Hansen C-C, Søreide K. Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century. Medicine (Baltimore) 2018; 97(35): e12154.

Chen Q, Gao Z, Zhang L, et al. Multifaceted behavior of Meckel’s diverticulum in children. J Pediatr Surg 2018; 53(4): 676–681.

Hu Y, Wang X, Jia L, et al. Diagnostic accuracy of high-frequency ultrasound in bleeding Meckel diverticulum in children. Pediatr Radiol 2020; 50(6): 833–839.

Kotha VK, Khandelwal A, Saboo SS, et al. Radiologist’s perspective for the Meckel’s diverticulum and its complications. Br J Radiol 2014; 87(1037): 20130743.

Elsayes KM, Menias CO, Harvin HJ, et al. Imaging Manifestations of Meckel’s Diverticulum. Am J Roentgenol 2007; 189(1): 81–88.

Almaramhy HH. Acute appendicitis in young children less than 5 years: review article. Ital J Pediatr 2017; 43(1): 15.

Khan R, Menon P, Rao KLN. Beware of neonatal appendicitis. J Indian Assoc Pediatr Surg 2010; 15(2): 67.

Gongidi P, Bellah RD. Ultrasound of the pediatric appendix. Pediatr Radiol 2017; 47(9): 1091–1100.

Reddan T, Corness J, Mengersen K et al. Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci 2016; 63(1): 59–66.

Edwards EA, Pigg N, Courtier J, et al. Intussusception: past, present and future. Pediatr Radiol 2017; 47(9): 1101–1108.

Treasure Island: StatPearls Publishing. Child Intussusception. Available via https://www.ncbi.nlm.nih.gov/books/NBK431078/. Published January, 2021. Updated July 17, 2021. Accessed January 1, 2022

Lin-Martore M, Kornblith A, Kohn M, et al. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis. West J Emerg Med 2020; 21(4): 1008-1016

Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev. 2005; 18(2): 417–422.

Mattoo TK, Shaikh N, Nelson CP. Contemporary Management of Urinary Tract Infection in Children. Pediatrics 2021; 147(2): e2020012138.

Duran C, Beltrán VP, González A, et al. Contrast-enhanced voiding urosonography for vesicoureteral reflux diagnosis in children. Radiographics. 2017; 37(6): 1854–1869.

Ovadia A, Nahum A, Tasher D, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol 2010; 126(6): S1–S58.

Yildizdas D, Aslan N. Is Ocular Sonography a Reliable Method for the Assessment of Elevated Intracranial Pressure in Children? J Pediatr Intensive Care 2021; 10(01): 014–022.

Caro-Domínguez P, Lecacheux C, Hernandez-Herrera C, et al. Cranial ultrasound for beginners. Transl Pediatr 2021; 10(4): 1117–1137.

Burton BK. Inborn Errors of Metabolism in Infancy: A Guide to Diagnosis. Pediatrics 1998; 102(6): e69–e69.

DOI: http://dx.doi.org/10.36162/hjr.v7i2.462


  • There are currently no refbacks.