Clinical and imaging analysis of intramural duodenal hematomain in children

LIN Huihui; WANG Xiaoyu; YIN Chuangao; FEI Weimin; LI Xu

doi:10.19300/j.2025.L22031

Abstract：Objective To explore the clinical and imaging characteristics of intramural duodenal hematoma(IDH)in children,aiming to provide a basis for early diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical and imaging data of 16 pediatric IDH cases,aged 3 to 10 years.Among the 16 cases,11 underwent CT scans(10 with contrast enhancement)and 5 underwent MRI scans(4 with contrast enhancement).Results Most of the IDH cases had a history of trauma(10 cases).The lesions were mostly solitary(15 cases),primarily involving the descending and horizontal portions of the duodenum.On non-contrast CT,the lesions appeared as heterogeneous iso-to hyperdense masses,with"melting ice sign"observed in 7 cases and"air cleft sign"in 11 cases.MRI revealed hyperintense signals on T1-weighted imaging(T1WI),hypointense or isointense signals on T2-weighted imaging(T2WI),and mixed hyperintensity on diffusion-weighted imaging(DWI).On contrast-enhanced scans,no enhancement was observed within the lesions,though 6 cases exhibited wall enhancement of the hematoma.Six cases were complicated with intestinal obstruction,and 7 cases showed elevated pancreatic enzymes.Fourteen cases were successfully treated conservatively,2 cases underwent surgery due to intestinal obstruction,and one case died from multi-organ failure.Conclusion The integration of clinical manifestations with characteristic CT and MRI imaging features is essential for the early diagnosis of pediatric IDH.Imaging follow-up can effectively assess the absorption of the hematoma and the progression of complications.