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(BQ) Part 2 book Diagnostic pediatric ultrasound presents the following contents: Spleen, pediatric intestinal ultrasonography, pancreas, kidneys, adrenal glands, sonography of the female genital tract, male genital tract, musculoskeletal ultrasound, ultrasound guided inter ventional procedures - biopsy and drainage
| 11.05.15 - 18:17 Chapter 10 Spleen 10.1 Normal Anatomy and Variants 324 10.2 Pathology 332 10.3 Acknowledgements 354 10 | 11.05.15 - 18:17 10 Spleen Samuel Stafrace The spleen is a pyramid-shaped organ normally located in the left upper quadrant It forms part of and is the largest organ within the lymphoproliferative system It plays a major role in the immune system and also functions as a filter of damaged and abnormal red blood cells Imaging of the spleen starts and often rests very much with ultrasound Depending on a child’s age, this organ can be imaged with transducers of different frequencies Exquisite images can be obtained with higher frequency, particularly in the younger child Requests for examining this organ are often related to a clinically palpable increase in its size Other frequent indications are for the assessment of hematologic conditions and in the setting of trauma The assessment and measurement of the spleen are part of the normal ultrasound examination of the pediatric abdomen This chapter describes the normal appearances, variants, and most common pathologies of the spleen as seen with ultrasound 10.1 Normal Anatomy and Variants 10.1.1 Embryology The spleen begins to develop at the fifth week of fetal life It develops from multiple cellular nests located within the dorsal mesogastrium (▶ Fig 10.1) Symmetrical splenic precursors are thought to exist with preferential development of the left sided splenic tissue These cellular nests eventually fuse to form a single organ The small anterior notch often seen in the anterior aspect of the spleen is thought to result from this fusion process The presence of accessory small spleens (splenunculi), seen in about 10% of normal individuals, results from incomplete fusion of all the splenic tissue into one organ Given its embryonal development in the dorsal mesogastrium, the final location of splenic tissue is very much dependent on normal situs and normal bowel rotation At weeks’ gestation, the liver rotates to the right, and the stomach and spleen rotate to the left The peritoneal reflections between these organs follow their rotational movement 10.1.2 Anatomical Considerations The final anatomical splenic position and the layout of its associated peritoneal reflections are demonstrated in ▶ Fig 10.2 The spleen is surrounded by peritoneum, with folds that meet in positions anterior and posterior to the organ The gastrosplenic ligament connects the spleen with the greater curvature of the stomach anteriorly The lienorenal ligament in turn connects the spleen to the retroperitoneum posteriorly The tail of the pancreas is partly located within this latter peritoneal reflection and can be easily seen in close relation to the splenic hilum on ultrasound The splenic hilum effectively points medially between the stomach and the left kidney, both of which leave an indentation Medial to the gastrosplenic and lienorenal ligaments is the lateral aspect of the lesser sac of the peritoneal cavity Further peritoneal reflections run from the spleen superiorly to the diaphragm (phrenicosplenic ligament) and inferiorly to the colon (splenocolic ligament) Superiorly, the spleen is related to the diaphragm, lying in a concavity within the left hemidiaphragm Anteriorly, the organ is related to the stomach and left colon Posteriorly lie the diaphragm, left pleura, lung base, and chest wall Arterial blood supply comes through the splenic artery, which is a branch of the celiac trunk of the aorta This courses behind the pancreas and reaches the spleen through the lienorenal ligament The splenic artery divides into a number of branches before entering the spleen This is described to follow two main patterns In the distributed type (70%), the primary trunk is short and many long branches reach the splenic hilum Right Left FL Stomach GH Right Left GS Liver Liver Spleen LS IVC AO Stomach RK LR LK Spleen Fig 10.1 Developmental status of the spleen within the dorsal mesogastrium at weeks’ gestational age 324 Fig 10.2 Anatomical drawing demonstrating the final position of the spleen with the associated peritoneal reflections AO, aorta; IVC, inferior vena cava; FL, falciform ligament; GH, gastrohepatic ligament; GS, gastrosplenic ligament; LR, lienorenal ligament; LS, lesser sac; LK, left kidney; RK, right kidney | 11.05.15 - 18:17 Spleen Fig 10.3a,b Normal transverse ultrasound images of the spleen a Position of the probe in the left lateral aspect b Corresponding ultrasound image The stomach (St) can be seen anterior to the spleen Alternatively, in the magistral type (30%), the main trunk is long with short arterial branches at the hilum The splenic vein forms in the lienorenal ligament from venous tributaries, which leave the spleen at the hilum The unified vein travels with the artery behind the pancreas to join with the superior mesenteric vein and form the portal vein Histologically, the spleen is formed by a fibrous capsule that supplies a network of trabeculations serving as a supportive framework for the functional tissue The functional tissue consists of two types The white pulp (which derives its name from its appearance on gross pathology specimens) consists of groups of lymphocytes and lymphoid follicles The red pulp comprises the remainder of the spleen (approximately 75% of the volume) and is composed of venous sinusoids through which the blood slowly filters 10.1.3 Technique and Normal Ultrasound Appearances On interrogation with ultrasound, the normally located spleen is identified in the left upper quadrant, above the left kidney and under the left hemidiaphragm, either through a window under the left lower rib margin or through the lower intercostal spaces Images should be obtained in the transverse and coronal oblique planes along the length of the organ (▶ Fig 10.3 and ▶ Fig 10.4) These images can generally be obtained in the supine position, although rotating the child into the lateral decubitus position (▶ Fig 10.5) can assist in obtaining a suitable window when imaging in the supine position is proving difficult Occasionally, the lung and pleura can partially obscure the superior aspect of the spleen The examiner can ask compliant children, particularly older children, to hold their breath briefly in expiration while he or she gently slides the probe up and down the lower left intercostal spaces until the organ comes into view (▶ Fig 10.6; Video 10.6) 10.1.4 Echogenicity and Changes in Echogenicity with Age As a rule of thumb, the spleen is expected to have echogenicity similar to that of the liver and appear more echogenic than the adjacent kidney This is assuming that the hepatic and renal echogenicity is normal when these organs are used as a comparison for assessing the echogenic appearance of the spleen The spleen appears diffusely homogeneous When it is evaluated with higher-frequency probes, the echotexture can appear rather heterogeneous, and this finding should not be misinterpreted as pathology (▶ Fig 10.7) The degree of heterogeneity ranges from mild granularity to better-defined tiny areas of hypoechogenicity throughout the organ Some authors have clearly demonstrated that these heterogeneous appearances change with age and are best identified in children between the ages of and years Such appearances are attributed to the presence of white pulp/lymphoid follicles in the spleen, which are thought to account for the tiny focal areas of low echogenicity described The inability to demonstrate such heterogeneity in infants is thought to result from the immaturity of the organ at this tender age Difficulty in seeing such detail in older children may result from their increased size, reducing the resolution obtained, although the literature indicates that the chances of demonstrating such heterogeneity increases both with age and with organ size It is very important to become comfortable with normal splenic appearances at different frequencies and with the various probes that are part of one’s regular equipment 325 | 11.05.15 - 18:17 Spleen Fig 10.4a–c Normal coronal oblique ultrasound images of the spleen a Position of the ultrasound probe b Corresponding ultrasound image c The left kidney (LK) anterior to the spleen is visualized in the more coronal posterior plane Fig 10.5 The lateral decubitus position can be helpful when images of the spleen are obtained, particularly in the coronal/coronal oblique 326 | 11.05.15 - 18:17 Spleen Fig 10.6 Coronal oblique ultrasound image demonstrating artifact from the lung (white arrows), which obscures visualization of the spleen (black arrow) 10.1.5 Vascularity When interrogated with color Doppler ultrasound, the spleen appears hyperemic The splenic artery is seen to arise from the celiac trunk and can be followed along its course behind the pancreas into the lienorenal ligament and splenic hilum, where its branches can be identified (▶ Fig 10.8) Similarly, the draining venous tributaries are seen in the splenic hilum forming the splenic vein This can be followed behind the pancreas close to the artery to its junction with the superior mesenteric vein (▶ Fig 10.9) Fig 10.7 Coronal oblique image of the spleen obtained with a highfrequency (12 MHz) planar probe in a 4-year-old child The subtle, diffuse, heterogeneous appearances throughout the organ should not be misinterpreted as pathology identified incidentally on scanning Their echogenicity is similar to that of the main spleen Splenunculi derive their blood supply from branches of the splenic artery Splenunculi are common and often of no clinical significance They rarely can present with torsion and infarction (▶ Fig 10.11) They can also significantly enlarge and become hypertrophic, assuming the function of the larger spleen, in hematopoietic conditions after a splenectomy, resulting in recurrent hypersplenism Splenic Notch 10.1.6 Normal Variants Splenunculi In around 10% of healthy individuals, failure of all the embryonic splenic tissue to join and form a single spleen may result in the presence of a small round or oval area of normal splenic tissue adjacent to the main splenic organ, known as an accessory spleen or splenunculus If multiple areas are present, these are referred to as splenunculi (▶ Fig 10.10) These are often A small notch/cleft can occasionally be identified on the medial aspect of the undersurface of the spleen (▶ Fig 10.12) This is thought to be a remnant from the fusion of the splenic nests of tissue during embryonal development This is easier to appreciate in cross-sectional imaging than with ultrasound In the context of trauma, the notch can be mistaken for a peripheral laceration However, one would expect some free fluid/hemoperitoneum adjacent to such a finding in the case of an acute traumatic laceration 327 | 11.05.15 - 18:17 Spleen Fig 10.8a–c Normal appearances of the splenic arterial blood supply a Transverse midline ultrasound image of the retroperitoneum b Same image plane with color Doppler In both images (a and b) the splenic artery can be seen originating from the celiac trunk and coursing behind the pancreas toward the left (arrows) c Coronal oblique image at the splenic hilum with color Doppler showing the distal splenic artery (arrows) and its branches within the spleen (arrowheads) 328 | 11.05.15 - 18:17 Spleen Fig 10.9a–c Normal appearances of the splenic venous drainage a Transverse midline ultrasound image of the retroperitoneum b Same image plane with color Doppler In both images (a and b) the distal splenic vein (white arrows) can be seen behind the body of the pancreas, forming the portal vein (black arrow) after it joins with the superior mesenteric vein (out of plane) behind the neck of the pancreas c Coronal oblique image at the splenic hilum with color Doppler showing the venous tributaries in the hilum (arrows) These join to form one splenic vein 329 | 11.05.15 - 18:17 Spleen Fig 10.10a,b Curvilinear (a) and planar high-frequency (b) coronal oblique ultrasound images from a normal 10-year-old boy demonstrating an accessory spleen at the splenic hilum (arrows) Note that the echogenicity and texture of the splenunculus and the larger spleen are similar with both probes 330 Fig 10.11a,b Fifteen-year-old boy presenting with acute abdominal pain and fever a Transverse ultrasound image demonstrates an oval hypoechoic mass in the left upper quadrant (arrows) b Axial computed tomography after contrast shows that the nonenhancing mass (white arrows) lies anterior to the normal spleen (black arrow) This mass represented an infarcted torted splenunculus | 11.05.15 - 18:17 Spleen Fig 10.12 Axial computed tomographic scan demonstrating a splenic cleft/notch (arrow), which should not be misinterpreted as pathology Fig 10.13 Coronal oblique ultrasound image in a normal 10-year-old child demonstrating the appropriate method for measuring the length of the spleen Table 10.1 Splenic length in premature infants and neonates Splenic length (cm) Gestational age (weeks) No of patients Mean length (± SD) Minimum– maximum 24–31 29 2.4 (0.4) 1.6–3.2 32–35 34 2.8 (0.5) 1.7–4.0 36–37 35 3.3 (0.4) 2.6–4.2 38–41 155 3.4 (0.5) 2.4–4.9 Abbreviation: SD, standard deviation Source: Reprinted with permission of Elsevier from Soyupak SK, Narli N, Yapicioglu H, Satar M, Aksungur EH Sonographic measurements of the liver, spleen and kidney dimensions in the healthy term and preterm newborns Eur J Radiol 2002;43(1):73–78 Note: This study was performed in 261 healthy newborn infants Craniocaudal dimensions of the spleen were determined with ultrasonography 10.1.7 Normal Splenic Size The spleen grows with the growing child Normal data are available for splenic length in premature infants, neonates, and older children (▶ Table 10.1 and ▶ Table 10.2) ▶ Fig 10.13 demonstrates the appropriate method of measuring the spleen in the coronal plane At birth, the spleen measures between 2.5 and 4.9 cm in length At full growth, the spleen is expected to measure between 8.7 and 11.0 cm in a girl and 9.5 and 12.5 cm in a boy Tips from the Pro ● The spleen should be assessed systematically in two planes Always measure and document the craniocaudal length of the spleen Do get into the habit of assessing the splenic echotexture with a higher-frequency probe Although this may not allow the full depth of the spleen to be assessed, it provides great views of the echotexture and makes it possible to detect subtle lesions that, when small and diffuse, may not be seen with standard probes and settings Do not mistake the normal heterogeneity seen with higher-frequency probes for pathology 331 | 11.05.15 - 18:18 Spleen Table 10.2 Splenic length in childhood Spleen length (cm) Spleen length (cm) Age and sex Number Mean SD Min-max Age and sex Number Mean SD Min-max Age and sex Number Mean SD Min-max Age and sex Number Mean SD Min-max 0–3 mo 6–8 y F 22 4.4 0.57 3.2–5.5 F 25 8.2 0.99 6.6–10.0 M 35 4.6 0.84 2.8–6.8 M 26 8.9 0.91 7.4–10.5 F 5.2 0.47 4.5–5.6 F 26 8.7 0.92 6.4–10.5 M 10 5.8 0.65 4.9–7.0 M 15 9.0 1.02 7.4–11.2 F 15 6.3 0.68 5.1–7.5 F 34 9.1 1.09 6.8–11.4 M 12 6.4 0.78 5.4–7.4 M 19 9.8 1.05 7.3–11.3 3–6 mo 8–10 y 6–12 mo 10–12 y 1–2 y 12–14 y F 18 6.3 0.69 5.1–8.2 F 30 9.8 1.02 7.9–11.6 M 17 6.8 0.72 5.6–8.3 M 18 10.2 0.81 8.5–11.7 F 24 7.5 0.83 5.7–8.9 F 13 10.3 0.69 8.7–11.0 M 22 7.6 1.07 5.9–9.9 M 13 10.7 0.90 9.5–12.5 F 36 8.0 0.74 6.7–9.5 M 18 8.1 1.01 6.4–9.9 2–4 y 14–17 y 4–6 y F, female; M, male; SD, standard deviation Source: Robben S Van Rijn R Normal values In: Differential diagnosis in Paediatric Radiology Stuttgart: Thieme Medical Publishers 2001:636–637 10.2 Pathology 10.2.1 Abnormalities of Location and Number Wandering Spleen The splenic peritoneal ligaments, which are pivotal in supporting the spleen, may be elongated, allowing the spleen to be displaced inferiorly from its expected location, even down to the pelvis An abnormally located spleen can be detected incidentally during a routine ultrasound examination or palpated clinically and may be suspected to represent an abdominal mass A wandering spleen may present with abdominal pain in either of two different clinical scenarios: recurrent abdominal pain from intermittent torsion or severe acute pain from torsion, secondary ischemia and infarction of part or all of the spleen In the scenario of torsion, an ultrasound examination shows the spleen to be absent from its normal location in the left upper quadrant Once identified, the spleen is found to be enlarged, with a heterogeneous appearance Focal infarctions appear as areas of lower echogenicity with absence of flow on interrogation with color Doppler A whirlpool appearance of the vascular blood supply at the hilum and secondary ascites can be seen (▶ Fig 10.14) Splenic Fusion Abnormalities Splenogonadal fusion is a rare developmental anomaly in which aberrant splenic tissue is fused to ovarian or testicular tissue 332 Congenital fusion of splenic tissue with the kidneys (splenorenal fusion) has also been rarely described Splenosis After traumatic rupture of the spleen or occasionally after surgical splenectomy, splenic cells can seed within the peritoneal cavity and enlarge into functional masses of splenic tissue The splenic nodules/masses can be found anywhere in the peritoneal cavity Extra-abdominal splenosis in the thoracic cavity is also described Such nodules may mimic other pathology (e.g., lymphoma) and can result in complications such as torsion or recurrence of hemolytic disease after splenectomy Rotation Abnormalities and Heterotaxy Syndrome In complete situs inversus, the splenic tissue is located in the right upper quadrant and the liver in the left upper quadrant All the vascular structures and solid organs are inverted in a mirror image of the norm In such cases, one may find multiple splenules on the right instead of a spleen (▶ Fig 10.15) Heterotaxy syndrome is characterized by visceral malposition and indeterminate atrial arrangement This spectrum of conditions is generally rather simply classified as heterotaxy syndrome with asplenia or heterotaxy syndrome with polysplenia, although patients with heterotaxy syndrome may not fit into either category, and a number of anomalies may be present in both groups | 11.05.15 - 18:24 Ultrasound-Guided Interventional Procedures: Biopsy and Drainage Fig 18.5a–d Biopsy of a transplanted kidney a Local anesthetic (arrows) is injected through a hypodermic needle (arrowhead) from the skin to the transplanted kidney, which in this case lies in the right iliac fossa b The semiautomated biopsy needle (arrow) is inserted through the anesthetized area into the transplanted kidney c The tip of the needle is advanced, exposing the cutting slot (arrow) d The needle is fired, advancing the cutting sleeve and trapping a core of renal cortex Transplanted kidneys are biopsied with the patient in the supine position (▶ Fig 18.5) Biopsy in the early postoperative period (< 10 days) may be an additional risk factor for complications, which occur after about 3% of procedures overall Nontargeted biopsy of the native liver is often requested for the evaluation of neonatal cholestasis, hepatitis, certain metabolic diseases, or suspected hemophagocytic lymphohistiocytosis or Langerhans cell histiocytosis Relative contraindications include ascites and biliary dilatation The use of a subcostal approach (to either the right or the left lobe) may reduce the risk for complications Liver transplant biopsies may be performed with a similar technique, as long as consideration is given to the nature of the graft (whole liver, left lobe, or other) Transjugular liver biopsy is sometimes performed—for example, in children with uncorrectable coagulopathy It is customary in pediatric practice to use US to guide the jugular venous puncture and (in conjunction with fluoroscopy) to guide the biopsy needle to a safe part of the liver parenchyma The most important complication of liver biopsy is bleeding (intraparenchymal or intraperitoneal), which probably occurs in about 2% of cases Other potential complications include bile leak or hemobilia, 624 pneumothorax, and injury to other organs, such as the duodenum and colon Following biopsy, the vital signs should be monitored frequently for to hours Increasing pain in the abdomen, chest, or shoulder and unexplained tachycardia (even without hypotension) are indications for immediate abdominal US to exclude biopsy-related hemorrhage Routine US following biopsy is not necessary Tips from the Pro ● ● When a native kidney is biopsied, the trajectory of the biopsy needle should be planned carefully ○ Aim to sample cortex Avoid the central part of the kidney ○ This may be achieved in transverse, coronal, or oblique planes ○ It is easiest (and safest) to sample from the lower pole or lateral interpolar cortex When the liver is biopsied, care should be taken to avoid crossing the fissure for the ligamentum venosum | 11.05.15 - 18:25 Ultrasound-Guided Interventional Procedures: Biopsy and Drainage 18.2 Drainage Techniques and Equipment The same principles of preprocedural imaging, planning, and consent that were discussed for biopsy apply to drainage procedures Patients with sepsis are more likely to have deranged coagulation parameters A multidisciplinary team discussion should be arranged to confirm the goals of drainage In some cases, particularly when a collection is small, needle aspiration without drain insertion may be both diagnostic and therapeutic This is less painful and probably safer, and it may avoid the need for general anesthesia In patients with a large volume of ascitic or pleural fluid, the operator should decide preoperatively how much can safely be drained immediately, to minimize the risk for unpredictable fluid shifts (including pulmonary edema) In such cases, the drain may need to be clamped intermittently postoperatively to allow staged drainage Patients undergoing drainage of infected collections should be covered with intravenous antibiotics, to minimize the risk for septicemia Almost all collections can be drained with US guidance alone A wide range of US transducers should be available, from highfrequency “hockey stick” probes with a small footprint, used for small collections, to 3-MHz probes, used for deep-seated collections in older or larger children The 8- to 10-MHz sector probes have the advantage of a relatively small footprint yet good penetration, and they are invaluable for renal access in younger children and for intercostal approaches In most cases, the techniques used are simple and not much equipment is required, so the aspiration or drainage of collections is possible in an intensive care setting In general, the Seldinger technique is used to access collections for drain insertion An initial stab incision of the overlying skin and dilation of the subcutaneous tissues with forceps will make subsequent passage of the drain less traumatic The traditional approach is to use a two-part (trocar) needle, advance a relatively stiff guidewire through the outer needle into the collection, and then advance a series of dilators, followed by a drain, over the guidewire It is possible to break down internal septa by manipulating a stiff guidewire in the collection, but this technique should be used with caution, particularly in small children, because it increases the risks for bleeding and septicemia The size of the drain used is usually based on the consistency of the fluid in the collection The use of locking pigtail drains is strongly advised because the rate of inadvertent removal is lower The method of drain removal is different for different drain types and must be carefully documented in the patient’s medical records to facilitate tube removal Deep pelvic collections are best approached via a transrectal route (▶ Fig 18.6) The transrectal drain is well tolerated, and there is no cutaneous scar The transrectal route also avoids inadvertent damage to the bowel and pelvic vessels that may occur with a transabdominal approach Although the procedure can be performed with a transrectal transducer, in children transabdominal US guidance is usually straightforward This may involve filling the bladder through a urinary catheter at the start of the procedure With the patient supine, the trocar needle is advanced into the rectum along the operator’s finger until it abuts the collection Advancement of the needle and guidewire and insertion of the drain can be guided by real-time US The alternative, transgluteal approach requires CT guidance and will not be discussed here Very occasionally, the drainage of deep-seated collections in older children may require CT (or cone beam CT) guidance Pancreatic collections can be approached via a transgastric route The gastric wall can be extremely difficult to dilate, and a very stiff guidewire is often required to avoid buckling the drain into the gastric cavity Indications for the drainage of pseudocysts include infection, pain, significant increase in size, and biliary obstruction Clinicians involved in the care of patients with pancreatitis should be familiar with the revised Atlanta classification and management strategies Techniques for nephrostomy placement in children are very similar to those in adults Infected obstructed kidneys warrant urgent drainage Causes of obstruction include calculi, blood clots, fungal balls, and anatomical variants such as a pelviureteric junction anomaly Nephrostomy placement itself is usually slightly easier in children because the kidney is more superficial, and even nondilated systems are well visualized with US Unilateral nephrostomy is best performed with the patient in a semiprone position, but bilateral nephrostomy requires prone positioning or repositioning of the patient after one side has been drained Transplant nephrostomy is usually easiest with the patient in the supine position A single-puncture technique is usually advocated in children (▶ Fig 18.7) Tips from the Pro ● ● Nephrostomy can be performed without fluoroscopic guidance, but if an immediate contrast study (“nephrostogram”) is necessary, the procedure should be performed in a room with fluoroscopic facilities Complex fluid collections not drain well through percutaneous drains ○ Fibrinolytic agents can be instilled to try to break down septa and pus ○ Management of the drain, including fibrinolysis and surveillance imaging, should be controlled jointly by the referring clinical team and the operator 625 | 11.05.15 - 18:25 Ultrasound-Guided Interventional Procedures: Biopsy and Drainage Fig 18.6a–d Transrectal drainage of a pelvic abscess with transabdominal ultrasound guidance and no fluoroscopy a The abscess (A) lies at the tip of the operator’s finger (arrows), which has been inserted into the rectum The bladder (B) is full, providing an excellent acoustic window b An 18-gauge trocar needle is advanced along the operator’s finger with the trocar withdrawn into the blunt outer needle to minimize the risk for rectal injury When the needle is in position to puncture the abscess, the sharp trocar is advanced, and the two parts are advanced together through the rectal wall The trocar is then removed so that pus can be aspirated through the outer needle (arrow) c A guidewire, in this case a 75-cm-long stiff Amplatz wire with a 0.97-mm (0.038-in) diameter, is inserted through the needle into the abscess d A locking pigtail drain is advanced over the guidewire into the abscess 626 | 11.05.15 - 18:25 Ultrasound-Guided Interventional Procedures: Biopsy and Drainage Fig 18.7a,b Transplant nephrostomy a Color Doppler flow imaging of an obstructed transplant kidney shows the relatively avascular approach to a dilated calyx (c) through overlying cortex b An appropriate calyx is selected and punctured with a large (18- or 19-gauge) needle (arrows) This allows for the insertion of a relatively large (0.038- or 0.035-inch) stiff guidewire Following serial dilation of the track, an appropriate sized nephrostomy tube is inserted The entire procedure can be performed with US guidance alone Recommended Readings Abi-Jaoudeh N, Kobeiter H, Xu S, Wood BJ Image fusion during vascular and nonvascular image-guided procedures Tech Vasc Interv Radiol 2013; 16: 168–176 Barnacle AM, Roebuck DJ, Racadio JM Nephro-urology interventions in children Tech Vasc Interv Radiol 2010; 13: 229–237 Franchi-Abella S, Cahill AM, Barnacle AM, Pariente D, Roebuck DJ Hepatobiliary intervention in children Cardiovasc Intervent Radiol 2014; 37: 37–54 Garrett KM, Fuller CE, Santana VM, Shochat SJ, Hoffer FA Percutaneous biopsy of pediatric solid tumors Cancer 2005; 104: 644–652 Gervais DA, Brown SD, Connolly SA, Brec SL, Harisinghani MG, Mueller PR Percutaneous imaging-guided abdominal and pelvic abscess drainage in children Radiographics 2004; 24: 737–754 Hogan MJ, Hoffer FA Biopsy and drainage techniques in children Tech Vasc Interv Radiol 2010; 13: 206–213 Light RW Pleural controversy: optimal chest tube size for drainage Respirology 2011; 16: 244–248 Muraca S, Chait PG, Connolly BL, Baskin KM, Temple MJ US-guided core biopsy of the spleen in children Radiology 2001; 218: 200–206 Nobili V, Comparcola D, Sartorelli MR et al Blind and ultrasound-guided percutaneous liver biopsy in children Pediatr Radiol 2003; 33: 772–775 Olsen JW, Barger RL, Jr, Doshi SK Moderate sedation: what radiologists need to know AJR Am J Roentgenol 2013; 201: 941–946 Robertson EG, Baxter G Tumour seeding following percutaneous needle biopsy: the real story! Clin Radiol 2011; 66: 1007–1014 Roebuck DJ Genitourinary intervention in children Pediatr Radiol 2011; 41: 17–26 Sidhu MK, Goske MJ, Coley BJ et al Image gently, step lightly: increasing radiation dose awareness in pediatric interventions through an international social marketing campaign J Vasc Interv Radiol 2009; 20: 1115–1119 Sinha MD, Lewis MA, Bradbury MG, Webb NJ Percutaneous real-time ultrasoundguided renal biopsy by automated biopsy gun in children: safety and complications J Nephrol 2006; 19: 41–44 Smith TP, McDermott VG, Ayoub DM, Suhocki PV, Stackhouse DJ Percutaneous transhepatic liver biopsy with tract embolization Radiology 1996; 198: 769–774 Ward TJ, Goldman RE, Weintraub JL Electromagnetic navigation with multimodality image fusion for image-guided percutaneous interventions Tech Vasc Interv Radiol 2013; 16: 177–181 Zaheer A, Singh VK, Qureshi RO, Fishman EK The revised Atlanta classification for acute pancreatitis: updates in imaging terminology and guidelines Abdom Imaging 2013; 38: 125–136 627 | 11.05.15 - 18:25 | 11.05.15 - 18:25 Index 22q11.2 deletion syndrome 157 A Abdominal aorta 215, 215, 216 Abdominal aorta thrombosis 215, 216 Abdominal neuroblastoma 215 Abdominal ultrasound, see Intestines and intestinal ultrasound, specific organs and structures Aberrant thymus 157, 158 Abscess – adrenal 517, 517 – breast 204 – chest wall 187, 190 – in renal transplantation 494 – lymph node 134, 135, 135, 187 – pancreatic 446 – pyogenic –– liver 259, 261–263 –– spleen 338 Abusive head trauma 93 Accessory adrenal gland 513 Accessory hepatic vein 246, 248 Accordion sign 394, 398 Acinar adenocarcinoma 441 Acoustic properties of materials and tissues 10 Acute lymphoblastic leukemia 313– 314 Adnexal torsion 560, 565–566 ADPKD, see Autosomal-dominant polycystic kidney disease (ADPKD) Adrenal cortical tumors 520, 529–532 Adrenal glands – abscesses in 517, 517 – accessory 513 – anatomy of 512 – cavernous hemangioma in 531, 533 – congenital adrenal hyperplasia in 517, 518 – cyst in 514, 516–517 – embryology of 512 – extrarenal rhabdoid tumor in 531, 533 – hemolytic anemia and 531 – hemorrhage in –– in older child 514, 516 –– neonatal 514, 515 – in Wolman disease 531, 534 – juxta-diaphragmatic pulmonary sequestration and 531, 533 – lipomatous tumors in 528, 533 – lymphangioma in 531, 533 – myelolipoma in 528, 533 – myeloproliferative disorder and 531 – neuroblastoma in 402–409, 516, 519, 519 – pheochromocytoma in 520, 529 – sonographic appearance of 512, 513 – teratoma in 528 – variants 513, 513, 514 – ”horseshoe” 513, 514 – ”lying down” 513, 513 Adrenal hyperplasia 518 – See also Congenital adrenal hyperplasia (CAH) Adrenal hypoplasia 518, 519 Adrenogenital syndrome 159 AHW, see Anterior horn width (AHW) Aliasing 18, 18 Alobar holoprosencephaly 84 Amenorrhea 539, 560 Amplitude mode 13, 14 Amyloidosis 170 Anal atresia 397, 404 Anesthesia for biopsy 618 Angiomatoid fibrous histiocytoma 611, 611 Angiomyolipoma in kidney 478, 480 Angiosarcoma in spleen 341 Ankle assessment 600, 601 Annular pancreas 426, 426–427 Anorexia nervosa 568 Anterior horn width (AHW) 38, 38–39 Anterior sacral meningocele 99, 104 Anus 397, 404 Aorta abdominal 215, 215, 216 Aortic arch – anomalies 163, 164–168, 170 – double 166, 168, 170 – in mediastinal anatomy 155, 157 – left with aberrant right subclavian artery 164, 164 – right with aberrant left subclavian artery 164, 165–167 Appendicitis 225, 227, 387, 389–390, 392–393 Appendix – abscess 391 – in cystic fibrosis 388 – in hemolytic uremic syndrome 388, 400 – in intestinal ultrasound 387, 388– 393 Appendix testis torsion of 583, 583, 584 Appointment Appointment letter Arachnoid cyst 78 Arteria lusoria 164, 164 Arteriovenous fistula in renal transplantation 495, 499 Arteriovenous malformation (AVM) 194, 197, 607 Arthritis 598, 598, 599–604 – juvenile idiopathic 598, 599 – septic 598, 599 Artifact(s) – aliasing as 18, 18 – defined 17 – enhancement as 17, 17 – flash 19, 19 – in 2D ultrasound 17 – in Doppler ultrasound 18 – mirror 18, 18 – reverberation as 17, 18 – shadowing as 17, 17 – twinkle 464, 464–465, 470 Ascariasis 428 Ascaris lumbricoides 377, 379 Ascensus medullaris 99 Ascites 221, 221, 222–224 Askin tumor 192 Astrocytomas 84 Ataxia telangiectasia 157 Atelectasis 202, 204–205 Attenuation 11, 12 Attitude of staff Atypical mycobacterial infection 134, 135 Atypical teratoid rhabdoid tumors 84 Autoimmune hepatitis type I 277, 281 – See also Hepatitis Autosomal-dominant polycystic kidney disease (ADPKD) 469, 469, 470–474 Autosomal-recessive polycystic kidney disease (ARPKD) 470, 470, 471 AVM, see Arteriovenous malformation (AVM) Axial deformation 19 Axial resolution 16 Azygos vein 155, 157 B Baby changing area 3, Back masses – non skin-covered 98 – skin-covered 98 Baker cyst 609 Banal lymphadenitis 132 Bartonella henselae 132, 133–134, 140 Beckwith-Wiedemann syndrome 440, 446, 474, 520 Benign enlargement of subarachnoid space (BESS) 92, 93–94 Benign small-bowel intussusception 381, 384 – See also Intussusception BESS, see Benign enlargement of subarachnoid space (BESS) Bile sludging 271, 272 Biliary tract, see Common bile duct, Gallbladder – air in 317, 317, 318, 320 – anatomy 246, 247–248 – benign masses of 298, 301 – rhabdomyosarcoma 316 – transducers for 246 Bilobed testicle 589, 590 Biological effects 20 Biopsy – anesthesia for 618 – bone 619 – coaxial systems for 619, 619–621 – complications of 618 – core needle 619 – equipment 618 – fine needle aspiration cytology for 619 – informed consent for 618 – kidney 619, 623, 623 – liver 619, 624 – lung 619 – lymph node 619 – needles for 619, 619 – renal tumor 620 – seeding of malignant cells in 618, 620 – spleen 619 – techniques 618 – tumor 620, 622 Bladder – anatomy 456 – calculi 504 – congenital urethral polyps in 504, 508 – diverticula 500, 501–502 – duplication 500 – in duplicate collecting system 461, 461 – infection 504, 506 – rhabdomyosarcoma 504, 506–507 – tumors 504, 506–508 Blake pouch cyst 78 Bochdalek hernia 208 Bone biopsy 619 Bone tumors of chest 199, 199, 200 Botulinum toxin A for drooling 141, 143 Bowel obstruction 403 – in Hirschsprung disease 409, 411 – in inspissated milk syndrome 404, 406 – in meconium ileus 407, 408, 408– 409 – in meconium peritonitis 408, 409– 410 – in meconium plug syndrome 406, 406 – in meconium pseudocyst 409, 410 Brachiocephalic vein 119, 119, 155, 157 Brain tumors congenital 84, 91–92 Branchial cleft cyst 122, 122, 123 BRCA gene carriers 208 Breast – abscess 204 – carcinoma 208 – congenital anomalies in 202, 205– 206 – cystic lesions in 205, 207–208 – development 185 – in chest anatomy 184, 185 – in gynecomastia 202 – in premature thelarche 202, 205 – inflammation of tissue in 204, 206 – malignant lesions in 208, 208 – metastatic disease in 208 Brightness mode 13, 14 Brucellosis 335, 339 Bucket handle deformity of anus 404 Budd-Chiari syndrome 282, 286–287 Bunny sign 251 Burkitt lymphoma 386 – See also Lymphoma C CAKUT, see Congenital anomalies of kidney and urinary tract (CAKUT) Calcifying epithelioma of Malherbe 127, 130–131 Candida albicans – in liver 259, 263 – in spleen 202 Candidiasis splenomegaly in 335 Capillary malformations 607 Carney complex 520 Caroli disease 251, 256 Carotid arteries 117, 118, 155, 157 Cat-scratch disease 187 – See also Bartonella henselae Cauda equina 102 Caudal cell mass 98 Caudal regression syndrome 99, 109, 111 629 | 11.05.15 - 18:25 Index Cavernous hemangioma adrenal 531, 533 Cavum septum pellucidum 40 Ceftriaxone 266, 270 Celiac artery 418, 420 Central dot sign 251, 256 Central venous line 119, 119, 120, 177, 177, 178 Cephalohematoma 146, 147, 148 Cerebellar vermis in Dandy-Walker malformation 39 Cerebral structures measurements of 38, 40 Cervical rib 146, 146 Cervix in female genital tract anatomy 475, 536 Changing area 3, Chemotherapy 369 Chest and chest ultrasound, see Breast – advantages of 182 – anatomy in 183, 183, 184–186 – approaches for 182, 182 – arteriovenous malformation in 197 – Askin tumor in 192 – atelectasis in 202, 204–205 – cystic lesions in 205, 207–208 – diaphragm in –– anatomy 186, 186 –– congenital anomalies of 208, 209– 211 –– eventration of 209, 210–211 –– trauma to 211 – diaphragmatic hernia in 208, 209– 210 – diaphragmatic paralysis in 210 – Ewing sarcoma in 199 – extraosseous Ewing sarcoma 192 – fibroadenoma in 207, 207–208 – gynecomastia in 202 – hematoma in 205, 207 – indications for 183 – infantile hemangioma in 192, 196, 196 – infectious lesions in 187, 190 – juvenile papillomatosis in 208 – lung consolidation in 202, 203 – lungs in 184, 184, 185 – lymphadenopathy in 187, 191–192 – lymphoma in 192, 194 – malignant lesions in 208 – mastitis in 204, 206 – noninvoluting congenital hemangioma in 197 – pleura in 184 – pleural fluid collection in 200, 200, 201 – pleural mass in 202, 203 – pleural thickening in 202 – pneumothorax in 202 – Poland syndrome in 187, 259 – premature thelarche in 202, 205 – probe for 182 – rapidly involuting congenital hemangioma in 197 – retroareolar cysts in 205, 207 – rhabdomyosarcoma in 192, 193 – rib abnormalities in 186, 188 – thoracic wall in 183, 183, 184 – trauma in 187, 188–190 – tumors of 192, 192, 193–194 –– in bone 199, 199, 200 – vascular lesions in 192, 194, 196– 199 630 – venous malformations in 197, 197 Chest wall abscess 187, 190 Chiari malformation 78, 82–83 Child-friendly staff Chloroma – in neck 148 – in pancreas 444, 445 Cholangitis – infectious 259, 264–265 – primary sclerosing 271, 273–274 Chole(docho)lithiasis 266, 266, 267– 271 Cholecystitis 259, 264 Choledochal cysts 251, 253–257 Cholestatic diseases 266, 272 Cholesterol polyp in gallbladder 298, 301 Chondrodysplasia punctata 159 Chondrosarcoma 199, 200 Choriocarcinoma in female genital tract 552 Choroid plexus tumors 84 Ciliopathies 468 Cirrhosis 275, 277 Clear cell carcinoma 477, 479 Cloacal malformation 540, 547–549 Clostridium difficile 394, 398–399 Coccyx 102, 103 Colitis, see Enterocolitis – infectious 394 – pseudomembranous 394, 398–399 – ulcerative 394, 395 Colon, see Large bowel Color Doppler 14, 360 Column of Bertin 454 Comet tail artifact 17, 18 Common bile duct – diameter 247 – in pancreatic anatomy 418, 420–421 – transection of in surgery 266, 271 Communication of results Compound imaging 19 Compression graded 360, 362 Congenital abnormalities – in breast 202, 205–206 – in cranial ultrasonography in term infants 78, 80–83, 85–93 – in female genital tract 538, 539–546 – of diaphragm 208, 209–211 – vascular in mediastinum 163, 164, 168–172 Congenital adrenal hyperplasia (CAH) 517, 518, 540 Congenital anomalies of kidney and urinary tract (CAKUT) 468 Congenital brain tumors 84, 91–92 Congenital fibrosarcoma 192 Congenital portosystemic shunts 251, 258–259 Congenital posterior urethral valve 502, 503 Congenital teratoma 84 Congenital urethral polyps 504, 508 Conn syndrome 520 Consent for biopsy 618 Continuous wave Doppler 13 Contrast-enhanced cystosonography (CSG) 493, 506, 508–509 Conus medullaris – ascension of 99 – in spine ultrasound 100 Coronal planes in neonatal cranial ultrasonography 22, 22, 23–26 Corpus callosum (CC) – dysgenesis of 84, 85–87 – measurement of 38, 40 Corrosive esophagitis 162, 163 Cortical dysplasia 84, 88 Couch 5, Coxsackievirus B infection 428 Cranial ultrasonography (cUS) neonatal – advantages of 22 – anatomy in 22, 22, 23–26 – deep gray matter in 31, 31, 32–33 – frontal echodensities in 26, 26–27 – in term infants 70, 71–83, 85–94 – maturational changes in 26 – measurements in 36, 39–40 – periventricular echodensities in 26, 27 – physiologic vs pathologic echogenic areas in 26 – preterm infant pathology in 39, 41– 69 – timing of 31, 34–37 – transducers for 70 – white matter in 26, 26, 27–29 Crohn disease 428 – in large bowel 393, 394, 394 – in small bowel 373, 373–375 Crying CSG, see Contrast-enhanced cystosonography (CSG) Currarino triad 111, 235, 240 Cushing syndrome 518, 520 Cystadenocarcinoma in female genital tract 552 Cystadenoma in female genital tract 552 Cystic fibrosis – appendix in 388 – gallstones in 266, 267 – intussusception in 382 – liver disease in 275, 278–280 – pancreas in 436, 437–439 Cystic lymphatic malformations 175, 175 Cystic transformation of rete testis 587, 588 Cystitis 504, 506 Cytosarcoma 208 D Dandy-Walker complex 78, 80–81 Dandy-Walker malformation 39, 78, 80 Deep pelvic collections 625, 626 Deformation 19 Deletion syndrome 157 Denys-Drash syndrome 474 Dermoid cyst 123, 123, 124–125 Desk administration 2, Desmoplastic small round cell tumors 230, 230 Developmental dysplasia of hip (DDH) 594, 595–598 Dextrocardia 334 Dialysis peritoneal 225 Diaphragm – congenital anomalies of 208, 209– 211 – eventration of 209, 210–211 – in chest anatomy 186, 186 – trauma to 211 Diaphragmatic hernia 208, 209–210 Diaphragmatic paralysis 210 Diastematomyelia 107, 110 Diastrophic dysplasia 159 Dillinger-Ellison syndrome 441 Diplomyelia 107 Disorders of sulcation and migration 84, 88–89 Distractions Domestic sedation 360, 362 Doppler echo 12 Doppler effect 12, 12 Doppler spectogram 12, 13 Doppler ultrasound – artifacts in 18 – color 14, 360 – continuous wave 13 – in joints 605, 606 – power 15, 15 – pulsed wave 13 Dorsal dermal sinus 107, 108, 109 Dorsal enteric fistula 107 Double aortic arch 166, 168, 170 Douglas pouch fluid in in females 221, 221 Drainage 625, 626–627 – complications of 618 Drooling 141, 143 Dual-imaging function 604 Duplicate collecting system 460, 461– 463 Duplication cyst – in stomach 364, 365 – intestinal 379, 381, 382–385 Dysgerminoma in female genital tract 552, 558, 558–561 E Echinococcus granulosus in liver 259, 263 Echoscopic image construction 13 ECMO, see Extracorporeal membrane oxygenation (ECMO) therapy Ectopic pancreas 426, 428 Ectopic thymus tissue – in mediastinum 157 – in neck 143, 145 Ectopic thyroid gland 137, 137 Ehlers-Danlos syndrome 500 Elastography 19, 19, 20, 275 Elbow assessment 602, 602 Elevational resolution 17, 17 Emla cream 205 Endomesenchymal tract 107 Endoscopic ultrasound of esophagus 360 Enhancement 17, 17 Entamoeba histolytica in liver 259 Enteric duplication cyst 238, 241–242 Enterocolitis, see Colitis – necrotizing 377, 379, 380 – neutropenic 394, 396 Ependymomas 84 Epidermoid cyst 123, 125 – splenic 338, 342 – testicular 577 Epididymal cyst 587, 588 Epididymis 570 Epididymitis 584, 584, 585–586 Epididymo-orchitis 584, 584, 585–586 Epiploic appendagitis 397, 402 Epstein-Barr virus 335 Esophageal achalasia 161, 162 | 11.05.15 - 18:25 Index Esophageal atresia 111, 159, 160, 363, 363 Esophageal foreign body 161, 163 Esophagitis corrosive 162, 163 Esophagus – endoscopic ultrasound of 360 – in intestinal ultrasound 360, 361 – in mediastinal anatomy 155, 157, 157 – in mediastinal pathology 159, 160– 163 – tracheoesophageal fistula in 159, 160 Ewing sarcoma – extraosseous 192 – in chest 199 – in liver metastasized 312 Examination Examination room 3, 4–5 Extracorporeal membrane oxygenation (ECMO) therapy 514 Extraosseous Ewing sarcoma 192 Extravaginal testicular torsion 582, 582, 583 F Familial hereditary pancreatitis 428 Familial juvenile hereditary nephritis 468 FAST, see Focused assessment with sonography for trauma (FAST) Fast-flow malformation 197 Fasting 2, Fecalith 227 Female genital tract – adnexal torsion in 560, 565–566 – amenorrhea and 539, 560 – anatomy 536, 536, 537 – cloacal malformation in 540, 547– 549 – congenital anomalies of 538, 539– 546 – granulosa-theca cell tumor in 552, 558, 562 – in pubertas praecox 568, 568 – measurements 538 – Müllerian duct anomalies in 538, 539–546 – ovarian cyst in 551–552, 552, 553– 558 – ovarian torsion in 560, 565–566 – ovarian tumors in 551, 551, 552–564 – pelvic inflammatory disease in 560, 567 – probe for 536 – rhabdomyosarcoma in 558, 563–564 – sexual development disorders in 540, 549–551 – small-cell carcinoma in 558 – teratoma in 552 Fibroadenoma in chest 207, 207–208 Fibroblastic tumors in musculoskeletal ultrasound 612, 612 Fibrohistiocystic tumors in musculoskeletal ultrasound 611, 611 Fibrolamellar carcinoma 302, 309 Fibroma in female genital tract 552 Fibromatosis colli 127, 131, 612, 612 Fibrosarcoma congenital 192 Fibrous hamartoma of infancy 612, 613 Filar cyst 103, 104 Filum terminale – in spinal ultrasound 100, 102, 102 – lipoma of 99, 107 – thickened 111 – tight 99, 111, 112 Fine needle aspiration 619 Flash artifact 19, 19 Focal infarction in preterm infants 64, 67–69 Focal nodular hyperplasia 298, 300– 301 Focused assessment with sonography for trauma (FAST) 225, 226, 287 Foreign body esophageal 161, 163 Forked ribs 186, 188 Foveolar hyperplasia 364, 367–368 Frame rate 604 Frontal echodensities in neonatal cranial ultrasonography 26, 26–27 Fungal infection in liver 259, 263 Fused ribs 186, 188 G Galactoceles 205 Gallbladder, see entries at Chol – benign masses of 298, 301 – cholesterol polyp in 298, 301 – distension of in fasting 246, 246 – hydrops 259 – in preterm infants volume of 247 – volume 247 Gallstones 266, 266, 267–271 Ganglion cell tumors retroperitoneal 235, 236 Ganglion in musculoskeletal ultrasound 609, 610 Ganglioneuroblastoma 175, 176, 192 Ganglioneuroma 175, 176 Gastric volvulus 364, 366 Gastrinoma 441 Gastritis 364 Gastroduodenal artery 418, 420 Gastroesophageal junction 363, 364 Gastroesophageal reflux disease (GERD) 363 Gaucher syndrome 335, 340, 341 GCTTS, see Giant cell tumor of tendon sheath (GCTTS) Genital tract, see Female genital tract, Male genital tract GERD, see Gastroesophageal reflux disease (GERD) Germinal matrix-intraventricular hemorrhage (GMH-IVH) 31, 36, 39, 40– 52, 54–57 Gerota fascia 214 Giant cell tumor of tendon sheath (GCTTS) 611 Glomerular nephropathy 485–487, 487, 488 Glomerulocystic kidney disease 468, 472 GMH-IVH, see Germinal matrix-intraventricular hemorrhage (GMH-IVH) Gonadal stromal cell tumors in male genital tract 577 Graded compression 360, 362 Granulosa-theca cell tumor in female genital tract 552, 558, 562 Graves disease 137, 138 Gray matter deep in neonatal cranial ultrasonography 31, 31, 32–33 Gray matter heterotropias 84 Great vessels in mediastinal anatomy 155, 157 Guidance, see Ultrasound guidance Gynecomastia 202 H Hamartoma – fibrous of infancy 612, 613 – in pancreas 441 – in spleen 340, 341, 349 – mesenchymal of liver 298, 299–300 – renal 478, 480 – tuber cinereum 568, 568 Harmonic imaging 19, 604 Hashimoto thyroiditis 137, 137 Head, see Cranial ultrasonography (cUS) neonatal Head trauma abusive 93 Heart in mediastinal anatomy 155, 157 Hemangioendothelioma in pancreas 441 Hemangioendothelioma in spleen 340, 341, 350 Hemangioma 194 – adrenal cavernous 531, 533 – congenital vs infantile 295 – in chest 192, 196, 196 – in liver 292, 292, 293–298 – in musculoskeletal ultrasound 607, 607 – in neck 124, 125–130, 140–141 – in spleen 338, 340, 345–346 – noninvoluting 197, 294, 295 – rapidly involuting congenital 197, 295, 295 – scrotal 578 – subglottic 159, 159 Hematoma – chest 205, 207 – in renal transplantation 494, 497 Hematoperitoneum 225, 225, 226–227 Hemihypertrophy syndrome 520 Hemolytic anemia – adrenal gland and 531 – splenomegaly in 339 Hemolytic uremic syndrome 388, 394, 400, 428 Henoch-Schönlein purpura 375, 377, 378, 382, 388, 428 Hepatic arterial flow 249, 251 Hepatic veno-occlusive disease 282, 285 – See also Budd-Chiari syndrome Hepatic venous flow 249, 251 Hepatitis 258, 260, 277, 281 Hepatoblastoma 301, 302–308 Hepatocellular carcinoma 302, 308 Heterotaxy syndrome – defined 332 – with asplenia 335 – with polysplenia 335, 336–337 Hiatal hernia 209 HIE, see Hypoxic-ischemic encephalopathy (HIE) Hip – assessment of 600, 600 – classification 595, 596–597 – developmental dysplasia of 594, 595–598 – in musculoskeletal ultrasound 594, 594, 595–599 – normal development of 594, 594 – transient synovitis of 598, 598, 599 – ultrasound technique for 595, 595, 596 Hirschsprung disease 409, 411 Histoplasmosis 170, 348, 352 Hodgkin disease 136, 174 Holoprosencephaly 84, 87 Horseshoe kidney 461, 463 Human immunodeficiency virus (HIV) infection parotid gland in 140 Hydrocele 570, 572–573 Hydromyelia 107 – See also Syringohydromyelia Hydrops of gallbladder 259 Hygroma colli 126, 129 Hyperlipidemia 428 Hypersplenism recurrent 327 Hypertension portal 275, 279, 281–282 – splenomegaly in 340 Hypertrophic pyloric stenosis 367, 370 Hypoxic-ischemic encephalopathy (HIE) 70, 71, 74–75, 77–79 I Idiopathic scrotal edema 585, 586 Iliac crest 100 Image construction 13, 19 Indirect inguinal hernia 573, 574–576 – in hydrocele 570, 572 Infants, see Preterm infants, Term infants Infectious cholangitis 259, 264–265 Infectious colitis 394 – See also Neutropenic enterocolitis Infectious lesions – in chest 187, 190 – in liver and biliary system 258, 260– 265 Infectious splenomegaly 335, 335, 339 Inferior vena cava 157, 216, 217–219 Inferior vena cava occlusion 216, 218– 219 Inflammatory bowel disease (IBD), see Colitis, Crohn disease Informed consent for biopsy 618 Inguinal hernia indirect 573, 574–576 – in hydrocele 570, 572 Innominate artery in mediastinal anatomy 155, 157 Inspissated milk syndrome 404, 406 Insulinoma 441 Intensive care mediastinal ultrasound in 177, 177, 178 Interhemispheric lipoma 87 Interstitial nephropathies 488 Intestinal duplication cyst 379, 381, 382–384 Intestinal polyps 373, 376–377, 382 Intestines and intestinal ultrasound, see Bowel obstruction, Large bowel, Small bowel, Stomach – appendix in 387, 388–393 – bowel obstruction in 403, 405–411 – color Doppler in 360 – esophagus in 360, 361 – gas in 360 – gastroesophageal junction in 363, 364 – graded compression in 360, 362 – large bowel in 393, 393, 394–402 – rectum in 397, 403 631 | 11.05.15 - 18:25 Index – small bowel in 367, 370–387 – stomach in 364, 364, 365–370 – ”gut signature” in 360, 360–361 Intracranial hemorrhage in term infants 70, 71–74 Intraductal papilloma 208 Intradural lipoma 107, 107, 107 Intraparenchymal hemorrhage in term infants 70, 72–74 Intraperitoneal fluid collections 221, 221, 222–227 Intravaginal testicular torsion 580, 581–582 Intraventricular hemorrhage in term infants 69, 70, 71 Intussusception – benign small-bowel 381, 384 – colocolic 381, 386 – contrast and air enema techniques with 382 – ileo-ileal 387 – ileo-ileocolic 381–382 – ileocolic 381–382, 384–387 – on conventional abdominal radiography 382 – pathologic lead points in 382, 385– 386 – reduction of 386, 387 Islet cell tumors 441, 448 Ivemark syndrome 513 J Jejunal atresia 405 JIA, see Juvenile idiopathic arthritis (JIA) Johnson-Blizzard syndrome 440 Joint(s), see Musculoskeletal ultrasound – assessment 599, 600–604 – infection in 606 – trauma 604, 606 Jugular veins 117, 118, 119, 120 Jugulodigastric node 127, 132, 132 Juvenile idiopathic arthritis (JIA) 598, 599 Juvenile papillomatosis 208 Juvenile polyps 394, 401–402 Juxta-diaphragmatic pulmonary sequestrations 531, 533 K Keutel syndrome 159 Kidneys and kidney ultrasound – anatomy of 452, 452, 454–456 – autosomal-dominant polycystic kidney disease in 469, 469, 470–474 – autosomal-recessive polycystic kidney disease in 470, 470, 471 – biopsy 619, 623, 623 – bladder in 456 – clear cell carcinoma in 477, 479 – column of Bertin in 454 – complicated cysts in 473, 473, 474 – compound calices in 454, 455 – cortical fusion defects in 454 – cysts and cystic nephropathies in 467, 468–469 – duplicate collecting system in 460, 461–463 – glomerular nephropathy in 485– 487, 487, 488 632 – glomerulocystic kidney disease in 468, 472 – horseshoe 461, 463 – in Henoch-Schönlein purpura 377, 378 – in renal hypodysplasia 457, 457, 458 – in ureteropelvic junction stenosis 457, 458–459 – in ureterovesical junction stenosis 457, 459–460 – in urolithiasis 464, 464, 465–468 – interstitial nephropathies in 488 – laceration 490, 490 – lymphoma in 477 – medullary sponge kidney disease in 472 – mesoblastic nephroma in 478 – metanephric adenoma in 478 – multicystic kidney disease in 472, 472, 473 – multilocular cystic nephroma in 478, 479 – nephroblastomatosis in 474, 475– 476 – nephrocalcinosis in 466, 466, 467, 467 – nephronophthisis in 468, 472, 472 – parenchymal nephropathy in 485, 485, 486–489 – persistent fetal lobulation in 452, 452 – protein deposits in in neonates 454, 455 – renal artery stenosis in 481, 482– 483 – renal cell carcinoma in 477 – renal vein thrombosis in 482, 483– 484 – renovascular disease in 481, 482– 484 – rhabdoid tumor in 477 – simple cysts in 468–469, 473 – size of 453 – technique for 452, 452 – transplantation of –– abscesses in 494 –– arteriovenous fistula in 495, 499 –– biopsy in 624 –– graft dysfunction in 496 ––– nephrologic complications causing 287, 491 ––– surgical complications causing 494, 496–497 –– hematoma in 494, 497 –– lymphoceles in 494, 496–497 –– post-transplant lymphoproliferative disorder in 500, 501 –– postoperative assessment of 491, 494 –– pseudoaneurysm in 495, 499 –– pyelonephritis in 498, 500 –– renal artery stenosis in 494, 498 –– renal artery thrombosis in 494 –– renal vein thrombosis in 494 –– renovascular disease in 500 –– urinary tract obstruction in 495– 496, 499 –– urinoma in 494 –– vascular complications in 494, 498– 499 – trauma in 490, 490, 491–493 – tubular nephropathies in 487, 488 – tubulopathies in 467 – – – – tumors in 474, 475–480 ureters in 455, 456 vascular nephropathies in 489, 489 Wilms tumor in 216, 218, 219, 219, 308, 310, 474, 474, 475–476, 476, 477–478 Klinefelter syndrome 204 Klippel Trenaunay syndrome 608 Kwashiorkor 221 L Langerhans cell histiocytosis 170, 199, 340, 354, 613, 614 Large bowel, see Bowel obstruction – Crohn disease in 393, 394, 394 – epiploic appendagitis in 397, 402 – in hemolytic uremic syndrome 394, 400 – in intestinal ultrasound 393, 393, 394–402 – infectious colitis in 394 – juvenile polyps in 394, 401–402 – meconium calcifications in 397, 402 – neutropenic enterocolitis in 394, 396 – nonstratified thickening of with loss of haustral folds 394 – nonstratified thickening of with preservation of haustral folds 394 – pseudomembranous colitis in 394, 398–399 – stratified thickening of 394 – ulcerative colitis in 394, 395 Laryngeal calcification 159 Lateral deformation 19, 20 Lateral resolution 16 Left aortic arch with aberrant right subclavian artery 164, 164 Leiomyoma in spleen 340, 352 Lenticulostriate infarct 67 Lenticulostriate vasculopathy 31, 33 Letter appointment Leukemia 135, 311, 313–314, 369 – See also Chloroma Li-Fraumeni syndrome 520, 529 Linear array transducer 15, 15 Lipoblastoma – in chest wall 192 – peritoneal 231, 231, 232 Lipoblastomatosis 231 Lipoma – in male genital tract 578 – in musculoskeletal ultrasound 608, 609 – in neck 145, 145 – in pancreas 441 – interhemispheric 87 – intradural 107, 107, 107 – of filum terminale 99, 107 Lipomyelocele 106, 106 Lipomyelomeningocele 99, 106, 106 Lisencephaly 84, 89 Liver, see entries at Hepatic – anatomy 246, 246, 247–249 – biopsy 619, 624 – calcifications neonatal 320–321, 321 – fibrolamellar carcinoma in 302, 309 – fungal infection of 259, 263 – hemangioma in 292, 292, 293–298 – hepatitis in 258, 260 – in Budd-Chiari syndrome 282, 286– 287 – in cirrhosis 275, 277 – in cystic fibrosis 275, 278–280 – in focal nodular hyperplasia 298, 300–301 – in nonalcoholic fatty liver disease 275, 275, 276 – in premature infants size of 246 – in situs inversus 334 – infection 258, 260–265 – mesenchymal hamartoma of 298, 299–300 – metastatic disease in 308, 310–314 – parasitic infection of 259, 263 – pyogenic abscess in 259, 261–263 – size of 246–247 – transducers for 246 – trauma 287, 287, 288–291 – tumors 292, 292, 293–301, 303–316 – vasculature 246, 248–249 Lobar holoprosencephaly 84 Lumbosacral junction 99 Lungs – atelectasis in 202, 204–205 – biopsy of 619 – consolidation in 202, 203 – in chest anatomy 184, 184, 185 Lymph node(s) – abscesses 134, 135, 135, 187 – biopsy of 619 – levels 127, 132 – malignant 135, 136 – necrotic 135 – reactive 132 – sonographic and clinical features of 127, 132–133 – supraclavicular 135 Lymphadenitis banal 132 Lymphadenopathy – in chest 187, 191–192 – in mediastinum 170, 173 – in neck 127, 132–136 – mesenteric 219, 220 – retroperitoneal 219, 220 Lymphangiomas – adrenal 531, 533 – in mediastinum 175, 175 – in neck 126, 129–130 – in pancreas 441 – in spleen 341, 347–348 – intra-abdominal 231, 233 Lymphangiomatosis in musculoskeletal ultrasound 607, 608 Lymphatic malformations – cystic 175, 175, 194, 198, 198, 199 – in musculoskeletal ultrasound 607, 608 Lymphoceles in renal transplantation 494, 496–497 Lymphoma – Burkitt 386 – in chest 192, 194 – in kidneys 477 – in mediastinum 174, 174 – in pancreas 444, 444–445 – in spleen 340, 341, 351 – intussusception in 386 – non-Hodgkin 135, 174 – retroperitoneal 231, 233 – splenomegaly in 335 M Male genital tract – anatomy in 570, 570, 571–572 | 11.05.15 - 18:25 Index – appendix testis torsion in 583, 583, 584 – bilobed testicle in 589, 590 – cystic transformation of rete testis in 587, 588 – epidermoid cyst in 577 – epididymal cyst in 587, 588 – epididymis in 570 – epididymitis in 584, 584, 585–586 – epididymo-orchitis in 584, 584, 585–586 – fibrous pseudotumors in 578 – gonadal stromal cell tumors in 577 – idiopathic scrotal edema in 585, 586 – indications for ultrasound in 570 – inguinal hernia in indirect 573, 574– 576 –– in hydrocele 570, 572 – lipoma in 578 – mediastinum in 570, 571–572 – polychordism in 589, 590 – retractile testicle in 590, 590, 591 – rhabdomyosarcoma in 578, 580 – scrotal tumors in 576, 577–580 – spermatic cord in 570, 571 – spermatic cyst in 573, 573 – technique with 570 – testicular microlithiasis in 576, 578 – testicular torsion in 580, 581–584 –– extravaginal 582, 582, 583 –– intravaginal 580, 581–582 – testicular trauma in 585, 586–587 – testicular tumors in 576, 577–578 –– secondary 576, 578–580 – testis in 570, 571 – tubular ectasia in 587, 588 – undescended testicle in 590, 590, 591 – varicocele in 588, 588, 589 – vas deferens in 570, 571 – Wilms tumor in 577, 579 Malrotation of small bowel 370, 372, 372 Mammary duct ectasia 205 Mammography 183 Mastitis 204, 206 Mastitis neonatorum 204 Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome 538, 539 McCune-Albright syndrome 568 Meckel diverticulum 377, 379–380, 382, 387, 426 Meckel-Gruber syndrome 446 Meconium calcifications 397, 402 Meconium ileus 407, 408, 408–409 Meconium peritonitis 397, 408, 409– 410 Meconium plug syndrome 406, 406 Meconium pseudocyst 409, 410 Mediastinum and mediastinum ultrasound – aberrant thymus in 157, 158 – anatomy 154, 155–156 – aortic arch in 155, 157 – approaches for 154 – chest radiography of 154 – congenital vascular anomalies in 163, 164, 168–172 – corrosive esophagitis in 162, 163 – cystic lymphatic malformations in 175, 175 – double aortic arch in 166, 168, 170 – ectopic thymus in 157 – – – – – – – – esophageal achalasia in 161, 162 esophageal atresia in 159, 160 esophageal foreign body in 161, 163 esophagus in 155, 157, 157, 159, 160–163 great vessels in 155, 157 heart in 155, 157 in intensive care 177, 177, 178 in male genital tract anatomy 570, 571–572 – indications for 154 – innominate artery in 155, 157 – left aortic arch with aberrant right subclavian artery in 164, 164 – lymphadenopathy in 170, 173 – lymphoma in 174, 174 – masses in 170, 170, 173–176 – neuroblastoma-ganglioneuroblastoma-ganglioneuroma complex in 175, 176 – pulmonary artery sling in 166, 169 – right aortic arch with aberrant left subclavian artery in 164, 165–167 – subglottic hemangioma in 159, 159 – thymic aplasia in 157, 158 – thymus in 154, 155 – total anomalous pulmonary venous return in 167, 169, 171 – trachea in 155, 157, 159, 159, 160 – tracheobronchial calcification in 159, 160 – tracheoesophageal fistula in 159, 160 – transducer placement in 154 – transducers for 154 Medullary carcinoma thyroid 138, 311 Medullary sponge kidney disease 472 Mega cisterna magna 78 Meningocele 104, 147 – anterior sacral 99, 104 – posterior 104 Mesenchymal hamartoma of liver 298, 299–300 Mesenteric cyst 238, 243 Mesenteric lymphadenopathy 219, 220 Mesenteric lymphoma 231, 233 Mesoblastic nephroma 478 Metabolic syndrome 440 Metanephric adenoma 478 Metastatic disease – in breast 208 – in liver 308, 310–314 – in pancreas 444 – peritoneal 231, 234–236 Middle aortic syndrome 215, 215–216 Midgut volvulus 370, 372, 372 Midline tumors of skull 146, 147 Migration disorders 84, 88–89 Milk curd syndrome 404, 406 Miller-Dieker syndrome 84 Mirror artifacts 18, 18 Mitochondrial succinate dehydrogenase enzyme defects 520 Montgomery cysts 205, 207 Morgagni hernia 209 Motion mode 14, 14, 98, 100 MRKH, see Mayer-Rokitansky-KüsterHauser (MRKH) syndrome Müllerian duct anomalies 538, 539– 546 Multicystic kidney disease 472, 472, 473 Multilocular cystic nephroma 478, 479 Multiple endocrine neoplasia syndrome 138, 140, 520 Musculoskeletal ultrasound – ankle assessment in 600, 601 – arteriovenous malformation in 607 – arthritis in 598, 598, 599–604 – Baker cyst in 609 – capillary malformations in 607 – congenital vascular lesions in 606 – elbow assessment in 602, 602 – fibroblastic tumors in 612, 612 – fibrohistiocystic tumors in 611, 611 – fibrous hamartoma of infancy in 612, 613 – ganglion in 609, 610 – hemangioma in 607, 607 – hip assessment in 600, 600 – hip in 594, 594, 595–599 – joint assessment in 599, 600–604 – juvenile idiopathic arthritis in 598, 599 – Langerhans cell histiocytosis in 613, 614 – lipoma in 608, 609 – lymph nodes in 608, 608 – lymphangiomatosis in 607, 608 – lymphatic malformations in 607, 608 – neurofibroma in 610, 611 – pilomatrixoma in 612, 613 – popliteal cyst in 609 – rhabdomyosarcoma in 613, 613 – septic arthritis in 598, 599 – subcutaneous granuloma annulare in 610, 610 – synovial cyst in 609 – transient synovitis of hip in 598, 598, 599 – vascular malformations in 607 – venous malformation in 607, 607 – wrist assessment in 602, 602 Myelocele 99, 103, 104 Myelocystocele 105, 105 Myelolipoma adrenal 528, 533 Myelomeningocele 99, 103, 104 Myeloproliferative disorder, adrenal gland and 531 Myofibroma 149, 312 Myometrium in female genital tract anatomy 536, 537 N NAFLD, see Nonalcoholic fatty liver disease (NAFLD) Near field 604, 606 Neck and neck ultrasound – anatomy in 116, 116, 117–119 – brachiocephalic vein in 119, 119 – branchial cleft cyst in 122, 122, 123 – carotid arteries in 117, 118 – central line in 119, 119, 120 – cervical rib in 146, 146 – cystic lesions in 120, 121–125 – dermoid cyst in 123, 123, 124–125 – ectopic thymus tissue in 143, 145 – ectopic thyroid gland in 137, 137 – epidermoid cyst in 123, 125 – fibromatosis colli in 127, 131 – hemangiomas in 124, 125–130, 141 – hygroma colli in 126, 129 – indications for 116 – jugular veins in 117, 118, 119, 120 – lipomas in 145, 145 – lymph nodes in 117 –– abscesses 134, 135, 135 –– levels 127, 132 –– –– –– –– malignant 135, 136 necrotic 135 reactive 132 sonographic and clinical features of 127, 132–133 –– supraclavicular 135 – lymphadenopathy in 127, 132–136 – lymphangiomas in 126, 129–130 – neuroblastoma in 150 – orbital cyst in 123, 124 – paraganglioma in 146, 146 – parotid gland in 116, 116 – pilomatrixoma in 127, 130–131 – retropharyngeal region in 116 – salivary gland stones in 141, 142 – salivary gland tumors in 126, 141, 142 – salivary glands in 116, 138 – subclavian arteries in 117, 118–119 – subclavian veins in 117, 118, 119, 119–120 – sublingual glands in 116, 117 – submandibular gland in 116, 116– 117 – superior caval vein in 119 – thymus in 117, 118 – thyroglossal duct cyst in 120, 121 – thyroid gland in 117, 117–118, 137, 137, 138–140 – thyroid nodules in 138, 138, 139– 140 – thyroiditis in 137, 137, 138 – transducers for 116 – tumors in 127, 131–136 – vascular malformations in 124, 125– 130 – vessel pathology 119, 119, 120 Necrotizing enterocolitis 377, 379, 380 Needles biopsy 619 Neonatal ascites 224 Neonatal bowel obstruction 403, 405– 411 Neonatal cranial ultrasonography, see Cranial ultrasonography (cUS) neonatal Neonatal isoimmune thrombocytopenia 70 Neonatal liver calcifications 320–321, 321 Neonates, see Preterm infants, Term infants Nephroblastomatosis 474, 475–476 Nephrocalcinosis 466, 466, 467, 467 Nephroma – mesoblastic 478 – multilocular cystic 478, 479 Nephronophthisis 468, 472, 472 Nephrostomy placement 625, 627 Nephrotic syndrome 221 Neural groove 98, 99 Neural plate 98, 99 Neural tube 98 Neurinomas in pancreas 441 Neuroblastoma, see Ganglion cell tumors – abdominal 215 – adrenal 402–409, 516, 519, 519 – in chest wall 192 633 | 11.05.15 - 18:25 Index – in liver metastasis of 308, 310–311, 313 – in neck 150 – in pancreas 444, 444 – retroperitoneal 219, 311 – splenic displacement by 335, 338 Neuroblastoma-ganglioneuroblastomaganglioneuroma complex 175, 176 Neuroendocrine adenomatosis 441, 443 Neurofibroma in musculoskeletal ultrasound 610, 611 Neurofibromatosis type I 204, 578 Neurogenic tumors of chest wall 192 Neurulation – primary 98 – secondary 98 Neutropenic enterocolitis 394, 396 – See also Infectious colitis Newman-Pick disease 335, 341 NICH, see Noninvoluting congenital hemangioma (NICH) Non-Hodgkin lymphoma 135, 174 – See also Lymphoma Nonalcoholic fatty liver disease (NAFLD) 275, 275, 276 Noninvoluting congenital hemangioma (NICH) 197, 294, 295 Norman-Roberts syndrome 84 Notochord 98, 99 Nyquist-Shannon theorem 13 O Obesity – gallstones in 266, 267 – gynecomastia in 204 – lymphadenopathy imaging and 219 – nonalcoholic fatty liver disease in 275, 275 – pancreas in 440, 448 Occult spinal dysraphism 98, 107, 107, 108–113 Orbital cyst 123, 124 Orthotopic thymus 145 Osteochondroma 200, 200 Osteosarcoma primary 199 Ovarian carcinoma 170 Ovarian cyst 551–552, 552, 553–558 Ovarian follicles in female genital tract anatomy 536, 537 Ovarian small-cell carcinoma 558 Ovarian torsion 560, 565–566 Ovarian tumors 551, 551, 552–564 Ovaries size of 538 P PAIS, see Perinatal arterial ischemic stroke (PAIS) Pampiniform plexus 570 Pancreas and pancreas ultrasound – abscesses in 446 – anatomy 416–417, 417, 418–425 – annular 426, 426–427 – chloroma in 444, 445 – congenital cysts of 446, 447 – cystic lesions in 444 – cystic neoplasms of 446 – developmental anomalies of 426, 426, 427–430 – echogenicity of 421, 424 634 – – – – gastrinomas in 441 hamartoma in 441 hemangioendoethelioma in 441 in Beckwith-Wiedemann syndrome 440, 446 – in cystic fibrosis 436, 437–439 – in Johnson-Blizzard syndrome 440 – in Shwachman-Diamond syndrome 439, 440 – in situs inversus 428, 430 – indications for 416 – insulinomas in 441 – islet cell tumors in 441, 448 – isthmus of 418, 420 – lipoma in 441 – lymphangioma in 441 – lymphoma in 444, 444–445 – metastatic disease in 444 – neck of 418, 420 – neoplasms 440, 441–448 – neurinoma in 441 – neuroblastoma in 444, 444 – neuroendocrine adenomatosis in 441, 443 – pseudocysts in 444, 446–447 – size of 421, 422 – solid papillary tumor in 441, 442, 448 – tail of 416–417, 418 – technique for 416, 416, 417–419 – uncinate process of 397, 418, 420, 424 Pancreas divisum 426, 426, 428 Pancreatic adenocarcinoma 441 Pancreatic collections 625 Pancreatic duct 416, 418, 421 Pancreatic duct obstruction 434 Pancreatic hypoplasia 428, 429 Pancreatitis – acute 428, 428, 430–434, 448 – chronic 434, 435–437 – familial hereditary 428 – necrotizing 225 Pancreatoblastoma 441, 448 Papillary carcinoma thyroid 138, 139 Papillomatosis juvenile 208 Paraganglioma in neck 146, 146 Paragranuloma 136 Parasitic infection in liver 259, 263 Parenchymal nephropathy 485, 485, 486–489 Parotid gland 116, 116, 138, 140 – See also Salivary glands Parotitis bacterial 140 Patent urachus 503 PCOS, see Polycystic ovarian syndrome (PCOS) Peliosis 340 Pelvic inflammatory disease (PID) 560, 567 Peptic ulcer disease 364 Perianal abscesses 403 Perinatal arterial ischemic stroke (PAIS) in preterm infants 64, 67–69 Perineal fistula 403 Peristalsis in small bowel vs colon 367 Peritoneal cavity – air in 229, 229, 229, 230 – anatomy of 214, 214 – in males vs females 214 Peritoneal dialysis 225 Peritoneal fluid 214 – See also Intraperitoneal fluid collections Peritoneal metastases 231, 234–236 Peritoneal tumors 229, 230–236 Peritonitis 225, 227–228 – meconium 397, 408, 409–410 Periventricular echodensities (PVEs) in neonatal cranial ultrasonography 26, 27, 31 Periventricular hemorrhagic infarction (PVHI) 31, 40, 69 Periventricular leukomalacia (PVL) 36, 65 Perthes disease 598 Phakomatoses 84, 90 Phased array transducer 16, 16 Pheochromocytoma 520, 529 Phleboliths 197 PHVD, see Post-hemorrhagic ventricular dilatation (PHVD) Phyllodes tumor 208 PID, see Pelvic inflammatory disease (PID) Piezoelectric effect 15, 15 Pigmented villonodular synovitis (PVNS) 611 Pilomatricoma, see Pilomatrixoma Pilomatrixoma 127, 130–131, 612, 613 Pleomorphic adenoma 141, 142 Pleura in chest anatomy 184 Pleural fluid collection 200, 200, 201 Pleural mass 202, 203 Pleural thickening 202 Plunging ranula 140, 142 PNET, see Primitive neuroectodermal tumors (PNET) Pneumobilia 317, 317, 318 Pneumocystis carinii 170 Pneumoperitoneum 229, 229, 229, 230 Pneumothorax 202 Poland syndrome 187, 259 Polychordism 589, 590 Polycystic ovarian syndrome (PCOS) 568 Polyps, see Intestinal polyps, Juvenile polyps – congenital urethral 504, 508 Popliteal cyst 609 Portal hypertension 275, 279, 281–282 – See also Budd-Chiari syndrome – splenomegaly in 340 Portal vein thrombosis 282, 283–285 – splenomegaly in 335, 340 Portal venous air 317, 318–319 Portal venous flow 249, 249, 250 Portosystemic shunts congenital 251, 258–259 Post-hemorrhagic ventricular dilatation (PHVD) 31, 36, 38, 39–40, 42, 52, 57–60 Post-transplant lymphoproliferative disorder (PTLD) in renal transplantation 500, 501 Posterior fossa abnormalities 78 Posterior triangle 127 Posterior urethral valve congenital 502, 503 Power Doppler 15, 15 Precocious puberty 568, 568 Premature thelarche 202, 205 Preterm infants – cranial pathology in 39, 41–69 – germinal matrix-intraventricular hemorrhage in 31, 36, 39, 40–52, 54–57 – inspissated milk syndrome in 404, 406 – liver size in 246 – perinatal arterial ischemic stroke in 64, 67–69 – post-hemorrhagic ventricular dilatation in 31, 36, 38, 39–40, 42, 52, 57– 58 – splenic length in 331 – white matter injury in 60, 60, 61–66 Primary pigmented nodular adrenal hyperplasia 518 Primary sclerosing cholangitis (PSC) 271, 273–274 Primitive neuroectodermal tumors (PNET) 84, 558 Principles of ultrasound 10 Private room Probes, see Transducers Procedures, see Ultrasound guidance Propagation of ultrasonic waves 10 Prostatic utricle cysts 503 PSC, see Primary sclerosing cholangitis (PSC) Pseudoaneurysm in renal transplantation 495, 499 Pseudoangiomatous stromal hyperplasia 208 Pseudochole(docho)lithiasis 266, 270 Pseudocysts pancreatic 444, 446–447 Pseudomembranous colitis 394, 398– 399 Pseudosinus tract 103, 104 PTLD, see Post-transplant lymphoproliferative disorder (PTLD) Pubertas praecox 568, 568 Pulmonary artery – left 155, 157 – right 155, 157 – sling 166, 169 Pulmonary veins in total anomalous pulmonary venous return 167, 169, 171 Pulsed wave Doppler 13 Pulsus tardus et parvus pattern 481, 483 PVEs, see Periventricular echodensities (PVEs) PVHI, see Periventricular hemorrhagic infarction (PVHI) PVL, see Periventricular leukomalacia (PVL) PVNS, see Pigmented villonodular synovitis (PVNS) Pyelonephritis transplant 498, 500 Pyloric stenosis 367, 370 Pyogenic abscess – in liver 259, 261–263 – in spleen 338 R Radial aplasia 159 Ranula 140, 142 Rapidly involuting congenital hemangioma (RICH) 197, 295, 295 Rectum 397, 403 Recurrent hypersplenism 327 Reflection 10, 11 Refraction 11, 11 | 11.05.15 - 18:25 Index Renal agenesis 111 Renal artery 455, 456 Renal artery stenosis 481, 482–483 – in renal transplantation 494, 498 Renal artery thrombosis in renal transplantation 494 Renal cell carcinoma 477 Renal cystic hypodysplasia 468 Renal dysplasia 159 Renal hamartoma 478, 480 Renal hypodysplasia 457, 457, 458 Renal laceration 490, 490 Renal transplantation – abscesses in 494 – arteriovenous fistula in 495, 499 – graft dysfunction in 496 –– nephrologic complications causing 287, 491 –– surgical complications causing 494, 496–497 – hematoma in 494, 497 – lymphoceles in 494, 496–497 – post-transplant lymphoproliferative disorder in 500, 501 – postoperative assessment of 491, 494 – pseudoaneurysm in 495, 499 – pyelonephritis in 498, 500 – renal artery stenosis in 494, 498 – renal artery thrombosis in 494 – renal vein thrombosis in 494 – renovascular disease in 500 – urinary tract obstruction in 495– 496, 499 – urinoma in 494 – vascular complications in 494, 498– 499 Renal trauma 490, 490, 491–493 Renal tumors 474, 475–480 Renal vein thrombosis 482, 483–484 – in renal transplantation 494 Renovascular disease 481, 482–484 – in renal transplantation 500 Resolution 16, 17 Results communication of Rete testis cystic transformation of 587, 588 Retractile testicle 590, 590, 591 Retroareolar cysts 205, 207 Retroperitoneal anatomy 214, 215 Retroperitoneal lymphadenopathy 219, 220 Retroperitoneal lymphoma 231, 233 Retroperitoneal neuroblastoma 219, 311 Retroperitoneal tumors 234, 236–240 Retropharyngeal region 116 Reverberation 17, 18 Reye syndrome 428 Rhabdoid tumor 477 – extrarenal adrenal gland and 531, 533 Rhabdomyosarcoma – biliary tract 316 – bladder 504, 506–507 – chest wall 192, 193 – in female genital tract 558, 563–564 – in male genital tract 578, 580 – in musculoskeletal ultrasound 613, 613 – mediastinum 170 – retroperitoneal 219 Rib(s) – abnormalities 186, 188 – cervical 146, 146 – forked 186, 188 – fused 186, 188 RICH, see Rapidly involuting congenital hemangioma (RICH) Right aortic arch with aberrant left subclavian artery 164, 165–167 Roundworm, see Ascaris lumbricoides S Sacral dimple 104, 112–113, 113 Sacrococcygeal dimple 98 Sacrococcygeal teratoma 235, 237–240 Safety 20, 20 Salivary gland stones 141, 142 Salivary gland tumors 126, 141, 142 Salivary glands 116, 138 Sarcoidosis 170, 173 Scattering 11 Schizencephaly 84 SCID, see Severe combined immune deficiency syndrome (SCID) Sclerosing angiomatoid nodular transformation in spleen 341 Sclerosing encapsulating peritonitis 225, 228 Scrotal edema idiopathic 585, 586 Scrotal hemangioma 578 Scrotal trauma 585, 586–587 Scrotal tumors 576, 577–580 Scrotum, see Male genital tract Sedation 5, 360, 362, 618 Seldinger technique 625 Semilobar holoprosencephaly 84, 87 Seminoma 170 Septic arthritis 598, 599 Sertoli-Leydig cell tumor in female genital tract 552, 558 Severe combined immune deficiency syndrome (SCID) 157 Sexual development disorders in female genital tract 540, 549–551 Shadowing 17, 17 Shwachman-Diamond syndrome 439, 440 Sialoliths 141, 142 Sialorrhea 141, 143 Sickle cell disease gallstones in 266, 267 Situs inversus 332, 334 – liver and biliary system in 332, 334 – pancreas in 428, 430 Sjörgen disease 140, 141 Small bowel, see Bowel obstruction – Ascaris lumbricoides in 377, 379 – caliber of 367 – contents 367 – Crohn disease in 373, 373–375 – duplication cysts in 379, 381, 382– 385 – folds in 367 – Henoch-Schönlein purpura in 375, 377, 378 – in intestinal ultrasound 367, 370– 387 – intestinal polyps in 373, 376–377 – location of 367 – malrotation/volvulus of 370, 372, 372 – Meckel diverticulum in 377, 379– 380 – necrotizing enterocolitis in 377, 379, 380 – peristalsis in 367 Small-cell carcinoma ovarian 558 Snell’s law 10 Solid papillary tumor (SPT) 441, 442, 448 Spectogram Doppler 12, 13 Spermatic cord – cellular neurofibroma in 578 – hydrocele in 573, 573 – in male genital tract anatomy 570, 571 – in testicular torsion 580, 581 Spermatic cyst 573, 573 Spherocytosis 335, 339 Spinal dysraphism – defined 98 – occult 98 Spine and spinal ultrasound – acoustic window in 98 – caudal regression syndrome in 99, 109, 111 – closed lesions of 98, 107, 107, 108– 113 – diastematomyelia in 107, 110 – – – – – – – dorsal dermal sinus in 107, 108 embryology of 98, 99 indications for 98 intradural lipoma in 107, 107 last rib in 99, 100 lipomyelocele in 106, 106 lipomyelomeningocele in 99, 106, 106 – lumbosacral junction in scans of 99 – motion mode for 100 – myelocele in 99, 103, 104 – myelocystocele in 105, 105 – myelomeningocele in 99, 103, 104 – non skin-covered back masses in 98, 103, 104 – normal anatomic variants in 102, 103–104 – normal sonographic anatomy in 100, 101–103 – occult lesions of 98, 107, 107, 108– 113 – panoramic view of 99, 100 – sacral dimple in 104, 112–113, 113 – sagittal images of 99 – skin-covered back masses in 98, 104, 105–106 – syringohydromyelia in 107, 109 – tight filum terminale in 111, 112 – transducers for 98 – transverse images of 99–100, 101 – ultrasound technique with 99 Spleen and spleen ultrasound – anatomical considerations with 324, 324 – angiosarcoma in 341 – biopsy 619 – calcification in 340, 348, 352–354 – candidiasis of 202 – displacement of by other pathologic processes 335 – echogenicity in 325, 327 – embryology of 324, 324 – epidermoid cyst in 338, 342 – fungal infection of 202 – hamartoma in 340, 341, 349 – hemangioendothelioma in 340, 341, 350 – hemangioma in 338, 340, 345–346 – hematopoietic activity of 335 – histology of 325 – in heterotaxy syndrome –– defined 332 –– with asplenia 335 –– with polysplenia 335, 336–337 – in Langerhans cell histiocytosis 340, 354 – in preterm infants 331 – in situs inversus 332, 334 – indications for 324 – leiomyoma in 340, 352 – lymphangioma in 341, 347–348 – lymphoma in 340, 341, 351 – pyogenic abscess in 338 – sclerosing angiomatoid nodular transformation in 341 – size of 331, 331, 332 – technique for 324–325, 325, 326 – trauma 348, 355–357 – traumatic cysts in 338, 343 – variants 327, 330–331 – vascularity of 327, 328–329 – wandering 332, 333 – with age 325 Splenic artery 324, 327, 328 Splenic contusion 348 Splenic cysts 335, 341–347 Splenic fusion abnormalities 332 Splenic hematoma 348, 356 Splenic lacerations 348, 356–357 Splenic notch 327, 331 Splenic vein 325, 329 Splenogonadal fusion 332 Splenomegaly generalized 335, 335, 339 Splenorenal fusion 332 Splenunculi 327, 330 Split cord malformation 107 SPT, see Solid papillary tumor (SPT) Staff child-friendly Sternocleidomastoid in fibromatosis colli 127, 131 Stomach – duplication cyst in 364, 365 – food in 364, 364 – in chemotherapy 369 – in foveolar hyperplasia 364, 367– 368 – in gastric volvulus 364, 366 – in gastritis 364 – in intestinal ultrasound 364, 364, 365–370 – in peptic ulcer disease 364 – pyloric stenosis in 367, 370 Struma 138, 139 Subarachnoid hemorrhage 70 Subarachnoid space – benign enlargement of 92, 93–94 – in spinal ultrasound 100 – mean size of 93, 94 Subclavian arteries 117, 118–119, 155, 157 – aberrant left with right aortic arch 164, 165–167 – aberrant right with left aortic arch 164, 164 Subclavian veins 117, 118, 119, 119– 120 Subcutaneous granuloma annulare 610, 610 635 | 11.05.15 - 18:25 Index Subdural hematoma in benign enlargement of subarachnoid space 93, 94 Subdural hemorrhage 70 Subglottic hemangioma 159, 159 Sublingual gland obstruction 140, 142 Sublingual glands 116, 117, 140 Submandibular gland 116, 116–117 – See also Salivary glands Submandibular gland stones 141, 142 Submandibular nodes 127 Submental nodes 127 Sucrose 360, 362 Sulcation disorders 84, 88–89 Superior caval vein 119 Superior mesenteric artery (SMA) in midgut volvulus 372, 372 Superior mesenteric vein (SMV) in midgut volvulus 372, 372 Superior vena cava 155, 157 Supraclavicular lymph nodes 135 Synovial cyst 609 Syringocele 503 Syringohydromyelia 107, 109 Syringomyelia 107 Syrup 360, 362 T T cell-related immunodeficiencies 157 Takayasu arteritis 215 Teratoid rhabdoid tumors atypical 84 Teratoma – adrenal 528 – cranial 84 – in female genital tract 552 – in neck 148 Term infants – benign enlargement of subarachnoid space in 92, 93–94 – brain tumors in 84, 91–92 – Chiari malformation in 78, 82–83 – corpus callosum dysgenesis in 84, 85–87 – cranial congenital abnormalities in 78, 80–83, 85–93 – cranial ultrasonography in 70, 71– 83, 85–94 – Dandy-Walker complex in 78, 80–81 – disorders of sulcation and migration in 84, 88–89 – holoprosencephaly in 84, 87 – hypoxic-ischemic encephalopathy in 70, 71, 74–75, 77–79 – intracranial hemorrhage in 70, 71– 74 – intraparenchymal hemorrhage in 70, 72–74 – intraventricular hemorrhage in 69, 70, 71 – liver size in 246 – migration disorders in 84, 88–89 – phakomatoses in 84, 90 – posterior fossa abnormalities in 78 – sulcation disorders in 84, 88–89 – tuberous sclerosis in 84, 90 Testicular microlithiasis 576, 578 Testicular torsion 580, 581–584 – extravaginal 582, 582, 583 – intravaginal 580, 581–582 Testicular trauma 585, 586–587 Testicular tumors 576, 577–578 – secondary 576, 578–580 Testicular volume 570, 570 636 Testis – bilobed 589, 590 – in male genital tract anatomy 570, 571 – retractile 590, 590, 591 – undescended 590, 590, 591 Tethered cord early detection of 98 Thalamo-occipital distance (TOD) 38, 38–39, 42 Thecoma in female genital tract 552 Thelarche premature 202, 205 Thoracic wall in chest anatomy 183, 183, 184 Thorax, see Chest and chest ultrasound Thrombocytopenia neonatal isoimmune 70 Thymic aplasia 157, 158 Thymic hypoplasia 158 Thymopharyngeal duct cysts 143 Thymus 117, 143 – aberrant 157, 158 – as acoustic window 143 – ectopic –– in mediastinum 157 –– in neck 143, 145 – in mediastinum anatomy 154 – in neck anatomy 118 – involution of 154 – orthotopic 145 – size of 154 – with aging 143, 143, 154 Thyroglossal duct 137 Thyroglossal duct cyst 120, 121, 137 Thyroid cyst 138, 138 Thyroid gland 117, 117–118, 137, 137, 138–140 – ectopic 137, 137 Thyroid nodules 138, 138, 139–140 Thyroiditis 137, 137, 138 Tight filum terminale 99, 111, 112 TOD, see Thalamo-occipital distance (TOD) Total anomalous pulmonary venous return 167, 169, 171 Trachea – in mediastinal anatomy 155, 157 – in mediastinal pathology 159, 159, 160 – subglottic hemangioma in 159, 159 Tracheobronchial calcification 159, 160 Tracheoesophageal fistula 159, 160– 161, 363 Transducers 15 – for chest ultrasound 182 – for cranial ultrasound 70 – for female genital tract 536 – for hip 595 – for joint soft tissue masses 604 – for liver and biliary tract 246 – for neck 116 – for spine 98 – linear array 15, 15 – phased array 16, 16 – types of 15 Transient dilatation of central canal 103 Transient synovitis of hip 598, 598, 599 Transplantation renal – abscesses in 494 – arteriovenous fistula in 495, 499 – biopsy in 624 – graft dysfunction in 496 –– nephrologic complications causing 287, 491 –– surgical complications causing 494, 496–497 – hematoma in 494, 497 – lymphoceles in 494, 496–497 – post-transplant lymphoproliferative disorder in 500, 501 – postoperative assessment of 491, 494 – pseudoaneurysm in 495, 499 – pyelonephritis in 498, 500 – renal artery stenosis in 494, 498 – renal artery thrombosis in 494 – renal vein thrombosis in 494 – renovascular disease in 500 – urinary tract obstruction in 495– 496, 499 – urinoma in 494 – vascular complications in 494, 498–499 Transrectal drainage 625, 626 Transverse cerebellar diameter (TCD) 39, 40, 70 Trauma – abusive head 93 – chest 187, 188–190 – diaphragm 211 – focused assessment with sonography for 225, 226, 287 – joint 604, 606 – liver 287, 287, 288–291 – pancreatitis in 428 – renal 490, 490, 491–493 – scrotal 585, 586–587 – spleen 348, 355–357 – testicular 585, 586–587 Triangular cord sign 249, 252 Triple A syndrome 162 Trisomy 18 474 Tuber cinereum hamartoma 568, 568 Tuberculosis 170, 173, 335 Tuberous sclerosis 84, 90 Tubular ectasia 587, 588 Tubular nephropathies 487, 488 Tubulopathies 467 Tumors – biopsy of 620, 622 – bladder 504, 506–508 – brain congenital 84, 91–92 – liver 292, 292, 293–301, 303–316 – neck 127, 131–136 – of chest –– in bone 199, 199, 200 –– in breast 208 – of chest wall 192, 192, 193–194 – of pancreas 440, 441–448 – ovarian 551, 551, 552–564 – peritoneal 229, 230–236 – renal 474, 475–480 – retroperitoneal 234, 236–240 – scrotal 576, 577–580 – seeding of in biopsy 618, 620 – testicular 576, 577–578 –– secondary 576, 578–580 Tunica albuginea 570 Turner syndrome 560 Twinkle artifact 464, 464–465, 470 Typhitis 394, 396 Tyrosinemia type I 277 U Ulcerative colitis 394, 395 Ultrasonic waves – as longitudinal compression waves 10 – attenuation of 11, 12 – frequencies of 10 – propagation of 10 – reflection of 10, 11 – refraction of 11, 11 – scattering of 11 – wavelengths of 10 Ultrasound – biological effects of 20 – history of 10 – principles of 10 Ultrasound guidance – advantages of 618 – in biopsy –– anesthesia for 618 –– bone 619 –– coaxial systems for 619, 619–621 –– complications of 618 –– core needle 619 –– equipment 618 –– fine needle aspiration cytology for 619 –– informed consent for 618 –– kidney 619, 623, 623 –– liver 619, 624 –– lung 619 –– lymph node 619 –– needles for 619, 619 –– renal tumor 620 –– seeding of malignant cells in 618, 620 –– spleen 619 –– techniques 618 –– tumor 620, 622 – in drainage 625, 626–627 Undescended testicle 590, 590, 591 Urachal anomalies 503, 504 Urachal cyst 504 Urachal diverticulum 504 Urachal sinus 504 Urachus patent 503 Ureterocele 461, 462–463, 500, 502 Ureteropelvic junction stenosis 457, 458–459 Ureterovesical junction stenosis 457, 459–460 Ureterovesical reflux 457, 457, 460 – See also Contrast-enhanced cystosonography (CSG) Ureters 455, 456 Urethral anomalies 502, 503 Urethral polyps congenital 504, 508 Urethral valve congenital posterior 502, 503 Urinary bladder, see Bladder Urinary tract infection (UTI) 457, 480, 480, 481–482 Urinary tract obstruction – in renal transplantation 495–496, 499 – in urolithiasis 464, 465 Urinoma in renal transplantation 494 Urolithiasis 464, 464, 465–468 Uromodulin-associated nephropathies 468 Uterus size of 538 UTI, see Urinary tract infection (UTI) Utricle 503 V VACTERL (vertebral abnormalities anal atresia cardiac abnormalities tracheoesophageal fistula and/or esophageal atresia renal agenesis and dysplasia limb defects) 111, 159 | 11.05.15 - 18:25 Index Varicocele 588, 588, 589 Vas deferens 570, 571 Vascular anomalies congenital in mediastinum 163, 164, 168–172 Vascular lesions in chest 192, 194, 196–199 Vascular malformations – in musculoskeletal ultrasound 607 – in neck 124, 125–130 Vascular nephropathies 489, 489 Vascular rings 163 Vascular sling – defined 163 – pulmonary artery 166, 169 Venous malformation 194, 197, 197, 607, 607 Ventricular index (VI) 36, 38, 39 Ventricular measurements 36 Ventriculus terminalis 103 Vermis height 40 Vertebral column anomalies categories of 98 – See also Spine Vesicoureteral reflux (VUR) 457, 457, 460 – See also Contrast-enhanced cystosonography (CSG) VI, see Ventricular index (VI) Viral meningoencephalitis 33 Volvulus – gastric 364, 366 – midgut 370, 372, 372 Von Hippel-Lindau syndrome 520 VUR, see Vesicoureteral reflux (VUR) W Waiting area 2, Walker-Warburg syndrome 84 Wandering spleen 332, 333 Warfarin embryopathy 159 Warming of gel 5, 5, 360 Watershed pattern 74 Waves, see Ultrasonic waves Wegener granulomatosis 170 Whirlpool sign 372, 372 White matter in neonatal cranial ultrasonography 26, 26, 27–29 White matter injury in preterm infants 60, 60, 61–66 Williams syndrome 500 Wilms tumor 474, 476–478 – anomalies associated with 474 – in liver 308, 310 – inferior vena cava occlusion with 216, 218–219 – nephroblastomatosis and 474, 475 – paratesticular involvement of 577, 579 – retroperitoneal lymphadenopathy and 219 – staging of 476 – tumor seeding with in biopsy 620 Wilms tumor aniridia genitourinary abnormalities mental retardation (WAGR) 474 Wolman disease 531, 534 Wrist assessment 602, 602 X Xiphoid prominent 183, 184 Y Yolk sac tumor – in female genital tract 552 – in male genital tract 576, 578 Z Zellweger syndrome 88 Zuckerkandl fascia 214 “ “Blue dot” sign 583, 583 “Flag-shaped” echogenicity 27 “Gliding sign” 184, 184 “Gut signature” 360, 360–361 “Horseshoe” adrenal gland 513, 514 “Lying down” adrenal gland 513, 513 “Muscular rim sign” 238, 241 “Rat tail appearance” 458 “Seashore sign” 184, 185 “Stag horn” appearance 464, 465 “Thyroid inferno” 137 “Tramline”-like cerebral cortex 75 “Y-configuration” 238, 241–242 637 | 11.05.15 - 18:25 ... mo 6–8 y F 22 4.4 0.57 3 .2 5.5 F 25 8 .2 0.99 6.6–10.0 M 35 4.6 0.84 2. 8–6.8 M 26 8.9 0.91 7.4–10.5 F 5 .2 0.47 4.5–5.6 F 26 8.7 0. 92 6.4–10.5 M 10 5.8 0.65 4.9–7.0 M 15 9.0 1. 02 7.4–11 .2 F 15 6.3... 6.8–11.4 M 12 6.4 0.78 5.4–7.4 M 19 9.8 1.05 7.3–11.3 3–6 mo 8–10 y 6– 12 mo 10– 12 y 1 2 y 12 14 y F 18 6.3 0.69 5.1–8 .2 F 30 9.8 1. 02 7.9–11.6 M 17 6.8 0. 72 5.6–8.3 M 18 10 .2 0.81 8.5–11.7 F 24 7.5... patients Mean length (± SD) Minimum– maximum 24 –31 29 2. 4 (0.4) 1.6–3 .2 32 35 34 2. 8 (0.5) 1.7–4.0 36–37 35 3.3 (0.4) 2. 6–4 .2 38–41 155 3.4 (0.5) 2. 4–4.9 Abbreviation: SD, standard deviation