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The Pediatric Gastrointestinal Tract

Summary of Key Points Successful bowel ultrasound is facilitated by use of high-frequency transducers and real-time viewing of the bowel activity. Oral fluid administration and graded compression techniques help displace interfering bowel gas. Accurate measurement of the pyloric muscle thickness with adequate distention of the stomach with fluid is the key to correct diagnosis of hypertrophic pyloric stenosis. When the pylorus is normal, the duodenum should…

The Pediatric Urinary Tract and Adrenal Glands

Summary of Key Points Ultrasound can reliably characterize renal duplication, fusion, and rotational anomalies. Ultrasound is useful in evaluating renal, ureteral, and bladder anatomy in patients with suspected hydronephrosis. Contrast-enhanced voiding urosonography (CEVUS) is a promising technique that may eventually replace conventional voiding cystourethrography (VCUG) in selected cases. Ultrasound is used to assess renal size and to exclude anatomic abnormalities as the cause of acute kidney…

The Pediatric Liver and Spleen

Summary of Key Points Infants with neonatal jaundice should be imaged before 2 months of age to optimize surgical treatment of biliary atresia, if present. Steatosis and cirrhosis both attenuate the ultrasound beam, making imaging challenging, but it is important for determining the underlying cause of disease. Approximately 40% of liver tumors in children are benign, and hemangiomas are the most common of these. Among malignant…

The Pediatric Chest

Summary of Key Points Ultrasound of the chest plays an important role in diagnosis and treatment of pleural effusion and empyema. Real-time ultrasound is very useful in evaluation of diaphragmatic motion disorders. Ultrasound can determine if a neoplastic lesion is solid or cystic. Doppler and color ultrasound can evaluate vascularity of a lesion and vascular thrombosis. Ultrasound of the chest is very useful in differentiating among…

The Pediatric Spinal Canal

Summary of Key Points Spine ultrasound is used in the evaluation of neonates and infants (up to 3-4 months) with high- or moderate-risk cutaneous manifestations of closed spinal dysraphism, clinical signs of a tethered cord, or congenital anomalies that are frequently associated with spinal dysraphism. Additional indications for spine ultrasound include evaluation after failed lumbar puncture, guidance for lumbar puncture, and intraoperative guidance. The conus medullaris…

The Pediatric Head and Neck

Summary of Key Points Ultrasound is an excellent modality to evaluate head and neck masses in children because of its accessibility and lack of ionizing radiation. Lesion location is an important factor to consider in evaluation of head and neck masses in children. Common head and neck masses in children are related to lymph nodes, thyroglossal duct anomalies, branchial anomalies, inclusion cysts, and vascular anomalies. Use…

Doppler Sonography of the Brain in Children

Summary of Key Points Transcranial Doppler (TCD) can be performed, with or without imaging. Four windows are available after closure of the anterior fontanelle—temporal, orbital, transforaminal, and submandibular. Physiologic variables including age, gender, hematocrit, viscosity, carbon dioxide, temperature, blood pressure, and mental or motor activity can impact flow velocity. There are several established clinical applications for TCD and many potential applications for the assessment of cerebral…

Duplex Sonography of the Neonatal and Infant Brain

Summary of Key Points Duplex sonography is a valuable, functional addition to anatomic sonography of the pediatric brain. Various quantitative metrics can be extracted from the flow curves, including peak systolic, end-diastolic flow velocity, time average maximum mean blood flow velocity, and resistive index. The quantitative markers may be influenced or altered by mechanical ventilation, patent ductus arteriosus, extracorporeal membrane oxygenation (ECMO), arteriovenous shunting, and pathologies…

Neonatal and Infant Brain Imaging

Summary of Key Points Brain ultrasound of premature infants is best performed for germinal matrix hemorrhage and hydrocephalus at 10 to 14 days of life and for cystic periventricular leukomalacia at 30 days of life. The best time to assess for white matter injury of prematurity is at term-equivalent age. Cerebellar hemorrhage is missed if mastoid views of the posterior fossa are not obtained. High-resolution images…

Cervical Ultrasound and Preterm Birth

Summary of Key Points There is a significant association between cervix length and the risk of preterm birth. A cervical length of more than 3 cm has a high negative predictive value for delivery at less than 34 weeks' gestation. The most reliable method of documenting cervical length is transvaginal ultrasound. The single most reliable parameter for cervical assessment is a short cervical length. The earlier in…

Fetal Measurements: Normal and Abnormal Fetal Growth and Assessment of Fetal Well-Being

Summary of Key Points Accurate assignment of gestational age to a pregnancy is important for several reasons, including timing of screening tests for aneuploidy, monitoring fetal growth and diagnosing growth disturbances, and scheduling of delivery by elective induction or cesarean. If a woman has more than one sonogram during her pregnancy, the pregnancy should not be redated after the first scan; instead, the gestational age at…

Fetal Hydrops

Summary of Key Points Hydrops is defined as an abnormal accumulation of interstitial fluid in at least two body cavities (pleural, peritoneal, or pericardial) or one body cavity in association with anasarca (generalized massive edema). Placentomegaly and polyhydramnios are common findings in cases of hydrops but are not needed for the diagnosis. Hydrops represents a terminal stage for many conditions, the vast majority of which are…

The Fetal Musculoskeletal System

Summary of Key Points Two-dimensional ultrasound is the primary imaging modality for the majority of musculoskeletal disorders. When a fetal musculoskeletal dysplasia is suspected on ultrasound, referral to a center with expertise may be helpful. A main role of ultrasound is to determine if the condition is likely lethal; it is important to use multiple parameters to make this determination. After delivery or pregnancy termination, a…

The Fetal Urogenital Tract

Summary of Key Points Evaluation of amniotic fluid volume (subjective assessment combined with semiquantitative methods such as maximum vertical pocket or amniotic fluid index) provides important information about some maternal and fetal conditions, as well as placental function. Sonographic findings suspicious of renal cystic disease include cysts, renal hyperechogenicity, and/or large kidneys. Whenever renal cystic disease is suspected, it is useful to perform a renal ultrasound…

The Fetal Gastrointestinal Tract and Abdominal Wall

Summary of Key Points The gastrointestinal (GI) tract and abdominal wall anomalies are diverse. Although they may occur in isolation, many are associated with syndromic or karyotype abnormalities; thus it is important to search for associated anomalies. Familiarity with normal development is needed to recognize the varying appearances during gestation of structures such as the abdominal wall with physiologic midgut herniation, the identification of the gallbladder…

The Fetal Heart

Summary of Key Points Moderate to severe congenital heart disease (CHD) occurs in approximately 6 per 1000 live births. The incidence of CHD is much higher in the fetal population, estimated to be at least 15 per 1000. The incidence of CHD is higher with positive family history, monochorionic twins, and in vitro fertilization. Most fetuses with CHD have no known risk factors. Fetal echocardiography is…

The Fetal Chest

Summary of Key Points Normal fetal lungs appear homogeneously echogenic on ultrasound surrounding the heart with a cardiothoracic ratio that remains constant through the second and third trimesters. Pulmonary hypoplasia can be primary or secondary and unilateral or bilateral. Congenital pulmonary airway malformations (CPAMs) are a spectrum of disorders that include bronchopulmonary malformation, hybrid lesions (CPAM and sequestration), and congenital lobar overinflation/bronchial atresia. A large fetal…

The Fetal Spine

Summary of Key Points Neural tube defects (NTDs) are a common congenital anomaly with clinically important associated morbidity and mortality rates. Most open NTDs will have associated intracranial abnormalities, most commonly Chiari II malformation, detected by sonography. Although much less common, closed NTDs are less likely to have associated intracranial abnormalities and require careful examination of the spine for detection. Other spinal abnormalities such as scoliosis,…

The Fetal Brain

Summary of Key Points Protocol-based ultrasound carefully performed by a knowledgeable and experienced examiner following established guidelines is very sensitive in evaluating the central nervous system (CNS). Ventriculomegaly can be due to many underlying conditions, including obstruction, destruction, and dysmorphism, or a combination. In cases of brain abnormalities in which additional morphologic or functional information is needed beyond that available with ultrasound, magnetic resonance imaging can…