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Ultrasound Evaluation of Fetal Aneuploidy in the First and Second Trimesters

Summary of Key Points Major fetal malformations are highly associated with fetal chromosomal abnormalities, particularly central nervous system anomalies, facial abnormalities, cystic hygroma, diaphragmatic hernia, cardiac defects, gastrointestinal abnormalities, genitourinary anomalies, nonimmune hydrops fetalis (NIHF), and abnormalities involving the extremities. The combination of nuchal translucency (NT) measurement and maternal serum analytes, pregnancy-associated plasma protein-A (PAPP-A) and free β-hCG (human chorionic gonadotropin), is the most common aneuploidy…

Genetics and Prenatal Genetic Testing

Summary of Key Points In the population, 2% to 3% of newborns have a congenital malformation or genetic disease identified at birth. Despite advances in genetics, the cause of more than half of human congenital abnormalities remains unknown. Chromosomal abnormalities are present in about 0.9% of newborns and include abnormalities of chromosome number as well as abnormalities of chromosome structure. The embryo is most sensitive to…

Obstetric Ultrasound Examination

Summary of Key Points Recent years have seen dramatic advances in ultrasound technology, including improved spatial and contrast resolution, routine use of three-dimensional (3D) and four-dimensional (4D) imaging, volumetric scanning, expanded indications for color and spectral Doppler, new and improved ultrasound scanning probes, and improved digital review workstations. With improved imaging comes the complicating corollary as to what minor findings should be reported to the patient…

Ultrasound Artifacts: A Virtual Chapter

Summary of Key Points Artifacts are common in ultrasound imaging. Knowledge of artifacts can aid in diagnosis. Understanding ultrasound physics allows for correction of artifacts that distort the visualized anatomy. Chapter Outline ASSUMPTIONS IN GRAY-SCALE IMAGING Velocity of Sound Attenuation of Sound Path of Sound Beam Profile PROPAGATION VELOCITY ARTIFACT ATTENUATION ERRORS Shadowing Increased Through Transmission PATH OF SOUND-RELATED ARTIFACTS Mirror Image Artifact Comet-Tail Artifact Refraction…

Pediatric Interventional Sonography

Summary of Key Points Understanding of the different needs of the parents and the child being treated is essential for pediatric interventions. Multimodality interventional suites allow for procedural guidance with varied modalities at different points during the procedure. Although needle guides may be used, they add to the expense of the procedure. Therefore we typically advocate for a single-operator freehand technique with needle entry point chosen…

The Pediatric Hip and Other Musculoskeletal Ultrasound Applications

Summary of Key Points Ultrasound is the preferred technique in the diagnosis and management of development dysplasia of the hip (DDH). DDH is multifactorial: the highest risk factor is female breech delivery. The two basic methods, morphologic and dynamic, share the need for recognition of critical anatomic landmarks of the hip. The dynamic technique emphasizes stability. The American Institute of Ultrasound in Medicine Practice Parameter standard…

Pediatric Pelvic Sonography

Summary of Key Points Ultrasound is well suited for evaluation of the pediatric pelvis by providing excellent image quality without the use of radiation or the routine use of contrast material and without the need for sedation or anesthesia. Sonography of the pelvis is an excellent modality for serial assessment of pediatric pelvic abnormalities. Ultrasound can be used to evaluate congenital, infectious, inflammatory, endocrine, and neoplastic…

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…