9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

Recommendations

Info

THE PAEDIATRIC ABDOMEN 229 Table 9.3 Imaging the paediatric renal tract Ultrasound Contrast sonocystography Diuretic renogram (dynamic) Tc 99m MAG3 Radionuclide cystography (dynamic) Direct (via catheter or suprapubic injection of isotope into the bladder) or indirect (following diuretic renogram) Cortical scintigraphy (static)—Tc 99m DMSA Intravenous urography (IVU) Micturating cystourethrogram Plain X-ray CT MRI First-line investigation in all cases. Excellent structural detail Limited sensitivity for duplex kidneys, reflux, ureteral pathology and small scars Monitoring of disease progression Monitoring of treatment Alternative to X-ray or radionuclide cystography. Poor structural detail, unsuitable for the demonstration of urethral anomalies Outlines the pelvicalyceal system. Diagnosis of obstruction and relative renal function by analysis of excretion curves Diagnosis of reflux Demonstrates uptake in the renal cortex Superior detection of renal scarring in vesicoureteric reflux and acute pyelonephritis Demonstration of congenital anomalies, e.g. ectopic or solitary kidney Analysis of differential renal function Limited use in children Assessment of level of ureteric obstruction Assessment of congenital anomalies, e.g. ectopic ureters and duplex kidney Postoperative evaluation Accurate diagnosis of reflux, polyps, diverticula, strictures and urethral anomalies, but involving a significant radiation dose Some calculi, mainly those in the ureter Of limited value in paediatric renal work-up May show gross spinal anomalies Reserved mainly for confirmation and staging of malignant tumours, due to significant radiation dose Renal trauma Increasingly used for ureteric calculus detection Assessment of difficult congenital anomalies and focal masses. Staging of malignancy the two kidneys should prompt further investigation into renal function with a DMSA scan. Fungal infection Candidiasis is a fungal infection which is most commonly seen in infants who are acutely ill or immunocompromised or in sick ventilated neonates. Fungal balls dilate and may obstruct the collecting system of the kidney (Fig. 9.11). Ultrasound is particularly useful in making the diagnosis by demonstrating the hyperechoic fungal balls within the dilated collecting system. Fungal infection may also undergo haematogenous spread to the spleen and liver, where it can result in multifocal abscess formation. Wilms’ tumour The most common paediatric renal malignancy, Wilms’ tumour usually presents before the age of 3 years. Although the lesion generally occurs in previously fit individuals, there are several known predisposing conditions, including hemihypertrophy, Beckwith–Wiedemann syndrome and sporadic aniridia, with a 30–40% incidence in sporadic aniridia.
230 ABDOMINAL ULTRASOUND LT LT A B Figure 9.11 (A) The dilated collecting system of this kidney is filled with a large, rounded fungal ball of candidiasis infection. (B) The fungus ball is seen to disintegrate, emptying into the renal pelvis. The tumours are large at presentation, presenting with a palpable abdominal mass, and, less frequently, pain, haematuria and fever. About 5% of these tumours are bilateral. 20 The prognosis when unilateral is generally good. The ultrasound appearances are of a relatively well-defined heterogeneous mass, predominantly solid but frequently with some necrotic or haemorrhagic areas, often almost completely replacing the kidney (Fig. 9.12). Small focal areas of calcification are seen very occasionally. A search should be made for tumour invasion of the renal vein and IVC which occurs in up to 10% of cases. Tumour invasion may extend into the right atrium. Occasionally a large, right-sided Wilms’ tumour may compress the IVC but not invade it; colour or power Doppler may be useful in the difficult distinction between compression and invasion on ultrasound. Ultrasound also identifies associated lymphadenopathy, particularly in the para-aortic and paracaval regions, and metastatic liver disease. In a small percentage of cases, tumour may also be found in the contralateral kidney. This is usually much smaller than the mass on the presenting side and may be acoustically subtle. Up to 7% of contralateral tumours are missed on preoperative imaging due to their small size and the operator must be alert to the possibility of bilateral disease. 20 Occasionally a Wilms’ tumour may be found to be predominantly cystic, having the appearances of a large, multiloculated cystic mass. The main differential diagnosis would be of a mesonephric blastoma occurring during the first year of life and histology is required to establish the diagnosis. In most cases, an ultrasound and chest radiograph are sufficient to diagnose correctly Wilms’ tumour but CT of the chest and abdomen is generally used for staging, and to exclude metastatic disease in the chest and liver. 21 Percutaneous biopsy for confirmation of histological type is generally performed. CT or MRI is more sensitive than ultrasound scanning in demonstrating small tumours in the contralateral kidney. Xanthogranulomatous pyelonephritis Xanthogranulomatous pyelonephritis results from chronic infection in an obstructed kidney and children present with a history of general malaise, lowgrade fever and flank pain and may be found to be anaemic. The finding of a palpable abdominal mass on examination often leads to an early diagnosis of a possible Wilms’ tumour. On sonography the kidney is diffusely enlarged, with loss of the normal corticomedullary differentiation. The presence of calyceal dilatation with debris and calculi in the collecting system and confirmation of urinary infection in addition to the generalized involvement of the kidney helps to differentiate this condition from Wilms’ tumour (Fig. 9.12B). Occasionally
Page 2 and 3:
Abdominal Ultrasound
Page 4 and 5:
Abdominal Ultrasound How, Why and W
Page 6 and 7:
v Contents Contributors Preface ix
Page 8 and 9:
vii Contributors Rosemary Arthur FR
Page 10 and 11:
ix Preface Ultrasound continues to
Page 12 and 13:
ABBREVIATIONS xi MHA MHV MI MPV MRA
Page 14 and 15:
Chapter 1 1 Optimizing the diagnost
Page 16 and 17:
OPTIMIZING THE DIAGNOSTIC INFORMATI
Page 18 and 19:
Page 20 and 21:
Page 22 and 23:
Page 24 and 25:
Page 26 and 27:
Page 28 and 29:
Page 30 and 31:
Chapter 2 17 The normal hepatobilia
Page 32 and 33:
THE NORMAL HEPATOBILIARY SYSTEM 19
Page 34 and 35:
Page 36 and 37:
Page 38 and 39:
Page 40 and 41:
Page 42 and 43:
Page 44 and 45:
Page 46 and 47:
Page 48 and 49:
Page 50 and 51:
Page 52 and 53:
Page 54 and 55:
Chapter 3 41 Pathology of the gallb
Page 56 and 57:
PATHOLOGY OF THE GALLBLADDER AND BI
Page 58 and 59:
Page 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Chapter 4 79 Pathology of the liver
Page 94 and 95:
PATHOLOGY OF THE LIVER AND PORTAL V
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Chapter 5 121 The pancreas CHAPTER
Page 136 and 137:
THE PANCREAS 123 the patient’s le
Page 138 and 139:
THE PANCREAS 125 Acute pancreatitis
Page 140 and 141:
THE PANCREAS 127 E F G Figure 5.3 c
Page 142 and 143:
A C DISTANCE = 3.43 CM 5%. 13 Over
Page 144 and 145:
THE PANCREAS 131 G H I Figure 5.5 c
Page 146 and 147:
THE PANCREAS 133 head of pancreas.
Page 148 and 149:
THE PANCREAS 135 pancreatic juice i
Page 150 and 151:
Chapter 6 137 The spleen and lympha
Page 152 and 153:
THE SPLEEN AND LYMPHATIC SYSTEM 139
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Chapter 7 153 The renal tract CHAPT
Page 168 and 169:
THE RENAL TRACT 155 As with any oth
Page 170 and 171:
THE RENAL TRACT 157 A B q 0 LRA AO
Page 172 and 173:
THE RENAL TRACT 159 junctions of or
Page 174 and 175:
THE RENAL TRACT 161 A B Figure 7.5
Page 176 and 177:
THE RENAL TRACT 163 carcinomas, the
Page 178 and 179:
THE RENAL TRACT 165 the vesicourete
Page 180 and 181:
THE RENAL TRACT 167 Table 7.1 Sourc
Page 182 and 183:
THE RENAL TRACT 169 A B Figure 7.13
Page 184 and 185:
THE RENAL TRACT 171 Table 7.2 Diffe
Page 186 and 187:
THE RENAL TRACT 173 Ultrasound stil
Page 188 and 189:
THE RENAL TRACT 175 CT is useful fo
Page 190 and 191:
THE RENAL TRACT 177 Xanthogranuloma
Page 192 and 193: THE RENAL TRACT 179 As with acute t
Page 194 and 195: THE RENAL TRACT 181 der with increa
Page 196 and 197: THE RENAL TRACT 183 ● ● Morphol
Page 198 and 199: THE RENAL TRACT 185 ● ● hydrone
Page 200 and 201: THE RENAL TRACT 187 A Figure 7.27 A
Page 202 and 203: THE RENAL TRACT 189 vascular reject
Page 204 and 205: THE RENAL TRACT 191 B A C Figure 7.
Page 206 and 207: THE RENAL TRACT 193 computerised ul
Page 208 and 209: Chapter 8 195 The retroperitoneum a
Page 210 and 211: THE RETROPERITONEUM AND GASTROINTES
Page 228 and 229: Chapter 9 215 The paediatric abdome
Page 230 and 231: THE PAEDIATRIC ABDOMEN 217 A B SPLE
Page 232 and 233: THE PAEDIATRIC ABDOMEN 219 B A B Fi
Page 234 and 235: THE PAEDIATRIC ABDOMEN 221 probe de
Page 236 and 237: THE PAEDIATRIC ABDOMEN 223 When the
Page 238 and 239: THE PAEDIATRIC ABDOMEN 225 + 78 A 2
Page 240 and 241: THE PAEDIATRIC ABDOMEN 227 A B C D
Page 244 and 245: THE PAEDIATRIC ABDOMEN 231 A LT B C
Page 250 and 251: THE PAEDIATRIC ABDOMEN 237 mesenter
Page 252 and 253: THE PAEDIATRIC ABDOMEN 239 E F G Fi
Page 254 and 255: THE PAEDIATRIC ABDOMEN 241 system i
Page 256 and 257: Chapter 10 The acute abdomen 243 CH
Page 258 and 259: THE ACUTE ABDOMEN 245 scan of the p
Page 260 and 261: THE ACUTE ABDOMEN 247 LIVER LS GB S
Page 262 and 263: THE ACUTE ABDOMEN 249 D A RT B C E
Page 264 and 265: THE ACUTE ABDOMEN 251 17. Patlas M,
Page 266 and 267: Chapter 11 253 Interventional and o
Page 268 and 269: INTERVENTIONAL AND OTHER TECHNIQUES
Page 288 and 289: 275 Bibliography and further readin
Page 290 and 291: 277 Index A Abdomen, acute gastroin
Page 292 and 293:
INDEX 279 Continuous ambulatory per
Page 294 and 295:
INDEX 281 Intravenous urography (IV
Page 296 and 297:
INDEX 283 Phrygian cap, 29 Pneumobi
show all

9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

Create successful ePaper yourself

Delete template?

Save as template?