Diagnostic ultrasound ( PDFDrive )

1544 PART V Pediatric Sonography
A B C
D
E
FIG. 45.37 Subependymal Hemorrhage (SEH), Unilateral. (A) Coronal sonogram showing a subtle unilateral SEH. (B) Parasagittal sonogram
of normal caudothalamic notch. (C) Parasagittal sonogram of SEH. (D) Coronal sonogram obtained with a higher frequency linear transducer clariies
the SEH. (E) Parasagittal sonogram obtained with linear transducer shows the SEH (H) clearly separate from the choroid plexus (C).
A
B
FIG. 45.38 Intraventricular Hemorrhage. (A) and (B) Coronal and sagittal sonograms show intraventricular hemorrhage from bilateral SEH
breaking into the lateral ventricles.
occurs with complete resolution of hemorrhage or occasionally
development of a subependymal cyst. SEH may persist as a
linear echo adjacent to the ependyma. Hemorrhage is still evident
for months on MRI but becomes isodense on CT at about 10
days so that these comparison studies may suggest diferent
indings.
Intraventricular Hemorrhage
(Grade II Hemorrhage)
When SEH bursts into the lateral ventricle, IVH appears as
hyperechoic clot that ills a portion of the ventricular system or
all of a ventricle when the clot forms a cast of the ventricle (Fig.
45.38). he clot itself may obscure the ventricle owing to complete
illing of the lumen. he normally thick, echogenic choroid plexus
may appear asymmetrically thick and may be diicult to deine
within the ventricle separate from the densely echogenic hemorrhage
(Fig. 45.39). As the clot matures, it becomes echolucent
centrally and more well deined and separable from the more
echogenic choroid plexus. Low-level echoes from debris loating
in a ventricle may occur as the clot breaks apart. Use of the
posterior fontanelle or mastoid fontanelle axial views will increase
the detection of IVH in normal-sized ventricles, because at times
there are only small clots or CSF-blood luid levels in the occipital
horn (Fig. 45.39D-E).