Diagnostic ultrasound ( PDFDrive )

1548 PART V Pediatric Sonography
A
B
C
D
FIG. 45.44 Intraparenchymal Hemorrhage: Development of Porencephaly. (A) Coronal sonogram of 2-day-old infant shows intraparenchymal
hemorrhage in the left parietal lobe. (B) At 17 days old. (C) At 29 days old. (D) At 2 months old.
K deiciency), hemophilia, alloimmune thrombocytopenia or
Rh immune incompatibility, and hypernatremia. 119,120 Hemophilia
has been associated with intracranial hemorrhage. A review of
102 newborns with hemorrhage in 33 publications found 65%
intracranial and 35% extracranial. 121 Spontaneous IPH has been
reported in term infants but was associated with signs of trauma
or venous compression. If a unilateral thalamic hemorrhage
appears in a newborn, cerebral sinovenous thrombosis should
be strongly considered. 122,123
Extracorporeal membrane oxygenation (ECMO) complications
include IPH secondary to infarction, ischemia, and
thromboembolism. GMH or IVH is less common ater ECMO
because premature infants are at high risk for these types of
hemorrhage and thus this procedure is typically not done in
premature infants. 124 hese complications may be from the hypoxic
brain damage secondary to the underlying lung disease, even
before initiation of ECMO therapy. he complications from
ECMO are also caused by heparinization and transient
hypertension. 125
Ultrasound is used for daily evaluation of the newborn receiving
ECMO. he portability and ease of use in the critically ill
infant without the need for transport are the main advantages.
A 20-year study in Netherlands demonstrated 17% brain abnormalities
with 8% hemorrhage and 5% stroke, particularly on the
let. Sonography can alert the clinician to intracranial hemorrhage
and the option to stop ECMO therapy.
Cerebellar Hemorrhage
Cerebellar hemorrhage has been diagnosed more frequently with
special sonographic views through the mastoid fontanelle and
from MRI evaluation of disrupted cerebellar development. 126-131
Posterior fossa hemorrhage is a reported complication of a
traumatic delivery in full-term infants, in ECMO therapy, or
with a coagulopathy. However, cerebellar hemorrhage can occur
in premature infants because there is germinal matrix in the
fourth ventricle (Fig. 45.46). he periphery of the cerebellar
hemisphere is also a typical site of cerebellar hemorrhage.
Mastoid fontanelle imaging is now routinely used to visualize
the cerebellum in the optimum focal zone to allow cerebellar
hemorrhage to be seen and the posterior fossa fully evaluated.
Resolution of cerebellar hemorrhage into a cyst in the posterior
fossa may allow easier diagnosis; the normal echogenic cerebellum
may obscure hemorrhage when acute but is more clearly
visualized with an “optimized examination” to look for subtle