Diagnostic ultrasound ( PDFDrive )

1726 PART V Pediatric Sonography
for normal pleural respiratory movement. If the pleural respiratory
motion is absent, a pneumothorax should be suspected.
Central venous catheters can be placed under ultrasound
guidance, and the catheter tip position can be determined using
ultrasound. 70 Sclerotherapy for macrocystic lymphatic malformation
under ultrasound guidance has the advantage of dynamically
visualizing the procedure reaction that causes obliteration of the
macrocysts 71 (Fig. 50.39). Unlike luoroscopy guidance, the
residual cysts are easily seen under ultrasound guidance and
can be targeted for further sclerotherapy.
Acute rib pain from cystic ibrosis exacerbation has been
managed with ultrasound-guided placement of a continuous
thoracic paravertebral catheter. 23,28
OTHER LESS ESTABLISHED
INDICATIONS
Pneumothorax, 2,24,25,72,73 rib fracture, 74 and bronchiolitis 75 can be
detected sonographically. However, use of ultrasound may not
TABLE 50.2 Normal Thymic Index
Values for Children Younger Than 2 Years
Age in
Months
Average
THYMIC INDEX (cm 3 )
Standard Deviation (SD)
Premature 11.9 3.9
0-1 18.1 6.7
1-2 25.4 9.4
2-3 22.3 6.9
3-4 26.8 10.3
4-5 29.7 17.6
5-6 24.2 9.3
6-8 22.2 8.9
8-10 21.5 6.8
10-12 23.2 7.2
12-18 17.2 6.4
18-24 15.4 5.6
Modiied from Yekeler E, Tambag A, Tunaci A, et al. Analysis of the
thymus in 151 healthy infants from 0 to 2 years of age. J Ultrasound
Med. 2004;23(10):1321-1326. 56
FIG. 50.37 Retrosternal Seroma. Sonogram shows anechoic luid
collection in retrosternal space in 7-week-old girl with history of surgery
for ventricular septal defect and hypoplastic aortic arch performed 5
weeks before the ultrasound. Needle is visible within the luid collection
during ultrasound-guided aspiration of the luid.
Supine
L
L
A
B
FIG. 50.38 Empyema Requiring Surgical Decortications in Patient With Sickle Cell Anemia. (A) Thick luid (black arrow) around lung (L)
with multiple loculations. Thick putty rind was found at surgery. Possible intraparenchymal abscesses (white arrow) on upright transverse scan.
(B) On supine scan through the liver, only empyema surrounds the lung (L); no abscess is present.