Diagnostic ultrasound ( PDFDrive )

CHAPTER 51 The Pediatric Liver and Spleen 1743
A B C
D E F
FIG. 51.13 Cholelithiasis. (A) Transverse and (B) longitudinal views of a dilated common bile duct (between cursors in [A]) containing an
echogenic shadowing stone (stone seen only on [B] [arrow]) in a teenager with acute right upper quadrant pain. (C) and (D) Multiple echogenic,
shadowing gallstones in two other patients, with hemolytic anemia. Note that the stones show variable degrees of shadowing, likely related to
their mineral composition. (E) and (F) Gallbladder sludge without stones or gallbladder wall thickening in a patient receiving total parenteral
nutrition.
Liver Masses in Children
SOLID
Hemangioendothelioma (single or multiple)
Adenoma, hamartoma
Focal nodular hyperplasia
Regeneration nodules in cirrhosis
Hepatoblastoma
Hepatocellular carcinoma
Biliary rhabdomyosarcoma (can be cystic)
Lymphoma
Metastasis
CYSTS IN OR NEAR THE LIVER
Congenital cysts
Congenital hepatic ibrosis
Choledochal cysts
Duodenal duplication cyst
Hydatid cyst (“sand,” daughter cysts)
Caroli disease
Hamartoma
hemangiomas as well (Fig. 51.14, Video 51.4, Video 51.5). Solitary
hemangiomas are now recognized to be the hepatic form of
cutaneous rapidly involuting congenital hemangiomas (RICH),
which are fully developed at birth and demonstrate an accelerated
involution over the irst year of life. Multifocal and difuse
hemangiomas are still actively proliferating lesions, also known
as infantile hemangiomas. Difuse hemangiomas are more likely
to have complications of hemorrhage, cardiac compromise, hepatic
failure, hypothyroidism, or coagulopathy, and may be treated
with propranolol, embolization, resection, or transplant. Steroids
and chemotherapy are less frequently used. 34,35 As a typical solitary
hemangioma matures, vessel growth slows. Existing vessels may
enlarge and form “lakes” with minimal blood low. his is the
cavernous hemangioma typically seen in adults and rarely in
children. 36
Infantile Hemangioendotheliomas
Infantile hemangioendotheliomas are single or multiple solid
masses of varying echogenicity, oten containing ine, linear
foci of calcium. 37 Doppler sonography shows blood low in
multiple tortuous vessels both within and at the periphery