Diagnostic ultrasound ( PDFDrive )

1770 PART V Pediatric Sonography
E
F
G
H
FIG. 51.38, cont’d (E)-(H) Portal vein aneurysm several years after whole-liver transplant. (E) Twin screen (gray-scale and color Doppler)
display of swirling blood low in the main portal vein. (F) Color and pulsed Doppler waveform shows turbulent low within the aneurysm. (G)
Coronal computed tomography (CT) image of same patient shows the portal vein aneurysm displacing the hepatic artery. Note the perisplenic and
perigastric varices, best seen on the coronal reformatted CT image. (H) Pneumobilia. Transverse sonogram shows branching echogenic lines of
air with “dirty” shadowing (arrows). Air within the biliary tree is common after choledochoenterostomy and is not itself a complication, although
it can impair sonographic evaluation of the transplant liver. See also Video 51.11.
Causes of Splenic Enlargement
Infection (bacterial, viral, protozoal, fungal)
Lymphoma, leukemia
Lymphoproliferative disorders
Chronic granulomatous disease
Cirrhosis, portal hypertension
Sequestration
Sickle cell disease
Hemolytic anemia, extramedullary hematopoiesis
Langerhans cell histiocytosis
Storage diseases
Gaucher disease
Niemann-Pick disease
Mucopolysaccharidoses
Collagen vascular disease
Congestive heart failure
Sarcoidosis
he spleen is one of the most frequently injured organs
when abdominal trauma has occurred. Splenic hematomas are
usually hypoechoic lesions, oten located under the capsule (Fig.
51.40C). Fresh hematomas may be isoechoic or hyperechoic,
and some linear lacerations are diicult to see on sonography.
Hemoperitoneum is almost always present. Sonography is
being used as the initial screening examination in children with
abdominal trauma with variable results. 100,101 CT may be used
only in doubtful cases or when there is concomitant spinal or
head trauma. Proponents of sonography state that despite underdiagnosis
of some pancreatic and exceptional splenic hematomas
as well as some mesenteric tears, the surgical management of
the children was not afected, and no child died because lesions
were missed at the initial examination. 101 In these cases, CT was
performed if sonography was diicult because of rib fractures, or
if there was doubt or increasing unexplained hemoperitoneum.
CT remains the standard of care for pediatric abdominal trauma
in the United States, whereas ultrasound is favored in Canada
and some European countries.
Spontaneous rupture of the spleen occurs in the enlarged
fragile organ in infectious mononucleosis and is heralded by
hemoperitoneum. 102
Splenic infarcts occur frequently in children with sickle cell
anemia and also in children with various forms of vasculitis (see
Fig. 51.40D). Lesions are usually triangular and hypoechoic. If
the ligamentous attachments of the spleen are lax or absent, the
spleen may move about in the abdomen (wandering spleen)
and occasionally may undergo torsion on its pedicle. Torsion