Diagnostic ultrasound ( PDFDrive )

1854 PART V Pediatric Sonography
A
B
C
D
E
FIG. 53.37 Crohn Disease. (A) Transmural
thickening of the wall of the terminal ileum in a child.
(B) Note the thickened echogenic mesenteric fat in
the same patient (arrows). (C) Another patient with
ileal thickening secondary to Crohn disease (large
arrow) with an adjacent abscess (small arrows). (D)
Mesenteric inlammation caused enlargement of the
ovary in this patient that could be mistaken for torsion.
(E) Power Doppler of the same patient shows
hyperemia of the ovary. (A, D, and E courtesy of Clara
Neira, M.D.)
vasculogenesis in the early stages, are the predominant indings
on ultrasound with mild bowel dilation. Grat-versus-host disease
involves difuse long segments of bowel and may extend from
duodenum to rectum. Intestinal injury results in abdominal pain,
vomiting, and diarrhea. he thickened, featureless intestinal loops
are visible with ultrasound. A thin rim of echogenic material
lining the mucosal surface of the afected loops has been
described 99 (Fig. 53.39). his membrane is thought to represent
the ibrinous exudate oten seen covering the ulcerated mucosa
at endoscopy in this condition.
Necrotizing enterocolitis (NEC) is an important problem
in premature newborns, afecting close to 10% of infants weighing
less than 1500 g. NEC can also afect term and near-term infants.
he etiology is believed to be multifactorial involving altered
bacterial lora, ischemia, and activated proinlammatory intracellular
cascades. NEC is usually detected radiographically, but early
in the disease, the classic indings of bowel dilation and pneumatosis
intestinalis may not be apparent. In such cases, highresolution
sonography can assess the thickness of the intestinal
loops, pattern of bowel wall perfusion, pneumatosis, peristalsis,
free air, and subsequent luid collections with perforation (Fig.
53.40). Early in NEC, there is bowel thickening, but wall thinning
of less than 1 mm was seen by Faingold and colleagues as highly
suggestive of severe ischemia. 120,121 Pneumatosis intestinalis may
be visible on sonography before it is seen on radiographs, appearing
as small, punctate, echogenic foci in the nondependent wall