Diagnostic ultrasound ( PDFDrive )

CHAPTER
54
Pediatric Pelvic Sonography
William L. Simpson, Jr., Humaira Chaudhry, and Henrietta Kotlus Rosenberg
SUMMARY OF KEY POINTS
• Ultrasound is well suited for evaluation of the
pediatric pelvis by providing excellent image quality
without the use of radiation or the routine use of
contrast material and without the need for sedation or
anesthesia.
• Sonography of the pelvis is an excellent modality for serial
assessment of pediatric pelvic abnormalities.
• Ultrasound can be used to evaluate congenital, infectious,
inlammatory, endocrine, and neoplastic abnormalities of
the pediatric pelvis.
• The appearance of the gonads of both sexes undergoes
changes throughout the pediatric age range as they grow
and develop adult characteristics.
• Water can be used as a contrast agent to distend
structures that are normally collapsed (e.g., bladder, ureter,
vagina, rectum) to facilitate evaluation and diagnosis.
• Although transvaginal ultrasound (TVS) provides highresolution
imaging of the female pelvis, its use in most
pediatric female patients is precluded because they are not
sexually active.
CHAPTER OUTLINE
SONOGRAPHIC TECHNIQUE
NORMAL FEMALE ANATOMY
The Uterus
The Vagina
The Ovary
OVARIAN ABNORMALITIES
Ovarian Cysts
Complications: Torsion, Hemorrhage,
Rupture
Polycystic Ovarian Disease
(Stein-Leventhal)
Massive Ovarian Edema
Ovarian Neoplasms
UTERINE AND VAGINAL
ABNORMALITIES
Congenital Anomalies
Neoplasm
Pregnancy
Infection
Pelvic Inlammatory Disease
Foreign Bodies
ENDOCRINE ABNORMALITIES
Causes of Primary Amenorrhea
Precocious Puberty
NORMAL MALE ANATOMY
The Prostate
The Scrotum
The Testes
CONGENITAL MALE
ABNORMALITIES
ACUTE SCROTAL PAIN OR
SWELLING
Color Doppler Sonography in Testicular
Torsion
SCROTAL MASSES
Intratesticular Causes
Extratesticular Causes
Paratesticular Tumors
LOWER URINARY TRACT
Congenital Anomalies
The Ureter
Neurogenic or Dysfunctional Bladder
Infection
Neoplasm
Trauma
Postoperative Bladder
PRESACRAL MASSES
SONOGRAPHIC TECHNIQUE
High-resolution, real-time, gray-scale and color Doppler sonography
has emerged as the modality of choice for the evaluation
of the pelvis in infants, children, and adolescents. Using the
distended bladder as an acoustic window, the lower urinary tract,
uterus, adnexa, prostate gland, seminal vesicles, and pelvic
musculature and vessels can be easily evaluated. 1-6
Depending on the size of the child, a 5-2, 9-4, or 8-5 MHz
real-time curvilinear broad-bandwidth or sector transducer is
used to obtain scans, usually in the transverse and sagittal planes.
Linear probe technology is useful for evaluation of the bowel,
peritoneum, perineum, and supericial lesions using a 12-5 MHz,
17-5 MHz, or other high-frequency linear broad-bandwidth
probes.
Patients should be well hydrated before pelvic sonography so
that the bladder will be optimally illed. In infants and young
children who are unable to maintain a full bladder despite drinking
clear liquids, it may be necessary to catheterize and ill the bladder
with sterile water through a 5- or 8-French feeding tube, although
this is rarely necessary. he use of sterile water as a contrast
agent to outline the vagina (hydrosonovaginography) (Fig. 54.1,
Video 54.1), rectum (water enema) 7,8 (Fig. 54.2), or urogenital
sinus may be very helpful in the evaluation of the pediatric patient
with a pelvic mass or complex congenital anomalies of the
genitourinary tract. Meticulous real-time scanning is essential
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