Diagnostic ultrasound ( PDFDrive )

CHAPTER 54 Pediatric Pelvic Sonography 1871
Uterus
Tip of
Foley
H2O Vagina
A
H2O Vaginogram SAG
B
H2O Vaginogram TRV
C
Uterus
H2O Vaginogram SAG
FIG. 54.1 Normal Hydrosonovaginography
in Prepubertal Female With Prior
Vaginal Rhabdomyosarcoma. (A) Sagittal
sonogram obtained during early illing of
the vagina with sterile water. The water
was hand-injected through a Foley catheter
with the balloon inlated outside the vaginal
introitus to prevent leakage. (B) and (C)
Transverse and sagittal sonograms, when
the vaginal vault is well distended, show
that the uterus is normal in size, echotexture,
and coniguration for a prepubertal
female. The bright speckles within the water
are caused by air.
Rectum
Bladder
Rectum
Rectum
FIG. 54.2 Water Enema Technique in 5-Year-Old Boy With
Appendiceal Abscess. Sagittal sonogram shows a small, hypoechoic
luid collection (arrows) located posterior to the bladder and anterior to
the water-illed rectum.
because these structures are illed in a retrograde manner. When
transabdominal sonography (TAS) provides suboptimal images
in mature, sexually active teenage girls, transvaginal ultrasound
(TVS) can provide higher resolution with more detailed images,
thus aiding in the elucidation of the origin and characteristics
of pelvic masses and complex adnexal lesions. 6,9
he wall of the urinary bladder should be smooth in a distended
state, with the wall thickness not greater than 3 mm
during bladder distention, with a mean of 1.5 mm. 10 he wall
should not be greater than 5 mm thick with the bladder empty
or partially distended. In the nondistended state the internal
aspect of the bladder wall generally appears slightly irregular
sonographically. A urachal remnant may be visualized on
sonography, as a structure of variable form and size, lying ventral
to the peritoneum and situated between the umbilicus and the
apex of the urinary bladder. 11 he distal ureters, with the exception
of the submucosal intravesical portion, are not usually visualized
unless abnormally dilated. 12 he trigone, however, is easily
demonstrated (Fig. 54.3). he bladder neck and urethra can be
demonstrated in both males and females by angling the transducer
inferiorly 13 (Fig. 54.4). If a urethral abnormality is noted on
suprapubic imaging, scans through the perineum or transrectally
can conirm these indings using a diferent imaging plane. 14