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1936 PART V Pediatric SonographyABFIG. 55.12 Normal Neonatal Shoulder. (A) Illustration of anteriorand posterior axial planes of interrogation of the shoulder. (B) Anterioraxial image. Cartilaginous humeral head (H) anteriorly rests on glenoid(G) posteriorly. Biceps tendon (arrowhead) can be seen in the bicipitalgroove. M, Medial. (A reproduced with permission from Grissom LE,Harcke HT. Infant shoulder sonography: technique, anatomy, and pathology.Pediatr Radiol. 2001;31[12]:863-868. 85 )of protrusion is measured between the scapular line and a lineconnecting the osseous lip of the glenoid and the posterior marginof the humeral head cartilage as the alpha angle, normally lessthan 30 degrees. 89 he subluxated shoulder shows increasedprotrusion, delection of the labrum, and deformity of the glenoid,which becomes irregular and angled, and the dislocated shoulderis not in contact with the glenoid surface. With internal rotationthe position may worsen, and with external rotation the shoulderposition may improve. his examination is technically challengingbecause of patient movement and agitation, but with experienceit can be accomplished quickly and reproducibly. 87,90 One of thediiculties is determining the correct plane and angulation ofinterrogation. Repeat examination is recommended at 1, 3, 6,and 12 months of age, during which time there can be increasingdisplacement of the humeral head 90 (Fig. 55.13).InlammationInfectionUltrasound is increasingly used to evaluate pediatric patientsfor infection of the sot tissues, 91 oten to supplement othermodalities. Cellulitis (infection of subcutaneous sot tissues) andpyomyositis (infection of skeletal muscle) may be hematogenousor may originate from a puncture wound. Sonographically, thereis heterogeneous sot tissue thickening and increased echogenicityin the afected area, and there may be regional adenopathy. Ifthere is a puncture wound, foreign material or air may be present.Comparison with the contralateral unafected side is helpful tomake the diagnosis. he inlammatory process can progress toabscess formation or necrosis. Although inlammatory debriswithin the abscess may be hypoechoic, it can also be isoechoicor even hyperechoic and diicult to appreciate. 92 Color and powerDoppler may also assist in the diagnosis in that the rim of theabscess will demonstrate increased low, and the debris withinthe cavity should be avascular. 93 If the luid is mobile, motionmay cause color or power signal on Doppler sonography, butspectral analysis will not reveal any true vascularity. Sonographicguidance can be used to biopsy or drain an abscess. 94 A recenthematoma, early myositis ossiicans, or a necrotic mass can havea similar appearance to an abscess, and the best way to distinguishinfection from these entities is by clinical history and laboratorytests. In myositis ossiicans and hematoma, ater calciicationhas developed, the echo pattern changes, and being mistakenfor abscesses becomes unlikely.Septic arthritis can be an isolated abnormality or can besecondary to infection in the adjacent sot tissues or bone. Fluidis visible in the joint, and debris may or may not be seen withinit. When joint luid is anechoic or hypoechoic, it may be diicultto distinguish from the cartilage that caps the ends of the bonesforming the joint. In addition, if there is debris in the luid, itmay be diicult to detect the septic efusion, similar to the sottissue abscess (Fig. 55.14). Movement of the joint will show thecartilage-luid interface clearly. Application of pressure to thetissue around a joint will cause joint luid to shit, makingthe luid easier to recognize. Pressure along the sides of the knee,for example, can force luid into the suprapatellar bursa, therebyconirming an efusion. Color or power Doppler sonographymay help because there is typically hyperemia in the capsulewith infection. 95 he absence of hyperemia does not excludeseptic arthritis. 56 As with hip efusions, sonography can be usedto aspirate from the joints. 96Lyme disease, caused by the spirochete Borrelia burgdorferiand spread by deer ticks, can result in arthritis. his usuallyoccurs in the subacute or chronic phase of the infection and ischaracterized by relapsing efusions, particularly in the kneejoint. here may be synovial thickening, and cartilage loss isseen late in the course. his can be confused with juvenilerheumatoid arthritis, and the diagnosis should be considered inpatients with oligoarticular joint efusions. 97Osteomyelitis typically occurs in the metaphyses of thelong bones. he earliest sonographic sign is deep sot tissueswelling. Later signs are luid along the cortex of the bone or,subperiosteally, luid in the adjacent joint (either sterile or septic),
ABCDFIG. 55.13 Normal and Dislocated Shoulder. (A) Normal shoulder posterior axial sonogram. The humeral head (h) projects only minimallybeyond the margin of the scapula. The glenoid (g) is well formed, and the labrum (arrow) is small. s, Scapula. (B) Normal shoulder. Axial T2-weightedmagnetic resonance image shows the ield of view in the plane of sonographic interrogation (dashed lines). (C) and (D) Posterior dislocatedshoulder. (C) Posterior axial ultrasound. Note the posterior protrusion of the humeral head (h), the dysplastic glenoid (g), and the echogenic labrum(arrow). s, Scapula. (D) Dislocated humeral head with glenoid dysplasia. Axial T2-weighted magnetic resonance image.ABFIG. 55.14 Septic Arthritis. Coronal images of the shoulder. (A) Echogenic luid within the shoulder joint (arrowheads) superior to the humeralhead (H). c, Cartilage of humeral head; L, lateral; S, superior. (B) Normal side for comparison.
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1600 John F. Kennedy Blvd.Ste 1800P
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viiiContributorsOlga R. Brook, MDAs
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xContributorsChristy K. Holland, Ph
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xiiContributorsRupa Radhakrishnan,
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xxiiContentsVOLUME IIPART IV Obstet
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xxivVideo ContentsVideo 12.8 Angiog
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xxviVideo ContentsVideo 26.20 High-
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xxviiiVideo Contents42 Fetal Measur
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2 PART I Physicsphysics. he amplitu
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4 PART I Physics× ms×FIG. 1.4 Ult
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6 PART I Physicsθ 1 = 20°Tissue A
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8 PART I Physicssignature. Broad-ba
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10 PART I PhysicsFIG. 1.13 B-Mode I
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12 PART I PhysicsIn these transduce
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14 PART I PhysicsFIG. 1.17 Tissue H
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16 PART I PhysicsKey Points of Ultr
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18 PART I PhysicsA - Normal liverv
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20 PART I PhysicsFIG. 1.27 Reverber
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22 PART I Physics-0 dBUncorrected-0
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24 PART I Physicsθ = 0°cos θ = 1
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26 PART I PhysicsABFIG. 1.38 Color
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28 PART I PhysicsChanges in Doppler
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30 PART I PhysicsABFIG. 1.44 Wall F
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32 PART I PhysicsABCDFIG. 1.46 Alia
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CHAPTER2Biologic Effects and Safety
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36 PART I PhysicsPressurePulse repe
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38 PART I PhysicsUltrasound imaging
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40 PART I Physicsacoustic power and
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42 PART I PhysicsFIG. 2.6 Acoustic
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44 PART I PhysicsThe AIUM Statement
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46 PART I Physics1. Current ultraso
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48 PART I PhysicsEPIDEMIOLOGYWith a
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50 PART I Physicscontrols whether t
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52 PART I Physics70. Hwang JH, Tu J
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54 PART I PhysicsA B 5 μmFIG. 3.1
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56 PART I Physicsstudies with Levov
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58 PART I Physicsabdominal organs.
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60 PART I PhysicsHarmonic B-Mode Im
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62 PART I PhysicsFIG. 3.9 Contrast-
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64 PART I Physicsdramatic manifesta
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66 PART I Physics5 µmFIG. 3.15 Fra
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68 PART I Physicsplatelet lysis), n
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70 PART I PhysicsEnhancement1 2 3 4
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72 PART I Physics46. Hamilton MF, B
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PART TWO: Abdominal and Pelvic Sono
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76 PART II Abdominal and Pelvic Son
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100 PART II Abdominal and Pelvic So
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ABFIG. 5.20 Microabscesses in Two P
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ABFIG. 6.32 Distal Cholangiocarcino
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CHAPTER7The PancreasThomas Winter a
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CHAPTER8The Gastrointestinal TractS
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ABFIG. 8.16 Lymphadenopathy in Two
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A B CD E FG H IFIG. 8.23 Inlammator
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FIG. 8.56 Gastrointestinal Stromal
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CHAPTER9The Kidney and Urinary Trac
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Remnant ofpronephrosMesonephrosBMes
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CHAPTER11The Adrenal GlandsChristin
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CHAPTER12The RetroperitoneumRaymond
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CHAPTER13Dynamic Ultrasound of Hern
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CHAPTER14The PeritoneumAnthony E. H
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CHAPTER15The UterusDouglas Brown an
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CHAPTER16The AdnexaRochelle Filker
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692 PART III Small Parts, Carotid A
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CHAPTER20The Parathyroid GlandsBonn
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*** *FIG. 21.8 Terminal Ductolobula
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CHAPTER22The ScrotumDaniel Sommers
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CHAPTER23Overview of Musculoskeleta
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CHAPTER25Musculoskeletal Interventi
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ABCDFIG. 25.15 Biceps Tendon Sheath
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CHAPTER27Peripheral VesselsMark E.
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ABFIG. 27.29 Chronic Deep Venous Th
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1000 PART III Small Parts, Carotid
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e2APPENDIXUltrasound Artifacts: A V
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FIG. A.18 Comet-Tail Artifact. On c
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e12APPENDIXUltrasound Artifacts: A
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I-2 IndexAcetabulumdescription of,
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I-4 IndexAnemiafetal, hydrops from,
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I-6 IndexAttenuationcoeicient, 36of
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I-8 IndexBlood low. See also Cerebr
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I-10 IndexBreast(s) (Continued)thic
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I-12 IndexCat-scratch disease, pedi
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I-14 IndexChorion laeve, 1465-1466C
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I-16 IndexContrast agents (Continue
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I-18 IndexCyst(s) (Continued) Cyst(
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I-20 IndexDoppler ultrasound (Conti
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I-22 IndexEndocardial cushion(s), 1
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I-24 IndexFibroma(s) (Continued)par
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I-26 IndexGerminal epithelium, 565G
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I-28 IndexHematoma(s) (Continued)pe
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I-30 IndexHoloprosencephaly (HPE) (
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I-32 IndexImplants, breast (Continu
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I-34 IndexJaundice (Continued)bile
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I-36 IndexLipomyelocele, closed spi
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I-38 IndexMammary ductsnormal sonog
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I-40 IndexMolar pregnancy. See Hyda
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I-42 IndexNonrhizomelic chondrodysp
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I-44 IndexPancreas (Continued)percu
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I-46 IndexPeritoneum (Continued)tum
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I-48 IndexPosterior fossa (Continue
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I-50 IndexPyloric musclehypertrophy
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I-52 IndexSample volume size, Doppl
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I-54 IndexSpectral broadening, in D
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I-56 IndexSuperoanteromedial ridge,
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I-58 Indexhrombosis (Continued)of s
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I-60 IndexTrisomy 18 (Edwards syndr
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I-62 IndexUrinary tract, pediatric
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I-64 IndexWalker-Warburg syndromeco
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DIAGNOSTICULTRASOUND
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DIAGNOSTICULTRASOUND5TH EDITIONCARO
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ABOUT THE EDITORSCarol M. Rumack, M
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ContributorsviiCONTRIBUTORSJacques
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ContributorsixPeter M. Doubilet, MD
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ContributorsxiAna P. Lourenco, MDAs
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ContributorsxiiiWendy hurston, MDAs
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In memory of my parents, Drs. Ruth
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PrefacexviiPREFACEhe ith edition of
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AcknowledgmentsxixACKNOWLEDGMENTSWe
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ContentsxxiCONTENTSVOLUME IPART I P
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Video ContentsxxiiiVIDEO CONTENTS4
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Video Contentsxxv19 The Thyroid Gla
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Video Contentsxxvii33 The Fetal Fac
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Video Contentsxxix52 The Pediatric
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DIAGNOSTICULTRASOUND
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PART FOUR: Obstetric and Fetal Sono
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CHAPTER 28 Overview of Obstetric Im
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ABCDFIG. 28.9 Second-Trimester Biom
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CHAPTER 29 Bioeffects and Safety of
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CHAPTER 30 The First Trimester 1049
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CHAPTER 31 Chromosomal Abnormalitie
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ABCDFIG. 31.12 Sonographic Findings
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CHAPTER32Multifetal PregnancyMary C
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CHAPTER 32 Multifetal Pregnancy 111
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ABFIG. 32.5 Sonographic Findings Se
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CHAPTER33The Fetal Face and NeckAna
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CHAPTER 33 The Fetal Face and Neck
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Page 1313 and 1314:
Page 1315 and 1316:
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ABCDFIG. 33.13 Hypertelorism With E
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ABCDFIG. 33.16 Dacryocystocele. (A)
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ABCDEFFIG. 33.24 Unilateral Complet
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CHAPTER 34 The Fetal Brain 1167impo
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CHAPTER 34 The Fetal Brain 1169cmAB
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CingulatePOCalcarineAB21 wkCD25 wkI
Page 1345 and 1346:
CHAPTER 34 The Fetal Brain 1173FIG.
Page 1347 and 1348:
CHAPTER 34 The Fetal Brain 1175LTAR
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CHAPTER 34 The Fetal Brain 1177CC12
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CHAPTER 34 The Fetal Brain 1179SPEC
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CHAPTER 34 The Fetal Brain 1181ABCD
Page 1355 and 1356:
CHAPTER 34 The Fetal Brain 1183asym
Page 1357 and 1358:
CHAPTER 34 The Fetal Brain 1185FIG.
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CHAPTER 34 The Fetal Brain 1187Cere
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CHAPTER 34 The Fetal Brain 1189loba
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CHAPTER 34 The Fetal Brain 1191ABCF
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CHAPTER 34 The Fetal Brain 1193ABCF
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CHAPTER 34 The Fetal Brain 1195spor
Page 1369 and 1370:
ABCCCDEFFIG. 34.24 Type 2 Lissencep
Page 1371 and 1372:
CHAPTER 34 The Fetal Brain 1199ABFI
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CHAPTER 34 The Fetal Brain 120120 w
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CHAPTER 34 The Fetal Brain 1203Ultr
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CHAPTER 34 The Fetal Brain 1205ABCD
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VSSABHHPHCDEFFIG. 34.35 Intracrania
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CHAPTER 34 The Fetal Brain 1209VABC
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CHAPTER 34 The Fetal Brain 1211Huma
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CHAPTER 34 The Fetal Brain 1213121.
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CHAPTER 34 The Fetal Brain 1215221.
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CHAPTER 35 The Fetal Spine 1217ABCF
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CHAPTER 35 The Fetal Spine 1219L1S3
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CHAPTER 35 The Fetal Spine 1221FTFT
Page 1395 and 1396:
CHAPTER 35 The Fetal Spine 1223FIG.
Page 1397 and 1398:
CHAPTER 35 The Fetal Spine 1225TABL
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CHAPTER 35 The Fetal Spine 1227Feta
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CHAPTER 35 The Fetal Spine 1229MMAB
Page 1403 and 1404:
ABCDEFFIG. 35.15 Skin-Covered Myelo
Page 1405 and 1406:
CHAPTER 35 The Fetal Spine 1233diic
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CHAPTER 35 The Fetal Spine 1235CCSC
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CHAPTER 35 The Fetal Spine 1237chon
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CHAPTER 35 The Fetal Spine 1239BSCT
Page 1413 and 1414:
CHAPTER 35 The Fetal Spine 124162.
Page 1415 and 1416:
CHAPTER36The Fetal ChestDorothy Bul
Page 1417 and 1418:
CHAPTER 36 The Fetal Chest 1245seco
Page 1419 and 1420:
CHAPTER 36 The Fetal Chest 1247TABL
Page 1421 and 1422:
CHAPTER 36 The Fetal Chest 1249Left
Page 1423 and 1424:
CHAPTER 36 The Fetal Chest 12511ABC
Page 1425 and 1426:
CHAPTER 36 The Fetal Chest 1253ABCF
Page 1427 and 1428:
CHAPTER 36 The Fetal Chest 1255cent
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CHAPTER 36 The Fetal Chest 1257Left
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CHAPTER 36 The Fetal Chest 1259ABCD
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CHAPTER 36 The Fetal Chest 1261RTLT
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CHAPTER 36 The Fetal Chest 1263ARig
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CHAPTER 36 The Fetal Chest 12659. B
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CHAPTER 36 The Fetal Chest 1267107.
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CHAPTER 36 The Fetal Chest 1269204.
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CHAPTER 37 The Fetal Heart 1271TABL
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CHAPTER 37 The Fetal Heart 1273TABL
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CHAPTER 37 The Fetal Heart 1275Plac
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CHAPTER 37 The Fetal Heart 1277ADop
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CHAPTER 37 The Fetal Heart 1279LVRV
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CHAPTER 37 The Fetal Heart 1281RARV
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CHAPTER 37 The Fetal Heart 1283RARV
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CHAPTER 37 The Fetal Heart 1285Norm
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CHAPTER 37 The Fetal Heart 1287RVLV
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CHAPTER 37 The Fetal Heart 1289RVTA
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CHAPTER 37 The Fetal Heart 1291LVRA
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CHAPTER 37 The Fetal Heart 1293Aspl
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CHAPTER 37 The Fetal Heart 1295PLVL
Page 1469 and 1470:
CHAPTER 37 The Fetal Heart 1297HR-L
Page 1471 and 1472:
CHAPTER 37 The Fetal Heart 129951.
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CHAPTER 38 The Fetal Gastrointestin
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UrogenitalsinusMesonephrosMesonephr
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CHAPTER 39 The Fetal Urogenital Tra
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CHAPTER 40 The Fetal Musculoskeleta
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CHAPTER 41 Fetal Hydrops 1413ABFIG.
Page 1587 and 1588:
ABCDFIG. 41.2 Ascites. (A) Fluid ou
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CHAPTER 41 Fetal Hydrops 1417A B CD
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CHAPTER 41 Fetal Hydrops 1423later
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CHAPTER 41 Fetal Hydrops 1427CHABCH
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CHAPTER 41 Fetal Hydrops 1429Monoch
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CHAPTER 41 Fetal Hydrops 1431feedin
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CHAPTER 41 Fetal Hydrops 1433TABLE
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CHAPTER 41 Fetal Hydrops 1435sampli
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CHAPTER 41 Fetal Hydrops 1437Predel
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CHAPTER 41 Fetal Hydrops 143973. Ma
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CHAPTER 41 Fetal Hydrops 1441169. I
Page 1615 and 1616:
CHAPTER42Fetal Measurements: Normal
Page 1617 and 1618:
CHAPTER 42 Fetal Measurements 1445F
Page 1619 and 1620:
CHAPTER 42 Fetal Measurements 1447T
Page 1621 and 1622:
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CHAPTER 42 Fetal Measurements 1451p
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CHAPTER 42 Fetal Measurements 1453d
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CHAPTER 42 Fetal Measurements 1455A
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CHAPTER 42 Fetal Measurements 1459A
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CHAPTER 42 Fetal Measurements 14618
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CHAPTER 42 Fetal Measurements 14631
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CHAPTER43Sonographic Evaluation oft
Page 1639 and 1640:
CHAPTER 43 Sonographic Evaluation o
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CHAPTER44Cervical Ultrasound and Pr
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CHAPTER 44 Cervical Ultrasound and
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PART FIVE: Pediatric SonographyCHAP
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CHAPTER 45 Neonatal and Infant Brai
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CHAPTER46Duplex Sonography of the N
Page 1747 and 1748:
CHAPTER 46 Duplex Sonography of the
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CHAPTER47Doppler Sonography of the
Page 1765 and 1766:
CHAPTER 47 Doppler Sonography of th
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CHAPTER 48 The Pediatric Head and N
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CHAPTER 49 The Pediatric Spinal Can
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Page 1865 and 1866:
RA B CDEFGFIG. 49.27 Neuroblastoma
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CHAPTER50The Pediatric ChestChetan
Page 1875 and 1876:
CHAPTER 50 The Pediatric Chest 1703
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CHAPTER 51 The Pediatric Liver and
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Page 1943 and 1944:
ABCFIG. 51.39 Hepatosplenomegaly. W
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CHAPTER52The Pediatric Urinary Trac
Page 1949 and 1950:
CHAPTER 52 The Pediatric Urinary Tr
Page 1951 and 1952:
TABLE 52.4 Mean Total Renal Volumes
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CHAPTER53The Pediatric Gastrointest
Page 2007 and 2008:
CHAPTER 53 The Pediatric Gastrointe
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CHAPTER 54 Pediatric Pelvic Sonogra
Page 2045 and 2046:
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Page 2049 and 2050:
Page 2051 and 2052:
Page 2053 and 2054:
Page 2055 and 2056:
Page 2057 and 2058: CHAPTER 54 Pediatric Pelvic Sonogra
Page 2093 and 2094: CHAPTER 55 The Pediatric Hip and Ot
Page 2107: CHAPTER 55 The Pediatric Hip and Ot
Page 2115 and 2116: CHAPTER 56 Pediatric Interventional
Page 2131 and 2132: ABCFIG. 56.15 Access for Drainage o
Page 2141 and 2142: APPENDIXUltrasound Artifacts: A Vir
Page 2143 and 2144: APPENDIX Ultrasound Artifacts: A Vi
Page 2159 and 2160:
APPENDIX Ultrasound Artifacts: A Vi
Page 2161 and 2162:
Page 2163 and 2164:
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Page 2173 and 2174:
Page 2175 and 2176:
Page 2177 and 2178:
Page 2179 and 2180:
IndexAAA anastomoses. See Arterial/
Page 2181 and 2182:
Index I-3Adnexa (Continued)transvag
Page 2183 and 2184:
Index I-5Arrays, transducer, 11-12A
Page 2185 and 2186:
Index I-7Bioefects (Continued) Biop
Page 2187 and 2188:
Index I-9Brain, neonatal/infant (Co
Page 2189 and 2190:
Index I-11Carcinoma(s) (Continued)
Page 2191 and 2192:
Index I-13Cervix (Continued)for sym
Page 2193 and 2194:
Index I-15Color Doppler ultrasound
Page 2195 and 2196:
Index I-17Cystic artery, 194promine
Page 2197 and 2198:
Index I-19Diabetes mellituschronic
Page 2199 and 2200:
Index I-21Echinococcal disease (Con
Page 2201 and 2202:
Index I-23Exudate ascites, 506-507E
Page 2203 and 2204:
Index I-25Gallbladder (Continued)ad
Page 2205 and 2206:
Index I-27Gyriabnormalities of, in
Page 2207 and 2208:
Index I-29Hernia(s). See also Diaph
Page 2209 and 2210:
Index I-31Hyperechoic tissue, in br
Page 2211 and 2212:
Index I-33Internal jugular vein (IJ
Page 2213 and 2214:
Index I-35Kidneys, pediatric (Conti
Page 2215 and 2216:
Index I-37Liver transplantation (Co
Page 2217 and 2218:
Index I-39Mesentery, small bowel, 5
Page 2219 and 2220:
Index I-41Nasal bone, fetal (Contin
Page 2221 and 2222:
Index I-43Orbits, fetal (Continued)
Page 2223 and 2224:
Index I-45Patau syndrome. See Triso
Page 2225 and 2226:
Index I-47Pleural efusionsfetal, 12
Page 2227 and 2228:
Index I-49Prostate (Continued)thera
Page 2229 and 2230:
Index I-51Renal transplantation (Co
Page 2231 and 2232:
Index I-53Shunt(s) (Continued) Skel
Page 2233 and 2234:
Index I-55Splenic vein (Continued)t
Page 2235 and 2236:
Index I-57Testis(es) (Continued)cys
Page 2237 and 2238:
Index I-59Transcranial Doppler (TCD
Page 2239 and 2240:
Index I-61Umbilical cord, 1481-1487
Page 2241 and 2242:
Index I-63Vein of Galen (Continued)
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Page 2249:
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