Diagnostic ultrasound ( PDFDrive )

CHAPTER 56 Pediatric Interventional Sonography 1961
Targeted Organ Lesion Biopsy
Ultrasound-guided nontarget-organ biopsy such as for suspected
liver or kidney abnormality is a well-established procedure.
Targeted intraorgan lesion biopsy is more demanding. Each case
must be assessed on its merits, but caution should be exercised
for lesions close to the diaphragm or major intraorgan or
extraorgan vasculature. Figs. 56.18 and 56.19 illustrate two such
targeted lesion biopsies.
Musculoskeletal Procedures
Whereas CT or cone-beam CT is the usual guidance modality
for deep bone procedures, ultrasound can be useful for certain
periosteal or cartilage-related lesions (see Fig. 56.1; Fig. 56.20,
Video 56.5, Video 56.6, and Video 56.7).
Steroid injection for local treatment of speciic joints in diseases
such as juvenile rheumatoid arthritis can be achieved by
nonimage-guided access in large joints such as the knee, but
increasingly, rheumatologists are referring patients for imageguided
steroid injection for smaller or technically diicult
joints such as the subtalar, temporomandibular, or interphalangeal
joints. Ultrasound guidance can be used for accurate access
to these small joints. 28,29 Ultrasound-guided steroid injection
of tendon sheaths is a valuable procedure (Fig. 56.21,
Video 56.8).
Some deep foreign bodies can be removed under
ultrasound guidance (Fig. 56.22). It is important that the
ultrasound-guided procedure be done before the wound is
opened and probed in the emergency room or operating
room. Otherwise, air degrades the ability of ultrasound to
visualize the foreign body and the case must be cancelled and
rescheduled.
Head and Neck Lesions
Certain vascular and lymphatic malformations are amenable to
ultrasound-guided access and treatment, usually by sclerosing
agents. 30 Orbital lymphatic malformations are diicult to treat
surgically but respond well to percutaneous ultrasound-guided
sclerosis (Fig. 56.23).
Ranulas are rare lesions consisting of saliva-containing cysts
most commonly due to trauma or obstruction of the sublingual
duct. he sublingual duct secretes saliva continuously, whereas
the submandibular and parotid duct secrete only with oral stimuli
such as eating, and therefore the sublingual gland is more prone
to formation of ranula. Plunging ranula can be treated successfully
by ultrasound and luoroscopically guided sclerosis (Fig. 56.24).
NOTE FROM THE AUTHORS
he authors dedicate this chapter to the memory of Dr. William
(Bill) Shiels. Dr. Shiels was an interventional ultrasound innovator,
an extreme enthusiast, and co-author of this chapter in the fourth
edition. He pioneered many new and innovative techniques in
pediatric interventional radiology, oten involving ultrasound
guidance and monitoring. He established a popular system of
training phantoms and established and maintained active leadership
of the annual “hands-on” sessions at the RSNA for many
years. He inspired many young pediatric interventionalists and
taught us all. He will be remembered by all who came into contact
with this unique and inspiring person. hank you, Bill.
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FIG. 56.18 Targeted Left Upper-Pole Renal Lesion Biopsy in a Patient With Secondary Renal Cell Carcinoma After Prior Treatment for
Cerebral Primitive Neuroectodermal Tumor. (A) Lesion high in the upper pole of the left kidney (white arrows). Measurement calipers are estimating
the depth of the biopsy in order to avoid puncturing the adjacent diaphragm (white *) and spleen. Black * indicate posterior margin of kidney. (B)
Biopsy device (black arrows) passing through the lesion (white arrows), stopping short of the diaphragm. White * indicate upper pole of kidney.