Henrietta Kotlus Rosenberg

The predictive value of ultrasonography in evaluation of infants with posterior urethral valves

Between 1981 and 1989, 28 infants less than 6 months old with posterior urethral valves underwent ultrasound evaluation as part of the initial evaluation at our hospital. The single ultrasound feature that correlated with subsequent renal function was the status of corticomedullary differentiation. The presence of corticomedullary junctions in at least 1 kidney in 17 infants was always associated with a serum creatinine level of 0.8 mg./dl. or less in long-term followup. Of 11 patients with absent corticomedullary differentiation 7 had eventual creatinine levels of greater than 0.8 mg./dl. with 5 of them suffering clinically significant renal insufficiency. An association between vesicoureteral reflux and absent corticomedullary junctions was also found.

Ultrasound evaluation of scrotum in pediatrics

Scrotal abnormalities are difficult to assess using clinical criteria alone. Ultrasound provides an accurate means of demonstrating the scrotal contents so that appropriate therapy may be instituted. In a retrospective study, 119 ultrasound examinations of 96 patients (aged 4 days to 23 years) have been compared with the clinical diagnosis, surgical/pathologic findings, and other imaging modalities. The gamut of disease identified included congenital anomalies, neoplasm, trauma, torsion, varicocele, hydrocele, epididymo-orchitis, epididymal cyst/spermatocele, and post-radiation fibrosis. The ultrasound findings correlated well in 93/96 patients. In inconclusive cases, sequential imaging helps differentiate traumatic and inflammatory lesions from neoplastic processes.

Simple cysts of the testis in children: preoperative diagnosis by ultrasound and excision with testicular preservation.

We report on 2 children with simple cysts of the testis who were treated with excision and testicular preservation. To our knowledge both cases represent the first report of conservative surgery for these lesions in children. In 1 case the diagnosis of a simple intratesticular cyst was made by ultrasound. This patient was followed conservatively until enlargement resulted in excision of the cyst with preservation of the gonad. In the other case the diagnosis was made intraoperatively and simple excision of the lesion with testicular sparing was performed. High resolution real-time ultrasound should be performed routinely for all suspected testicular masses in children. Benign testicular tumors are more common than in adults and ultrasound may permit identification of lesions that can be excised locally with testicular preservation. Should the diagnosis of a simple, small intratesticular cyst be made by ultrasound regular followup may be appropriate. Should enlargement occur surgical excision can be done with the possibility of gonadal preservation.

Hemorrhagic Pancreatitis in a Young Child Following Valproic Acid Therapy Clinical and Ultrasonic Assessment

Hemorrhagic pancreatitis was diagnosed with portable realtime ultrasound in a critically ill 4-year-old child. The ultrasonic features were diffuse pancreatic enlargement, generally and focally increased pancreatic echogenicity, and ascites. Ultrasound was indispensable as a portable noninvasive imaging modality that allowed for rapid and accurate diagnosis.

AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

Nonsurgical management of obstructive aortic thrombosis complicated by renovascular hypertension in the neonate

The use of umbilical artery catheters has become commonplace in the intensive care nursery and has facilitated management in the very ill newborn infant. Thrombotic complications associated with the use of such catheters may be as high as 30%. The successful, nonsurgical management of either complete or partial aortic thrombosis, associated with renovascular hypertension, is reported in three infants. Aggressive supportive medical management resulted in a satisfactory outcome in all three infants.

Thyroid and parathyroid ultrasound examination

These guidelines are an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the American College of Radiology cautions against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.

Sonography of hip dysplasia.

Early diagnosis of developmental dysplasia of the hip (DDH) is important to institute appropriate treatment and reduce the incidence of long-term complications. Risk factors for DDH include genetic, developmental, mechanical, and physiologic factors. Physical examination using Ortolani and Barlow maneuvers is standard for early detection. Plain film radiography is limited for the diagnosis of DDH even when applying several classic landmarks, lines, and measurements, due to the lack of visualization of the cartilaginous components of the infant’s hip. Ultrasound arose as a tool for evaluation of the cartilaginous structures of the hip in the early 1980s. Graf’s method of examination by ultrasound stresses morphology, whereas dynamic examination uses physical maneuvers to elicit laxity of the hip. The Pavlik harness is the mainstay of treatment of DDH in the young infant, and ultrasound examination in the harness is useful to monitor progress. Closed or open surgical reduction is reserved for unresponsive or advanced cases. Universal ultrasound screening of newborns is not deemed cost effective by most North American authors, although in Europe non-selective screening has been more widely used.

An Unusual Presentation of an Infected Urachal Cyst Review of Urachal Anomalies

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckels diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.

Sonography of pediatric neck masses.

Duplex/color Doppler ultrasound is the imaging modality of choice for the evaluation of soft tissue masses of the pediatric neck. Information regarding the size, shape, borders, location, internal consistency and vascularity of the mass, and its relationship to the major neck vessels may be rapidly obtained. If the lesion is too large to be completely imaged within the ultrasound field of view available or malignancy is suspected, computed radiography or magnetic resonance imaging is required before surgical removal. Scintigraphy is reserved for evaluation of midline masses, which are thought to be due to ectopic thyroid, to determine preoperatively if the mass is the patients only functioning thyroid tissue. Correlation of the sonographic findings with the clinical information narrows the differential diagnosis; thus, more appropriate therapeutic decisions can be made. When indicated, ultrasound-guided interventional procedures can be performed for diagnosis and/or treatment.