Pediatric review

The three most common causes of jaundice in the neonatal period
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The three most common causes of jaundice in the neonatal period
Hepatitis, Billary atresia, choledochal cyst
Neonatal hepatitis sonographic findings
Liver normal size or in large. Parenchyma is hyper he Kovic decrease visualization of portal venous structures. GB and ducts not affected. If severe GB may be small
biliary atresia
Males more common
May result from inflammation of the hepatobiliary system
Affects intra-and extra hepatic ducts
Usually not gallbladder but be able to recognize persuade or gallbladder or abnormally shaped gallbladder
Biliary atresia Sonographic findings
Liver normal or enlarged
Parenchyma normal or hyperechoic
Decrease visualization of portals
Intrahepatic ducks not dilated
Remnant duct may be seen
Smalll Hyperechoic focal triangular area
Triangular chord sign seen anterior to the portal vein bifurcation
choledochal cyst
Abnormal cystic dilation of the biliary tree which most frequently affects the CBD
Associated with intrahepatic ductile dilation
Five types
Signs: jaundice pain palpable mass
The two most common pediatric neoplasms often asymptomatic
Hepatoblastoma and
infantile Hemangioendothelioma
Metastasis to the liver may arise from
Neuroblastoma, Wilms tumor, leukemia or lymphoma
Hepatoblastoma
Under age 4. Mostly under age 1.
Findings: hepatomegaly large solitary Heterogeneous mostly solid mass calcifications are common vascular
Hypoechoic areas with necrosis or hemorrhage
Signs: fever, pain, AFP
Hemangioendothelioma
Peak six months of life
Hepatomegaly, CHF, Cantania's hemangiomas, A FP.
Multiple hypoechoic lesions or solitary mass
Tumor is heterogeneous or Isoechoic with cystic components
May have calcifications
Well circumscribed or poorly marginated
Doppler may show arteriovenous shunt
Mesenchymel hamartoma
Rare, asymptomatic, under two
Multi septate cystic mass derived from peri portal mesenchyma
adenomaNot common an infant unless liver disease is present glycogen storage disease Elevated AFP Appearance hyper to hypoechoic non-specificappendicitisUsually 5 to 15 male prevalence Rlq pain and vomiting increase WBC fever nausea rebound pain Diameter >6-7mmSonographic appearance of appendicitisNon-compressible Measured outer to outer >7mm Increased echogenic fat Hypomotolity of bowel Hyperemic May have free fluid well we're abdomen Mesenteric lymph nodesappendicolithHyperechoic, shadowing, single or multiple Maybeee intraluminal or surrounded by phlegm on or abscess Right kidney may be Hydronephrotic From urethral inflammationintussusceptionTowel prolapses into more distal bowel Telescoping of bowel causes obstruction 90% prolapse of ileum into the cecum or beyond Six months-two years Old M:F 2:1 Usually HX of upper respiratory tract infection Cocky abdominal pain, vomiting bloody jelly stools abdominal distention or mass may be palpableSonographic finding of IntussusceptionAlternating hypoechoic and Hyperechoic rings surrounding and echogenic center donut target sign in TRV In sagital sandwich son hypoechoic layers with echogenic centerhypertrophic pyloric stenosisMostly males 3-12 weeks Bile free vomiting dehydration weight loss Peristaltic and reverse waves may see during Wall greater than or equal to 3 mm Weight greater than 15 to 16 mmNecrotizing enterocolitisIntramural gas appears as small punctate Hyperechoic foci within the intestinal wall with the loss of the normal hypoechoic muscularis haloCongenital hydronephrosisDilation of the urinary collecting system Most common urinary track anomaly in kids Causes: obstruction, reflux, abnormal muscle developmentSonographic appearance of congenital hydronephrosisVisible Renal parenchyma surrounding a central cystic component Small peripheral cyst (dilated calyces) Putting off a large central cyst (renal pelvis) Renal pelvis dilation is normal up to 10 mmposterior urethral valvesDecreased urine output Thickened bladder wall keyhole sign US findings: hydronephrosis hydroureterEctopic UreteroceleFemales more common Left side more common Results from the topic bladder insertion and cystic dilation of the distal ureter of a completely duplicated renal collecting systemPrune Belly SyndromeAbdominal muscle deficiency syndrome Rare unknown cause mostly males Includes: Hypoplasia of abdominal muscles, urinary tract anomalies, cryptorchidismPrune belly syndrome sonographic findingsBladder appears second and trabeculated with PUV's Hydronephrosis and Hydro Ureter usually bilateral May have urinomaMulticystic dysplastic kidneyCongenital, sporadic, results from urethral obstruction. High urethral atresia and pyelocalyceal usually presentSonographic findings of multicystic dysplastic kidney diseaseUnilateral mass resembling a cluster of grapes no identifiable renal pelvis If bilateral then fatalAutosomal recessive polycystic kidney diseaseNot common, female predominance Associated with Bilisry ectasia Hepatic fibrosis Can lead to liver failureAutosomal recessive polycystic kidney disease sono graphic findingsBilateral renal enlargement with the fuse increase echogenicity any loss of definition of the Renal sinus, medulla, and cortex. Macroscopic cyst like appearance throughout both kidneys reflects dilated renal tubule's less than 2 mm in diameterAdrenal hemorrhage Sonographic parentsOvoid enlargement of the gland or portion Annika work to hyperechoic or a mixture depending on the extent Blunting of superior kidney, inferiorly displaces kidney Will get smaller in 4 to 6 weeks May have calcificationsWilms tumor (nephroblastoma)2-5 years old Usually unilateral Bulky distorts the collecting system and capsule US findings: variable Homo or complex texture, calcifications, what qualification necrosis hemorrhage, well defined football key, hypo or hyper rim surrounding May have hydroNeuroblastomaTwo months to two years old 50% arise from the medulla of the adrenal gland Science: abdominal mass, hypertension, diarrhea. bone pain if metastasis is involved.Neuroblastoma sonographic appearanceUsually highly echogenic with calcifications If smaller may appear homogeneous and hyper If larger more complex Cystic form exist Displaces kidney inferiorly Vascular poorly defined heterogeneous with your regular hyperechoic areas caused by calcificationsUsually 5 to 15 male prevalence