Atlas of Pediatric Ultrasound

404 Pages·2012·89.91 MB·English

by  Tanveer Khalid Zubairi (editor), Nadir Khan (editor)

Atlas of
Pediatric Ultrasound
Atlas of
Pediatric Ultrasound
Tanveer Khalid Zubairi
MBBS MCPS
Consultant Radiologist
Tanveer Ultrasound and Radiology Clinic
Karachi, Pakistan
Assistant Editor
Nadir Khan
MBBS MD FCPS
Consultant Radiologist
Aga Khan University Hospital
Karachi, Pakistan
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© 2012 Tanveer Khalid Zubairi
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Atlas of Pediatric Ultrasound
First Edition : 2012
ISBN-13: 978-93-5025-770-8
Printed in Ajanta Offset
To
The sick children
the fuel for my skills….
the motivation for my skills….
Foreword
It so happened that in the middle of last century, a new science of Physics, the ultrasonic waves were put to use for
medical diagnostic purposes. X-rays, discovered over a century ago, were already helping the doctors and the
patients for reaching a diagnosis of the lesions hidden from human eyes in an otherwise intact body.
Ultrasonic waves are high frequency sound waves that behave just like normal sound waves. Professor Ian
Donald first made use of this in the fifties of last century, for Obstetric purposes. Since then, the usefulness of this
modality has made it a first line investigation in all fields of surgical and medical specialties, both in emergency
cases and in elective investigations. The machines have also been developed and refined, and are used for all soft
tissues, cardiac and circulatory system studies, and studies of the solid organs. Minutest of details can be seen; and
now the 3D version. Antenatal studies of fetus are remarkable for clarity.
It is matter of great pleasure for me to write foreword of the book in your hand. It is the effort of Dr Tanveer
Zubairi who has mastered the art. She has the maximum experience in pediatrics, over 25 years. As a practicing
pediatric surgeon, I can appreciate how easy she had made my life, and certainly of all other practicing pediatricians
and surgeons; thus helped in management of neonates, babies and children.
This book is basically an Atlas, with legend accompanying the pictures. The pictures are of highest quality and
resolution. It is easy to read and follow for radiology undergraduates, the pediatricians and the surgeons. I am
impressed with the coverage that Dr Tanveer Zubairi has provided; almost the entire body systems. The book is
divided into systems and chapters. The work is entirely one person’s collection of cases referred to her by various
clinicians in the city of Karachi, and she has to be congratulated for keeping such a decent record. The Publishers
are to be commended for producing such a nice Atlas.
I hope the book will find a place in the hands of all clinicians dealing with children, and on the shelf of every
radiology set up.
Dr S Mohsin Azhar Ali FRCS
Professor of Pediatric Surgery
Ex-Dean of Medical College
Ziauddin University
Karachi, Pakistan
Preface
The world of sonography thrilled and enchanted me and I took it as a challenge to explore and master it. After
years of hard work, dedication and struggle I felt elated as I went on learning its occult secrets and overt
demonstrations in slides and screens. One does not feel that one has mastered the art and craft until patients, as
well as their doctors are appeased.
That happened only when I reached Karachi in 1984 to work first in a hospital and then set up my own
clinics. At that time there were only one or two qualified Radiologists with skill of Ultrasound here, and
most clinicians were not well aware of its uses and advantages.
The urge to learn more and delve deeper into the subject was the factor which lured me on to read
more, discuss and attend courses and conferences in the USA, Austria, Japan, Singapore, Korea, China,
South Africa and other places.
I was lucky enough to have acquired latest ultrasound machines like 3D, 4D, color Doppler and others as they
become available.
My special field of interest focused on pediatrics as I encountered numerous anomalies in newborns and in
early childhood. The data that I thus collected (both diagnostic notes and pictures) prompted me to produce it in
atlas form for clinicians, radiologists and students. I hope it would be useful to you in some way.
Tanveer Khalid Zubairi
Acknowledgments
My first teacher was Dr Piran Aliabadi of Radiology Department in Shiraz University in Iran, who was always
encouraging and understanding. To him I owe gratitude for my career. I learned basic ultrasound from three
radiologists, Dr David Allan Parker, Dr DW Gregory and Dr RM Ginwala and ultrasonographer Ms Dianne of
Prince Charles Hospital, Merthyr Tydfil, S. Wales.
My other teachers of Ultrasound in different capacities and at different places from time to time were
Dr D Cosgrove, Dr HB Miere, Dr K Dewbury, and BB Goldburg. To them too I am indebted.
For getting me interested in pediatric sonography I am thankful to Prof Ghaffar Billo, who invited me to teach
ultrasound to Residents of Pediatric Department, Civil Hospital, Karachi, and also see children, who needed
diagnosis. Then I started collecting cases. I got referrals and feedback from Professor Mohsin Azhar Ali, Prof
Nizamul Hassan, Prof DS Akram, Prof Iqbal Memon, Professor Ayesha Mehnaz, Surgeon Talat Mehmood and
many other pediatricians and surgeons.
I must thank Prof Jamal Raza for providing me rare cases missing in my collection, and for giving me access to
the Radiology Department of National Institute of Child Health, Karachi.
I am thankful to my colleagues Dr Humaira Iqbal, Dr Raana Kazmi, Dr Rashida Liaqat, Dr Amtul Bakhtiari,
Dr Shakira Khan and Dr Iram Salman for encouraging me to write this book. I have to thank my computer department
staff Mr Farhan Khan and Mr Wilson who worked hard to compose this book.
This book would have been impossible without the support, the encouragement and the patience of my husband
Dr Khalid Khan.
I could not have completed this book and sent for publication without the help of Dr Nadir Khan, Consultant
Radiologist, Aga Khan University Hospital, Karachi. He in spite of his night calls and preparation for exams,
found time to compile and edit the book and improve resolution of picture using his computer skills.
Last but not the least, I have to mention Mr Salim Rana, the Administrator of my clinics, who has ensured that
everything from man to machine runs smoothly at all times of the day and night.
I am thankful to artist Mr Mashkoor Reza for drawing schematic diagrams of neonatal brain.
Contents
1. Central Nervous System: Brain ......... 1  TIME OF EXAMINATION 87
 GUIDELINES FOR PERFORMANCE OF ULTRASOUND  EXAMINATION VIEWS 87
– True Coronal View 87
EXAMINATION IN INFANTILE BRAIN 3
– Transverse Neutral View 89
 TECHNIQUE OF BRAIN ULTRASOUND 3
– Transverse Flexion View 89
– Coronal Images 3
– Sagittal View 6  HIP JOINT MEASUREMENTS 90
– Graf’s Technique for the Measurement of
 DOPPLER AND COLOR DOPPLER IMAGING 9
Neonatal Hip 90
 CONGENITAL INTRACRANIAL ANOMALIES 9
– Lateral Head Distance (LHD) Terjesen Method 90
– Encephalocele 9
– Arnold-Chiari Malformation 9  ULTRASOUND APPEARANCE IN DISLOCATION 97
– Dandy-Walker Malformation 13
4. Chest.............................................. 99
– Dysgenesis of Corpus Callosum 14
– Holoprosencephaly 15  ULTRASOUND OF THE CHEST 101
– Hemimegalencephaly 15 – Indications of Ultrasound Chest 101
– Hydranencephaly 15 – Ultrasound Technique 101
 BRAIN CYSTS 24  DIAPHRAGMATIC HERNIA 101
– Arachnoid Cysts 24  EVENTRATION OF DIAPHRAGM 101
– Choroid Plexus Cysts 26  MEDIASTINAL WIDENING 105
 ANEURYSM VEIN OF GALEN 26  LUNG CONSOLIDATION 110
 HYDROCEPHALUS 31  PLEURAL EFFUSION 110
 INTRACRANIAL INFECTIONS 36
– Neonatal Meningitis 37 5. Abdomen: Bowel and Mesentery . 113
– Brain Abscess 37
BOWEL
– Congenital Infections 37
 INTRACRANIAL HEMORRHAGES 43  ULTRASOUND OF THE BOWEL 115
– Technique 115
– Subependymal and Intraventricular
– Sonographic Layers of the Bowel 115
Hemorrhages 43
– Intracranial Hemorrhage in Full Term  HYPERTROPHIC PYLORIC STENOSIS (HPS) 115
– Ultrasound of Patient with HPS 115
Babies 52
– Subdural Hemorrhage 52  DUPLICATION CYST 117
– Duplication Cyst of Stomach 117
– Subarachnoid Hemorrhage 53
– Duplication Cyst of Duodenum 117
– Intraparenchymal Hemorrhage 53
 HYPOXIC-ISCHEMIC ENCEPHALOPATH 53  DUODENAL ATRESIA 117
– Ischemic Lesion in Premature Infants 54  BEZOAR 122
– Hypoxic-ischemic Encephalopathy in  INTUSSUSCEPTION 122
Term Babies 54  LYMPHOMA 127
 APPENDICITIS 129
– Ultrasound Findings 136
2. Central Nervous System: Spine....... 71
 INTESTINAL OBSTRUCTION 137
 ULTRASONOGRAPHY OF NEONATAL SPINE 73 – Small Bowel 137
 NORMAL ANATOMY OF SPINE 73 – Large Bowel 138
 SPINA BIFIDA 73  ULTRASOUND TECHNIQUE FOR IMPERFORATE
– Spina Bifida Occulta 74 ANUS 139
– Spina Bifida Cystica 74  HIRSCHSPRUNG’S DISEASE 139
– Spina Bifida Aperta 79  WORMS IN BOWELS 139
 PSOAS ABSCESS 79  TUBERCULOSIS 139
 NEUROGENIC TUMOR 82 MESENTERY
 MESENTERIC CYSTS 148
3. Neonatal Hip.................................. 85  MECONIUM PERITONITIS AND MECONIUM
PSEUDOCYST 148
 ULTRASOUND INDICATIONS OF NEONATAL HIP 87
 ANATOMY OF HIP JOINT 87  ASCITES 151
xii Atlas of Pediatric Ultrasound
6. Abdomen: Infiltrative  CHRONIC PANCREATITIS 228
Disorders of Liver ......................... 155  PANCREATIC TRAUMA 230
SPLEEN
 NORMAL ANATOMY AND APPEARANCE 157  NORMAL SPLEEN AND ANATOMY 231
 GENERALIZED INFILTRATION OF LIVER 157  POLYSPLENIA 234
– Acute Viral Hepatitis 157  WANDERING SPLEEN 234
– Chronic Persistent Hepatitis 159  SPLENIC CYST 235
– Granulomatous Hepatitis 159  SPLENIC ABSCESS 235
 CIRRHOSIS 161  SPLENIC TRAUMA 239
 BUDD-CHIARI SYNDROME 161  STORAGE DISEASES 239
 CONGESTIVE LIVER 166  MALIGNANT MASSES 241
 FATTY INFILTRATION LIVER 166
 LYSOSOMAL AND GLYCOGEN STORAGE DISEASES 169 10. Abdomen: Urinary Tract................ 243
– Gaucher’s Disease 169
RENAL ANATOMY AND APPEARANCE
 OTHER INFILTRATIVE DISEASES 169
RENAL ANOMALIES
7. Abdomen: Focal Lesions in  RENAL HYPOPLASIA 246
 SIMPLE ECTOPIA 246
Liver............................................. 173  CROSSED RENAL ECTOPIA 246
 SIMPLE LIVER CYST 175  HORSESHOE KIDNEYS 246
 ECHINOCOCCAL CYST 175  DUPLICATION ANOMALIES 250
 LIVER ABSCESSES 179  PUJ OBSTRUCTION 251
– Amebic Liver Abscess 179  URETEROVESICAL JUNCTION OBSTRUCTION 251
– Pyogenic Liver Abscesses 182  CONGENITAL HYDRONEPHROSIS 254
– Tuberculous Abscess 182  VESICOURETERIC REFLUX 256
 HEPATIC TRAUMA 185  POSTERIOR URETHRAL VALVE 259
RENAL CYSTIC DISEASE
 BENIGN LIVER MASSES 185
– Hemangioma 185  SIMPLE CYST 264
– Hemangioendothelioma 185  POLYCYSTIC DISEASE 264
– Focal Nodular Hyperplasia 187  AUTOSOMAL DOMINANT POLYCYSTIC DISEASE 267
 MALIGNANT TUMORS 187  MEDULLARY SPONGE KIDNEY 267
– Hepatoblastoma and Hepatocellular  MULTICYSTIC DYSPLASTIC KIDNEY 268
RENAL INFECTIONS
Carcinoma 187
– Metastasis 189  ACUTE PYELONEPHRITIS 270
– Lymphoma Liver 195  RENAL ABSCESS 272
 PYONEPHROSIS 272
8. Abdomen: Gallbladder and  CHRONIC PYELONEPHRITIS 275
 TUBERCULOSIS KIDNEYS 276
Common Bile Duct .................... 197 RENAL PARENCHYMAL DISEASE
GALLBLADDER  ACUTE GLOMERULONEPHRITIS 278
NEPHROLITHIASIS
 ANATOMY 199
 TECHNIQUE 199  NORMAL VARIANTS IN NEONATAL KIDNEYS 280
 BILIARY SLUDGE 200  NEPHROCALCINOSIS 280
 CHOLELITHIASIS 201  UROLITHIASIS 280
RENAL TUMORS
 ACUTE CALCULUS CHOLECYSTITIS 201
 ACUTE ACALCULUS CHOLECYSTITIS 201  RENAL LYMPHOMA 292
 CHOLESTEROLOSIS OF GALLBLADDER 205  BENIGN MASSES KIDNEYS AND ANGIOMYOLIPOMA294
URINARY BLADDER
 GALLBLADDER TUMORS 209
COMMON BILE DUCT  URACHUS 295
 CHOLESTASIS IN NEWBORN 211  BLADDER DIVERTICULA 296
– Neonatal Hepatitis 212  BLADDER INFECTION 296
– Biliary Atresia 213  NEUROGENIC BLADDER 298
 CHOLEDOCHAL CYST 213  ADENOMYOMATOSIS OF BLADDER 298
 BILIARY ASCARIS 218  BLADDER NEOPLASM 299
 BLADDER CLOT 299
9. Abdomen: Pancreas and Spleen ... 221
11. The Abdomen: Retroperitoneum.. 301
PANCREAS
 NORMAL PANCREAS AND ANATOMY 223 ADRENAL GLANDS
 ACUTE PANCREATITIS 223  NORMAL ANATOMY AND APPEARANCE 303
Contents xiii
 ADRENAL HEMORRHAGE 303 MISCELLANEOUS
 ADRENAL CYST 304  FIBROID UTERUS 345
 ADRENAL ABSCESS 304  LYMPHOMA 345
RETROPERITONEAL MASS
 NEUROBLASTOMA 307 13. Scrotum and Testis ....................... 349
 RETROPERITONEAL CYST 312
RETROPERITONEAL LYMPH NODES  ANATOMY 351
 TECHNIQUE 351
 HYDROCELE 352
12. Female Pelvis ............................... 317
 SCROTAL CYSTS 355
THE OVARY  EPIDIDYMO-ORCHITIS 355
 TECHNIQUE AND ANATOMY 319 – Chronic Epididymitis 356
NEONATAL PATHOLOGY  TORSION TESTIS 356
 HERNIATED OVARY IN INGUINAL CANAL 319  VARICOCELE 361
 NEONATAL OVARIAN CYST 320  CRYPTORCHIDISM 362
POST-MENARCHE PATHOLOGY  TESTICULAR MICROLITHIASIS 362
 FUNCTIONAL CYSTS 320  TESTICULAR TRAUMA 365
 CYSTADENOMAS 321  TESTICULAR TUMORS 365
 HEMORRHAGIC CYSTS 321  ADRENAL REST 370
 ENDOMETRIOSIS 322  EXTRATESTICULAR MASSES 370
NEOPLASMS
 GERM CELL TUMORS 325 14. Neck............................................. 377
 DERMOID CYSTS 325
THYROID GLAND
 DYSGERMINOMA 330
TORSION  ANATOMY 379
 TORSION OF OVARY 331  TECHNIQUE 379
 TORSION OF OVARIAN CYST 334  DIFFUSE THYROID DISEASE 379
 POLYCYSTIC OVARIES 335  FOCAL THYROID NODULES 382
LYMPH NODES
THE UTERUS
 NEONATAL UTERUS 335  ANATOMY 384
 POST-MENARCHE UTERUS 337  NEOPLASTIC NECK LYMPHADENOPATHY 389
OTHER NECK MASSES
 CONGENITAL VAGINAL OBSTRUCTION 337
POST-MENARCHE  CYSTIC HYGROMA 389
 IMPERFORATED HYMEN 338  THYROGLOSSAL DUCT CYST 392
 CONGENITAL ANOMALIES 338  HEMANGIOMA 392
 SEPTATE UTERUS 343  MALIGNANT TUMORS 394
Index....................................................................................................................................397