Pediatric Sonography

735 Pages·2010·127.257 MB·English

by  Marilyn J. Siegel MD

LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page i Aptara
Pediatric Sonography
F O U R T H E D I T I O N
Editor
Marilyn J. Siegel
Professor of Radiology and Pediatrics
The Edward Mallinckrodt Institute of Radiology
Washington University School of Medicine
St. Louis, Missouri
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page ii Aptara
Product Manager: Ryan Shaw
Vendor Manager:Alicia Jackson
Senior Manufacturing Manager: Benjamin Rivera
Senior Marketing Manager:Angela Panetta
Design Coordinator: Stephen Druding
Production Service: Aptara, Inc.
© 2011 by LIPPINCOTT WILLIAMS & WILKINS, a WOLTERS KLUWER business
Two Commerce Square,
2001 Market Street
Philadelphia, PA 19103 USA
LWW.com
All rights reserved. This book is protected by copyright. No part of this book may be repro-
duced in any form by any means, including photocopying, or utilized by any information stor-
age and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book pre-
pared by individuals as part of their official duties as U.S. government employees are not cov-
ered by the above-mentioned copyright.
Printed in China
Library of Congress Cataloging-in-Publication Data
Pediatric sonography / editor, Marilyn J. Siegel. — 4th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-60547-665-0 (alk. paper)
1. Diagnostic ultrasonic imaging. 2. Pediatric diagnostic imaging.
I. Siegel, Marilyn J.
[DNLM: 1. Ultrasonography–methods. 2. Child. 3. Infant. WN 240
P3726 2010]
RJ51.U45P43 2010
618.92(cid:2)00754—dc22
2010022392
DISCLAIMER
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors, editors, and publisher are not responsible
for errors or omissions or for any consequences from application of the information in this
book and make no warranty, expressed or implied, with respect to the currency, completeness,
or accuracy of the contents of the publication. Application of the information in a particular
situation remains the professional responsibility of the practitioner.
The authors, editors, and publisher have exerted every effort to ensure that drug selection
and dosage set forth in this text are in accordance with current recommendations and practice
at the time of publication. However, in view of ongoing research, changes in government reg-
ulations, and the constant flow of information relating to drug therapy and drug reactions, the
reader is urged to check the package insert for each drug for any change in indications and
dosage and for added warnings and precautions. This is particularly important when the rec-
ommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in the publication have Food and Drug Ad-
ministration (FDA) clearance for limited use in restricted research settings. It is the responsi-
bility of the health care provider to ascertain the FDA status of each drug or device planned
for use in their clinical practice.
To purchase additional copies of this book, call our customer service department at (800) 638-
3030 or fax orders to [phone]. International customers should call [phone].
Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams &
Wilkins customer service representatives are available from 8:30 am to 6 pm, EST.
10 9 8 7 6 5 4 3 2 1
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page iii Aptara
To my husband, Barry
my mentor, colleague, friend, and loving spouse. His unwavering support and
encouragement gave me the energy to make this project a reality.
To my parents, Harry and Bess
who taught me the value of learning and who were in large part responsible for my
achieving many of my academic goals and ultimately entering medicine.
To all the radiology residents and fellows with whom I have had the opportunity to work
at the Mallinckrodt Institute of Radiology. Their quest for knowledge acted as the stimulus
for me to write this book.
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page iv Aptara
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page v Aptara
Contributors
Ellen M. Chung, MD William D. Middleton, MD, FACR
Pediatric Radiologist Professor of Radiology
Department of Radiology and Radiologist Sciences The Edward Mallinckrodt Institute of Radiology
Uniformed Services University of the Health Sciences Washington University School of Medicine
Bethesda, Maryland Barnes Jewish Hospital
St. Louis, Missouri
Brian D. Coley, MD
Clinical Professor Marilyn J. Siegel, MD
Departments of Radiology and Pediatrics Professor of Radiology and Pediatrics
The Ohio State University College of Medicine and Public Health The Edward Mallinckrodt Institute of Radiology
Chief, Section of Ultrasound Washington University School of Medicine
Department of Radiology St. Louis, Missouri
Nationwide Children’s Hospital
Columbus, Ohio
Nirvikar Dahiya, MD
Assistant Professor
Department of Abdominal Imaging
The Edward Mallinckrodt Institute of Radiology
Washington University School of Medicine
Barnes and Jewish Hospital
St. Louis, Missouri
v
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page vi Aptara
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page vii Aptara
Preface
S
ince the publication of the third edition of Pediatric Sonogra- This book is intended primarily for practicing radiologists,
phyin 2002, important technologic advances continue to be radiology residents and fellows, and sonographers. Other physi-
made in ultrasonography. We have seen innovations in soft- cians, such as pediatricians and surgeons, also can derive useful
ware and technology, such as harmonic imaging, contrast agents, information about the clinical indications and relative value of
and 3D imaging, which have contributed to an increased utiliza- sonography in the pediatric patient.
tion of ultrasonography as a diagnostic tool. These changes have As in the first three editions, the first two chapters of this edi-
also impacted clinical practice by improving our understanding of tion present a detailed review of ultrasound physics and the artifacts
the role of ultrasonography in the evaluation of disease processes and pitfalls that are encountered in practice. The remainder of the
in children. In addition, compared with computed tomography book is divided into chapters covering thirteen anatomic areas:
and magnetic resonance imaging, ultrasonography is a more cost- head, neck, chest, breast, liver, biliary tract and gallbladder, spleen
effective imaging test for investigating many pediatric problems. and peritoneum, gastrointestinal tract, kidneys, retroperitoneum,
Particularly important is the fact that ultrasonography is nonin- female and male pelvis, and musculoskeletal system. Each chapter
vasive and does not use ionizing radiation, making a compelling includes practical sonographic techniques, normal sonographic
case for even more widespread use of this modality in the pedi- anatomy, and abnormal sonographic findings specific for that organ
atric population. Given these facts, there is a need for an updated system. Instruction also is provided on how to avoid technical and
text for radiologists to use in practice or training. interpretative errors. Additionally, the use of sonography and alter-
The goal of the fourth edition of Pediatric Sonography is native imaging studies for solving common clinical problems is dis-
again to provide a comprehensive text on the clinical applications cussed. The final chapter describes the role of sonography in guid-
of sonography in a pediatric population. Virtually all chapters ing aspiration, biopsy, and drainage procedures.
have been extensively revised with new illustrations and images It is my sincere hope that readers will find this work to be a
added. To reflect the evolving clinical applications of sonography, cornerstone of pediatric imaging and one that they will use fre-
there is a new chapter on breast sonography. Top radiologists quently in their daily practices. I have strived to produce a text
who are recognized authorities in sonography again have been that is readable and offers guidance for radiologists and sonog-
recruited to share their expertise in special areas. raphers on the appropriate use of sonography in children.
vii
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page viii Aptara
Acknowledgments
W
riting a book is a task that requires time and commitment remain dedicated to performing high-quality examinations on
from many people. As editor, it would not have been pos- children.
sible for me to complete this task without the contributions I would also like to express my appreciation to the publish-
of many other individuals, who I acknowledge below. ing team at Lippincott Williams & Wilkins for their effort and
I offer sincere thanks to Dr. Brian Coley of Columbus Chil- professionalism in directing this project. Most particularly, I
dren’s Hospital, Dr. Ellen M. Chung, Department of Radiologic would like to thank Ryan Shaw and Brian Brown, for their ded-
Pathology, Armed Forces Institute of Pathology, and Drs. William ication and advice. Of course, I need to thank Lisa McAllister
Middleton and Nirvikar Dahiya of the Mallinckrodt Institute of who cajoled me into taking up the editorial pen once again. With-
Radiology. They graciously shared their invaluable experience out her efforts, this book would not have happened. I also
and expertise to bring depth to important chapters. express appreciation to Chris Miller, who transformed the pages
A special note of gratitude goes to my secretary, Janine into print and prepared the illustrative material. Her dedication
Wuebbles, who spent many hours acquiring references and ulti- is reflected in the high quality of the final product.
mately checking their accuracy in the proofs. Without her sup- Finally, I wish to thank one more very important person—my
port, this book could not have been finished in a timely fashion. husband, Barry A. Siegel, M.D., for his support and patience dur-
My thanks also goes to my sonographers, Deborah Reiter, Janet ing the many hours that I spent writing and editing this book. His
Hurt, Angela Heffernan, Amy Devall, and Shelly Lopez, who unconditional support made the completion of this book a reality.
viii
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page ix Aptara
Contents
Contributors v 10
Gastrointestinal Tract . . . . . . . . . . . . . . . 339
Preface vii
Acknowledgments viii Marilyn J. Siegel
1 Physical Principles and Instrumentation . . . 1 11 Urinary Tract . . . . . . . . . . . . . . . . . . . . . 384
Nirvikar Dahiya, William D. Middleton, and Marilyn J. Siegel Marilyn J. Siegel
2 Ultrasound Artifacts . . . . . . . . . . . . . . . . 21 12 Adrenal Glands,Pancreas,and Other
William D. Middleton, Marilyn J. Siegel, and Nirvikar Dahiya Retroperitoneal Structures . . . . . . . . . . . 461
Marilyn J. Siegel and Ellen M. Chung
3
Brain . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
13
Marilyn J. Siegel Female Pelvis . . . . . . . . . . . . . . . . . . . . 509
Marilyn J. Siegel
4
Head and Neck . . . . . . . . . . . . . . . . . . . 118
14
Marilyn J. Siegel Male Genital Tract . . . . . . . . . . . . . . . . . 554
Brian D. Coley and Marilyn J. Siegel
5
Chest . . . . . . . . . . . . . . . . . . . . . . . . . . 164
15
Marilyn J. Siegel Musculoskeletal System and
Vascular Imaging . . . . . . . . . . . . . . . . . . 602
6
Breast . . . . . . . . . . . . . . . . . . . . . . . . . 200
Marilyn J. Siegel
Ellen Chung and Marilyn J. Siegel
16
Spinal Ultrasonography . . . . . . . . . . . . . . 647
7
Liver . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Brian D. Coley and Marilyn J. Siegel
Marilyn J. Siegel
17
Ultrasound-Guided
8
Gallbladder and Biliary Tract . . . . . . . . . . 275
Interventional Procedures . . . . . . . . . . . . 675
Marilyn J. Siegel
Brian D. Coley
9 Spleen and Peritoneal Cavity . . . . . . . . . 305 Appendix 701
Marilyn J. Siegel Index 711
ix
LWBK505-FM_i-x.qxd 09/07/2010 07:00 PM Page x Aptara