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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5790_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Acknowledgements
- •Contents
- •1: Theory and Basics
- •1.1.2.3 Reflection
- •1.1.2.4 Absorption
- •1.1.2.5 Deflection
- •1.1.2.6 Focus
- •1.1.2.7 Resolution
- •1.2 Practical Application in US Device
- •1.2.1 Emission, Transmission, Reception and Amplification
- •1.2.1.1 Emission
- •1.2.1.2 Transmission
- •1.2.1.3 Reception
- •1.2.1.4 Amplification
- •1.2.2 Signal Processing
- •1.2.2.1 Preprocessing
- •1.2.2.2 Post-processing
- •1.2.2.3 Time Gain Compensation (TGC)
- •1.2.2.4 Sound Energy = Output
- •1.2.2.5 Gain
- •1.2.2.6 Frame Rate/Persistence
- •1.2.3 Components of US Device
- •1.2.3.1 Transducers
- •Sector Transducers
- •Linear Array Transducers
- •Curved Linear Array
- •Other Transducers
- •1.2.3.2 Other Parts of US Device
- •1.3 US Methods
- •1.3.1 A (Amplitude)-Mode
- •1.3.2 (T)M-Mode (Time-Motion-Mode)
- •1.3.3 B (Brightness)-Mode
- •1.3.4 Doppler Sonography
- •1.4 Artefacts
- •1.4.1 General Remarks
- •1.1 Ultrasound (US) Physics
- •1.1.1 US Waves
- •1.1.2 Propagation and Modulation of US
- •1.1.2.1 Acoustic Impedance
- •1.1.2.2 Impedance Change
- •1.4.2 Common Artefacts
- •1.4.2.1 Side Loop Artefact
- •1.4.2.2 Bowing Artefact
- •1.4.2.3 Noise
- •1.4.2.4 Marginal Shadowing
- •1.4.2.5 Posterior Enhancement – Increased Through Transmission
- •1.4.2.6 Reverberation Artefact
- •1.4.2.7 Increment or Slice Thickness/Beam Width Artefact
- •1.4.2.8 Mirror Image Artefact
- •1.4.2.9 Shadowing
- •1.4.2.10 Refraction Artefact
- •1.4.2.11 Anisotropy
- •1.5 Biologic Effects
- •1.5.1 General Remarks
- •1.5.2 Thermal Effects
- •1.5.2.1 Tissue Heating
- •1.5.2.2 Biological Effects, Tissue Heating
- •1.5.3 Mechanical Effects and Resonance
- •1.5.3.1 Cavitation
- •Acoustic Cavitation
- •Negative Peak Pressure
- •1.5.4 Potential Risks of Diagnostic US
- •1.5.4.1 Specific Risks
- •1.5.4.2 Guidelines and Recommendations
- •1.5.5.1 Mechanical Index (MI)
- •1.5.5.2 Thermal Index (TI)
- •1.5.5.3 Display of Actual Indices
- •1.6 How to Perform Paediatric US
- •1.6.1 Requisites
- •1.6.1.1 Indications
- •1.6.1.2 Environmental Requisites
- •1.6.1.3 Specific Needs in Children
- •1.6.1.4 Specific Needs in Infants and Newborns
- •1.6.2 Positioning
- •1.6.3 Device Handling
- •1.6.4 Transducer Selection
- •1.6.4.1 General Remarks
- •1.6.4.2 Neurosonography
- •1.6.4.3 Small Part US
- •1.6.4.4 Chest US
- •1.6.4.5 Abdominal US
- •1.6.5 Course of Investigation and Measurements
- •1.6.5.1 General Remarks
- •1.6.5.2 Transducer Handling
- •1.6.5.3 Measurements
- •1.7 Documentation and Interpretation
- •1.7.1 Image Documentation
- •1.7.2 Report
- •1.7.2.1 How to Issue a Report
- •1.7.2.2 Diagnosis
- •1.7.2.3 Predefined Reports
- •1.7.2.4 Nomenclature
- •1.8 Doppler Sonography
- •1.8.1 The Doppler Phenomenon
- •1.8.2.1 Continuous Wave Doppler (CW)
- •1.8.2.2 Pulsed Wave Doppler (PW)
- •1.8.2.3 Duplex-Doppler Sonography
- •1.8.2.5 Amplitude-Coded Colour Doppler Sonography (aCDS)
- •1.8.2.6 Other Flow-Sensitive US Techniques
- •1.8.2.7 Important Parameters and Measurements (Fig. 1.16)
- •1.8.3 Artefacts in (Colour) Doppler Sonography
- •1.8.3.1 Aliasing
- •1.8.3.2 Spectral Broadening
- •1.8.3.3 Sample Volume Artefact
- •1.8.3.4 Filtering Artefacts
- •1.8.3.5 Scaling Problems
- •1.8.3.6 Gain-Induced Errors
- •1.8.3.7 Angle Correction
- •1.8.3.8 Motion Artefact
- •1.8.3.9 Twinkling Artefact
- •1.8.3.10 Others
- •1.8.4 How to Perform (Colour) Doppler Investigations
- •1.8.5 Limitations
- •1.8.6 Interpretation
- •1.9 Modern and Future US Methods and Techniques
- •1.9.1 High-Resolution US (HR-US)
- •1.9.2 Image Compounding
- •1.9.3 Harmonic Imaging (HI)
- •1.9.4 Extended Field of View US
- •1.9.5 US Texture Analysis
- •1.9.6 Sonoelastography
- •1.9.7.1 Basics
- •1.9.7.2 Applications
- •Contrast-Enhanced Voiding Urosonography (ce-VUS)
- •Other Intracavitary Use of ce-US: Sono-Genitography, Sonographic Pyelography, Etc.
- •Intravenous ce-US (CEUS)
- •Future ce-US Potential
- •1.9.8 Three- and Four-Dimensional US (3D-/4DUS)
- •1.9.8.1 Physics and Techniques
- •1.9.8.2 Typical Paediatric 3DUS Applications
- •Neonatal Neurosonography
- •3DUS of the Kidney
- •Urinary Bladder 3DUS
- •3DUS of the Paediatric (Female) Genitalia
- •Musculoskeletal 3DUS Applications
- •Small Part 3DUS Applications
- •Other Potential 3D-/4DUS Applications
- •1.9.8.3 Benefits of 3D-/4DUS
- •1.9.8.4 Restrictions of 3D-/4DUS
- •2: Ultrasound-Guided Interventions
- •2.1 General Aspects
- •2.1.1 Requisites
- •2.1.1.1 Other Important Needs
- •2.1.2 Precautions and Preparations
- •2.2 US-Guided Filling of Structures for Diagnostic or Therapeutic Purpose
- •2.2.2 Diagnostic Sonographic Enema
- •2.2.3 Therapeutic Sonographic Enema
- •2.2.4 US Genitography
- •2.2.5 Contrast-Enhanced Voiding Urosonography (ce-VUS)
- •2.2.6 Other Intracavitary Contrast Applications
- •2.2.7 Intravenous ce-US
- •2.3 Biopsies and Punctures
- •2.4 Drainage
- •2.5 Vascular Access
- •2.6 Lumbar Puncture
- •2.7 Foreign Body Removal
- •3: Neurosonography in Neonates, Infants and Children
- •3.1 Requisites
- •3.1.1 Equipment and Transducer Needs
- •3.1.2 Indications for Brain US
- •3.1.3 How to Investigate
- •3.2 Normal Findings
- •3.2.1 Transfontanellar Access
- •3.2.2 Alternate Access Findings
- •3.2.3 Colour Doppler Sonography (CDS)
- •3.2.4 Normal Variances in Preterm Babies
- •3.2.4.1 Periventricular Echogenicities
- •3.2.4.2 Ventricular Asymmetry
- •3.2.4.3 Ventriculomegaly
- •3.2.4.4 Cisterna Magna
- •3.2.4.5 Vascular Variations
- •3.3 Pathologic Findings
- •3.3.1 Neural Tube Defects
- •3.3.1.1 Anencephaly
- •3.3.1.2 Meningomyelocele and Encephalocele
- •3.3.1.3 Arnold Chiari Malformation
- •3.3.1.4 Dandy-Walker Malformations
- •3.3.1.5 Corpus Callosum Malformations
- •3.3.1.6 Lipoma
- •3.3.2 Migration and Gyration Alterations and Disturbances
- •3.3.2.2 Megalencephaly
- •3.3.2.3 Schizencephaly
- •3.3.2.4 Holoprosencephaly
- •3.3.2.5 Hydranencephaly
- •3.3.3 Phakomatoses
- •3.3.4 Cerebral Cysts
- •3.3.5 Ischemic Encephalopathy
- •3.3.5.1 Preterm Infant
- •3.3.5.2 Global or Diffuse Brain Oedema
- •3.3.5.3 Focal Hypoxemia and Ischemia
- •3.3.5.4 (C)DS in Brain Hypoxia
- •3.3.6 Inflammation
- •3.3.6.1 Prenatal Intrauterine Infections and Residuals
- •3.3.6.2 Postnatal Inflammation
- •3.3.7 Dilatation of CSF Spaces: Hydrocephalus
- •3.3.8 Cerebral Haemorrhage
- •3.3.8.2 Haemorrhage in Term Infants
- •3.3.8.3 Role of CDS in Neonatal Haemorrhage
- •3.3.8.4 Haemorrhage in Infants and Older Children
- •3.3.9 Tumours and Space-Occupying Lesions
- •3.3.9.1 Vascular Malformations
- •3.3.10 Cerebral Calcifications
- •3.4 Ultrasound of the Skull
- •3.4.1 Introduction
- •3.4.2 Haematoma
- •3.4.3 Space-Occupying Lesions and Tumours
- •3.4.4 Skull Fracture
- •3.5 Additional Imaging
- •3.5.1 Plain Film
- •3.5.2 CT
- •3.5.3 MRI
- •3.5.4 Catheter Angiography
- •3.5.5 Additional Supporting Procedures
- •3.6 Ultrasound of the Eye and the Orbit
- •3.6.1 Introduction
- •3.6.2 Normal Findings
- •3.6.3 Sonographically Depictable Pathology
- •3.7 Ultrasound of the Spinal Canal
- •3.7.1 Requisites
- •3.7.2 Transducers and Technique
- •3.7.3 Indications
- •3.7.4 Normal Findings
- •3.7.5 Pathologic Findings of the Spinal Cord
- •3.7.5.1 Dysraphism
- •3.7.5.2 Other Associated Pathology
- •3.7.5.3 Other “Occult” Dysraphisms
- •3.7.6 Trauma
- •3.7.7 Tumours
- •3.7.8 Other Spinal and Vertebral Pathology
- •3.7.9 Additional Imaging
- •3.7.10 Value of US
- •4: Ultrasound of the Neck
- •4.1 Indications, Requisites and Techniques
- •4.1.1 Transducers
- •4.1.2 Positioning and Handling
- •4.1.3 Typical Examinations
- •4.1.3.1 Cervical Lymph Nodes
- •4.1.3.2 Glands
- •4.1.3.3 Cervical Arteries
- •4.1.3.4 Cervical Veins
- •4.1.3.5 Intervention
- •4.2 Normal Findings
- •4.2.1 Lymph Nodes
- •4.2.2 Cervical Glands
- •4.2.2.1 Thyroid Gland
- •4.2.2.2 Parotid, Submandibular and Sublingual Glands
- •4.2.3 Other Cervical Soft Tissues
- •4.2.3.1 Muscles
- •4.2.3.2 Tonsils
- •4.2.3.3 Tongue
- •4.2.3.4 Para- and Retropharyngeal Spaces
- •4.2.3.5 Larynx
- •4.2.4 Cervical Vessels
- •4.3 Pathologic Findings
- •4.3.1 Lymph Nodes
- •4.3.2 Pathology of Cervical Soft Tissue
- •4.3.2.1 Malformations
- •Cervical Cyst
- •Dermoid Cyst
- •Duplication Cysts
- •Thymic Cyst
- •Cervical Ectopic Thymus
- •4.3.2.2 Tumours
- •Haemangioma
- •Lymphatic Malformation
- •Other Mesenchymal Tumours
- •Neuroblastoma, (Ganglio-)Neuroma, Neurofibroma and Other Nerve (Sheath) Tumours
- •Teratoma
- •Other Malignant Tumours
- •Role of US
- •4.3.2.3 Abscess Formations
- •4.3.2.4 Traumatic Changes
- •Haematoma (Including Sternocleidomastoid Muscle “Haematoma”)
- •4.3.3 Thyroid Gland
- •4.3.3.1 Cystic Changes
- •4.3.3.2 Malformations
- •4.3.3.3 Inflammation
- •4.3.3.4 Other Conditions
- •Hypothyroidism/Struma Diffusa/Colloides (Fig. 4.17)
- •Nodular Goitre
- •Amyloid Goitre
- •Adenoma/Carcinoma
- •4.3.4.1 Inflammation
- •4.3.4.2 Cysts
- •4.3.4.3 Calcifications/Sialolithiasis
- •4.3.4.4 Tumours
- •4.3.5 Cervical Vessels
- •4.3.5.1 Arteriosclerosis
- •4.3.5.2 Dissection
- •4.3.5.3 Stenosis
- •4.3.5.4 Other Vascular Anomalies
- •4.3.5.5 Thrombosis and Occlusion
- •5: Basics of Paediatric Echocardiography
- •5.1 Introduction
- •5.2 Equipment Needs and Specific Considerations
- •5.2.1 Transducers
- •5.2.2 Standard US Techniques
- •5.2.3 Patient Position
- •5.2.4 Sedation
- •5.3 Standard Planes and Standardised Course of Examination
- •5.4 Normal 2D Echocardiogram Findings
- •5.4.1 Parasternal Views
- •5.4.1.1 Parasternal Long Axis View (Fig. 5.2)
- •5.4.1.2 Parasternal Short Axis Views (Figs. 5.3 and 5.4)
- •5.4.2 Apical Views
- •5.4.3 Subcostal Views
- •5.4.3.1 Sagittal Subcostal View
- •5.4.3.2 Subcostal Four-Chamber View (Fig. 5.6)
- •5.4.4 Suprasternal View (Fig. 5.7)
- •5.5 Other Techniques
- •5.5.1 M (Motion)-Mode Echocardiography
- •5.5.2 Doppler Sonography
- •5.5.2.1 CDS with 2DUS
- •5.5.2.2 PW- and CW-Doppler
- •5.5.2.3 Calculation of Pressure ( P) Gradients ( P 1 Minus P 2)
- •5.5.3 Other Calculations and Functional Parameters
- •5.6 Special Echocardiographic Techniques
- •5.6.1 Transoesophageal Echocardiography (TEE)
- •5.6.2 Three-Dimensional (3D) Echocardiography
- •5.6.3 Tissue Doppler Imaging (TDI)
- •5.6.4 Contrast-Enhanced US
- •5.7 Normal Values
- •5.8 Pathologic Findings
- •5.8.1 Congenital Heart Defects with Left-to-Right Shunt
- •5.8.1.1 Atrial Septal Defect (ASD)
- •5.8.1.2 Atrioventricular Septal Defects (AVSD)
- •5.8.1.3 Ventricular Septal Defects (VSD)
- •5.8.1.4 Patent Ductus Arteriosus of Botalli (PDA)
- •5.8.1.5 Persistent Truncus Arteriosus (Truncus Arteriosus Communis)
- •5.8.2 Obstructions of Left Ventricular Outflow
- •5.8.2.1 Aortic Valve Stenosis (AS)
- •5.8.2.2 Subaortic Stenosis (Sub AS)
- •5.8.2.3 Supravalvular Aortic Stenosis
- •5.8.2.4 Aortic Coarctation (CoA)
- •5.8.2.5 Interrupted Aortic Arch
- •5.8.3 Obstructions of the Right Ventricular Outflow
- •5.8.3.1 Isolated Pulmonary Valve Stenosis (PS)
- •5.8.3.2 Subvalvular Pulmonary Stenosis
- •5.8.3.3 Supravalvular Pulmonary Stenosis
- •5.8.4 Miscellaneous Congenital Heart Defects
- •5.8.4.1 Transposition of Great Arteries (TGA)
- •5.8.4.2 Total Anomalous Pulmonary Venous Return (TAPVR)
- •5.8.4.3 Univentricular Heart (UVH)
- •5.8.4.4 Double Outlet Right Ventricle (DORV)
- •5.8.4.5 Ebstein Anomaly
- •5.8.4.6 Cor Triatriatum
- •5.9 Acquired Paediatric Heart Diseases
- •5.9.1 Cardiomyopathies (CMP)
- •5.9.1.1 Hypertrophic CMP
- •5.9.1.2 Hypertrophic Obstructive CMP (HOCMP)
- •5.9.1.3 Dilated (Congestive) CMP
- •5.9.1.4 Restrictive CMP
- •5.9.2 Acute Myocarditis
- •5.9.3 Acute (Infective) Endocarditis
- •5.9.4 Pericarditis/Pericardial Effusion
- •5.9.5 Kawasaki Disease
- •5.9.6 Intracardiac Thrombi
- •5.9.7 Cardiac Tumours
- •5.10 Complementing Investigations
- •5.10.1 Cardiac Catherisation and Angiography
- •5.10.2 Cardiac MRI and CT
- •5.11 When to Do What
- •5.11.1 Imaging in Typical Clinical Scenarios
- •5.11.1.1 Typical Orientating Examination
- •5.11.1.2 Typical Clinical Queries
- •5.11.2 Trauma and Emergency
- •6: Ultrasound of the Chest
- •6.1 Requisites
- •6.1.1 Transducers
- •6.1.2 Positioning
- •6.1.3 Indications
- •6.1.4 How to Perform Chest US
- •6.2 Normal Findings
- •6.2.1 Chest Wall
- •6.2.2 Breast
- •6.2.3 Pleural Space
- •6.2.4 Diaphragm
- •6.2.5 Lung
- •6.2.6 Mediastinum
- •6.2.6.1 Anterior Mediastinum/Thymus
- •6.2.6.2 Middle Mediastinum
- •6.2.6.3 Posterior Mediastinum
- •6.2.7 CDS
- •6.3 Pathology of Chest Wall
- •6.3.1 Aplasia, Variations of Ribs
- •6.3.2 Congenital Malformations
- •6.3.3 Traumatic Changes
- •6.3.4 Chest Wall Tumours
- •6.3.4.1 Lymphangioma (veno-lymphatic vascular malformation)
- •6.3.4.2 Lipoma
- •6.3.4.3 Fibroma/Neurofibroma
- •6.3.4.4 Other Tumours
- •6.3.5 Breast
- •6.3.6 Role of US and Additional Imaging
- •6.4 Pathology of Pleural Space
- •6.4.1 Pleural Effusion
- •6.4.2 Empyema
- •6.4.3 Other Pleural Pathology
- •6.4.4 Role of Imaging
- •6.5 Pathology of Diaphragm
- •6.5.1 Diaphragmatic Hernia
- •6.5.2 Diaphragmatic Motion Disturbance
- •6.5.3 Role and Potential of Imaging
- •6.6 Lung Pathology
- •6.6.1 Pneumonia
- •6.6.2 Lung Abscess
- •6.6.3 Atelectasis
- •6.6.5 Sequestration
- •6.6.6 Congenital Cystic Adenomatoid Malformation (CCAM)
- •6.6.7 Cysts
- •6.6.8 Infarction
- •6.6.9 Tumours and Space-Occupying Lesions
- •6.7 Other Miscellaneous and Rare Applications
- •Many More Partially Rare Applications Reported: Most Relevant Ones
- •6.7.1 US for Interstitial Lung Disease
- •6.7.2 US for Pneumothorax
- •6.8 Additional Imaging
- •7: Liver and Bile System
- •7.1 Requisites and Investigation
- •7.1.1 Preparation
- •7.1.2 Positioning
- •7.1.3 Transducers
- •7.1.4 Course of Investigation
- •7.1.5 Standard Planes
- •7.2 Normal Findings
- •7.2.1 Structure
- •7.2.2 Ligaments
- •7.2.3 Hepatic Veins (HV)
- •7.2.4 Portal Vein (PV)
- •7.2.5 Hepatic Artery (HA)
- •7.2.6 Gall Bladder
- •7.2.8 Intrahepatic Bile Ducts
- •7.2.9 Doppler Findings
- •7.2.9.1 Hepatic Veins (HV)
- •7.2.9.2 Portal Vein (PV)
- •7.2.9.3 Hepatic Artery (HA)
- •7.2.10 Special Aspects of Newborns and Infants
- •7.3 Pathology of the Liver
- •7.3.1 Congenital Changes and Normal Variance
- •7.3.1.1 Situs Inversus (Abdominalis)
- •7.3.1.2 Butterfly or Midline Liver
- •7.3.1.3 Hypoplasia/Atrophy of Left Liver Lobe and Other Variations
- •7.3.2 Inflammatory Conditions
- •7.3.2.1 Hepatitis
- •7.3.2.2 Liver Abscess
- •7.3.2.3 Granulomatous Disease
- •7.3.2.4 Role of US
- •7.3.3 Other Parenchymal Liver Disease
- •7.3.3.1 Hepatopathy
- •Fatty Liver/Steatosis
- •Liver Congestion
- •7.3.3.2 Liver Fibrosis
- •7.3.3.3 Cirrhotic Liver
- •7.3.3.4 Liver Involvement in Systemic Disease
- •Cystic fibrosis
- •Glycogen storage disease
- •Tyrosinaemia
- •Wilson disease
- •α1-antitrypsin deficiency
- •Haemosiderosis
- •7.3.3.5 Role of US
- •7.3.4 Portal Hypertension and Vascular Problems
- •7.3.4.1 Portal Hypertension
- •7.3.4.2 Vascular Malformations
- •7.3.4.3 Portal vein and hepatic artery stenosis
- •7.3.4.5 Hepatic vein thrombosis/occlusion/stenosis
- •Budd-Chiari syndrome
- •Veno-occlusive disease (VOD)
- •Increased right atrial/intrathoracic pressure
- •7.3.4.6 Portosystemic Shunts
- •7.3.5 Liver Trauma
- •7.3.5.1 Liver Haematoma
- •7.3.5.2 Contusion
- •7.3.5.3 Laceration
- •7.3.5.4 Haemobilia
- •7.3.5.5 Associated Diaphragmatic Injury
- •7.3.5.6 Liver Infarction
- •7.3.5.7 Role of US in Liver Trauma
- •7.3.5.8 Additional Imaging
- •7.3.6 Space-Occupying Liver Lesions
- •7.3.6.1 Simple Cysts
- •7.3.6.2 Complicated Cysts
- •7.3.6.3 Liver Calcifications
- •7.3.6.4 Intrahepatic Gas
- •7.3.6.5 Haemangioma
- •7.3.6.6 Mesenchymal Hamartoma
- •7.3.6.7 Focal Nodular Hyperplasia (FNH)
- •7.3.6.8 Hepatic Adenoma
- •7.3.6.9 Fatty Tumours
- •7.3.6.10 Hepatoblastoma
- •7.3.6.11 Hepatocellular Carcinoma
- •7.3.6.12 Hepatic Sarcomas
- •Embryonal Cell Sarcoma
- •Rhabdomyosarcoma
- •Angiosarcoma
- •Hepatic Leiomyosarcoma
- •7.3.6.13 Metastasis
- •7.3.6.14 Proliferative Disorders
- •7.3.6.15 Role of US
- •7.3.6.16 Additional Imaging
- •7.4 Biliary Tract and Gall Bladder
- •7.4.1 General Findings
- •7.4.2 Congenital Conditions and Normal Variants of Biliary Tract
- •7.4.2.1 Intrahepatic Gall Bladder
- •7.4.2.3 Choledochal cyst
- •7.4.3 Biliary Tract Diseases
- •7.4.3.1 Aerobilia
- •7.4.3.2 Cholestatic Changes/Inspissated Bile/Gall \stone
- •7.4.3.3 Sclerosing cholangitis
- •7.4.3.4 Other Forms of Cholangitis and Cholecystitis
- •7.4.4 Tumour-Like Conditions
- •7.4.4.1 Polyps
- •7.4.4.2 Tumours
- •Cholangiocellular Tumours
- •Granular Cell Tumour
- •7.4.5 Role of US
- •7.4.5.1 Cholestasis and Jaundice
- •7.4.5.2 Malformations
- •7.4.5.3 Trauma
- •7.4.5.4 Postoperative Conditions
- •7.4.5.5 Metabolic Disease
- •7.4.7 Additional Imaging
- •7.5 US in Liver Transplantation
- •7.5.1 Pretransplant US
- •7.5.1.1 Recipient Evaluation
- •7.5.2 Intraoperative US
- •7.5.3 Postoperative Assessment
- •7.5.4 Typical Complications
- •8: Spleen and Pancreas
- •8.1 Spleen
- •8.1.1 Requisites
- •8.1.2 Positioning
- •8.1.3 Indications
- •8.1.4 Course of Investigation
- •8.1.5 Normal Anatomy
- •8.1.6 Normal Variants
- •8.1.6.1 Splenunculus (Accessory Spleen)
- •8.1.6.2 Splenic Lobulations and Clefts
- •8.1.7 Malformations
- •8.1.7.1 Asplenia
- •8.1.7.2 Polysplenia Syndrome
- •8.1.7.3 Wandering Spleen
- •8.1.8 Splenomegaly
- •8.1.9 Trauma
- •8.1.10 Splenic Infarction
- •8.1.11 Space-Occupying Lesions of the Spleen
- •8.1.11.1 Cysts
- •8.1.11.2 Abscess
- •8.1.11.3 Tumours and Space-Occupying Lesions
- •8.1.11.4 Role of US
- •8.2 Pancreas
- •8.2.1 Requisites
- •8.2.2 Indication
- •8.2.3 Course of Investigation
- •8.2.4 Normal Findings
- •8.2.5 Variations and Malformations
- •8.2.5.1 Annular Pancreas
- •8.2.5.2 Pancreas Divisum
- •8.2.6 Inflammation: Pancreatitis
- •8.2.6.1 Oedematous or Reactive Pancreatitis
- •8.2.6.2 Haemorrhagic or Necrotising Pancreatitis
- •8.2.6.3 Chronic Pancreatitis
- •8.2.7 Trauma
- •8.2.8 Space-Occupying Lesions
- •8.2.8.1 Cysts/Pseudocysts
- •8.2.8.2 Tumours
- •8.2.9 Role of US
- •8.2.10 Additional Imaging
- •8.3.1 Abdominal Vessels
- •8.3.1.1 Positioning
- •8.3.1.2 Transducers
- •8.3.1.3 How to Investigate
- •8.3.1.4 US Findings
- •8.3.1.5 Important Variants and Malformations
- •8.3.2 Vascular Pathology
- •8.3.2.1 Thrombosis/Occlusion
- •8.3.2.2 Pelvic Congestion Syndrome
- •8.3.2.3 Mid-aortic Syndrome
- •8.3.2.4 Retroaortic Left Renal Vein: Nutcracker Syndrome (see Chap. 10)
- •8.3.2.6 Arteriosclerotic Changes and Aneurysms
- •8.3.2.7 Embolic Thrombus to Abdominal Aorta
- •8.3.2.8 Role of US
- •8.3.2.9 Complementing Imaging
- •8.3.3 Mesentery
- •8.3.3.1 Mesenteric (Peritoneal) Masses
- •Cyst
- •Lymphatic Vascular Malformation and Other Tumours
- •8.3.3.2 Abscesses
- •8.3.3.3 Twisted Appendices Epiploica
- •8.3.4 Mesenteric Lymph Nodes
- •8.3.5 Free Intraperitoneal Air
- •8.3.6 Free Intraperitoneal Fluid: Ascites
- •8.3.7 Retroperitoneal Soft Tissues
- •8.3.7.1 Lymph Nodes
- •8.3.7.2 Retroperitoneal Tumours
- •8.3.8 Abdominal Wall
- •9: US of the Gastrointestinal (GI) Tract
- •9.1 Stomach
- •9.1.1 Requisites
- •9.1.2 How to Investigate
- •9.1.2.1 Access
- •9.1.2.2 Functional Assessment of Bowel and Stomach
- •9.1.3 Normal Findings
- •9.1.4 Normal Variants
- •9.1.5 Malformations
- •9.1.5.1 Microgastria
- •9.1.5.2 Pyloric Atresia
- •9.1.5.3 Congenital Hiatal Hernia
- •9.1.6 Pathologic Findings
- •9.1.6.1 Gastro-Oesophageal Reflux (GOER)
- •9.1.6.2 Hypertrophic Pyloric Stenosis (HPS)
- •9.1.6.3 Other Stomach Conditions
- •Gastritis/Ulcers
- •Bezoars and Foreign Bodies
- •Hyperplastic Gastric Mucosa
- •Menetrier’s Disease: Giant Hypertrophy of Gastric Mucosa
- •Eosinophilic Gastr(oenter)itis
- •Gastric Perforation
- •Granulomatous Disease
- •Duplication Cysts
- •Teratoma
- •Focal Foveolar Hyperplasia
- •Inflammatory Pseudotumour
- •Other Benign Tumours
- •Malignant Masses
- •9.1.7 Role of US
- •9.2 Bowel
- •9.2.1 Preparation and Requisites
- •9.2.2 Course of Investigation
- •9.2.3 Normal US Findings
- •9.2.4 Pathology
- •9.2.4.1 Congenital Anomalies
- •Atresia
- •Malrotation
- •Volvulus
- •Hirschsprung Disease/Neuronal Intestinal Dysplasia (NID)
- •Duplication/Diverticula
- •Meckel’s Diverticulum
- •9.2.5 Acquired Obstructive Pathology
- •9.2.5.1 Meconium Ileus
- •9.2.5.2 Midgut Volvulus
- •9.2.5.3 Sigma Volvulus
- •9.2.5.4 Hernia
- •9.2.5.5 Intussusception
- •9.2.5.6 Tumours
- •9.2.6 Inflammatory Conditions
- •9.2.6.1 Necrotising Enterocolitis (NEC)
- •9.2.6.2 Gastroenteritis
- •9.2.6.3 Henoch-Schönlein Purpura
- •9.2.6.4 Appendicitis
- •9.2.6.5 Crohn’s Disease
- •9.2.6.6 Colitis
- •9.2.6.7 Other Inflammatory Bowel Conditions
- •9.2.6.8 Bowel Trauma
- •10: Ultrasound of the Urogenital Tract
- •10.1 Requisites
- •10.1.1 Indications
- •10.1.2 Preparation
- •10.1.3 Transducers
- •10.1.4 Positioning
- •10.1.5 How to Investigate
- •10.1.5.1 Diuretic US
- •10.2 Normal Findings
- •10.2.1 Bladder
- •10.2.2 Kidney
- •10.2.2.1 Normal Variants
- •Duplex Kidney
- •Ectopic Kidneys
- •Renal Agenesis
- •Fusion Anomalies and Other Rare Findings
- •10.3 Pathology of the Kidney
- •10.3.1 Congenital Conditions
- •10.3.1.1 Dysplasia/Hypoplasia
- •10.3.1.2 Cystic Renal Disease
- •Inherited/Congenital Cystic Disease
- •Acquired Cystic Kidney Disease
- •10.3.1.3 Alteration of Urinary Drainage
- •Hydronephrosis (HN)
- •Ureteropelvic Junction Obstruction (UPJO)
- •Uretero-Vesical Junction Obstruction (UVJO)/Obstructive Megaureter (POM/MU)
- •Posterior Urethral Valve (PUV)
- •Vesico-Ureteric Reflux (VUR)
- •Secondary Obstruction
- •10.3.2 Inflammatory Renal Parenchymal Conditions
- •10.3.2.1 Pyelitis
- •10.3.2.2 Acute Pyelonephritis (aPN)/Interstitial Nephritis
- •10.3.2.3 Necrosis and Abscess Formation
- •10.3.2.4 Scarring
- •10.3.2.5 Tuberculosis
- •10.3.2.6 Xanthogranulomatous Pyelonephritis
- •10.3.2.7 Glomerulonephritis/Nephrotic Syndrome
- •10.3.3 Vascular Conditions
- •10.3.3.1 Renal Artery Stenosis
- •10.3.3.2 Arteriovenous Fistula (AVF)
- •10.3.3.3 Infarction
- •10.3.3.4 Renal Vein Thrombosis
- •10.3.4 Nephrocalcinosis
- •10.3.5 Urolithiasis
- •10.3.6 Other Important Renal Parenchymal Disease
- •10.3.6.1 Haemolytic Uremic Syndrome (HUS)
- •10.3.6.2 Glomerulonephritis/Nephrotic Syndrome
- •10.3.6.3 Scars, Cirrhotic Kidney
- •10.3.7 Renal Failure (RF)
- •10.3.8 Renal/Urinary Tract Trauma
- •10.3.9 Renal Tumours
- •10.3.9.1 Benign Tumours
- •10.3.9.2 Pre- or Semimalignant Tumours
- •10.3.9.3 Malignant Tumours
- •10.4 Renal Biopsy and Interventions
- •10.4.1 Renal Biopsy
- •10.4.2 Drainage/Nephrostomy
- •10.4.3 Postoperative Imaging
- •10.4.3.1 After VUR Treatment
- •Cystoscopic Treatment
- •Antireflux Surgery
- •10.4.3.2 Findings After Pyeloplasty
- •10.4.3.3 After Various Interventions
- •10.5 Renal Transplant
- •10.5.1 Normal US Findings in Renal Transplant
- •10.5.2 Pathologic US Findings
- •10.6 Adrenal Glands and Pararenal Space
- •10.6.1 General Remarks
- •10.6.2 Typical Normal US Finding
- •10.6.3 Pathologic Findings
- •10.6.3.1 Adrenal Gland Haemorrhage
- •10.6.3.2 Inflammatory Condition
- •10.6.3.3 Tumours
- •Adrenal Cysts
- •Adrenal Adenoma
- •Neuroblastoma
- •Ganglioneuroma
- •Phaeochromocytoma
- •Adrenal Carcinoma
- •Role of US
- •10.7 US of Urinary Bladder
- •10.7.1 Requisites
- •10.7.2 Pathologic Findings
- •10.7.2.1 Atypical Shape (Neurogenic Bladder, “Valve Bladder”)
- •10.7.2.2 Polyps
- •10.7.2.3 Bladder Tumours
- •10.7.2.4 Calcification in/of Bladder
- •10.7.2.5 Ureterocele
- •10.7.2.6 Persisting Urachus
- •10.7.2.7 Megaureter
- •10.7.2.8 Infravesical Obstruction
- •10.7.2.9 Inflammation
- •10.7.2.10 Traumatic Changes
- •10.7.2.11 Vesico-ureteric Reflux
- •10.7.3 Paravesical Changes
- •10.7.3.1 Abscess Formations
- •10.7.3.2 Tumours of Paravesical Region
- •10.7.3.3 Cystic Perivesical Structures
- •10.7.4 Role of US
- •10.8 US of Male Genitals
- •10.8.1 US Technique
- •10.8.2 Normal Findings
- •10.8.3 Common Pathologic Findings
- •10.8.3.1 Hydrocele
- •10.8.3.2 Undescended Testes
- •10.8.3.3 Varicocele
- •10.8.3.4 Cystic Dysplasia of Rete Testis and Seminal Vesicles
- •10.8.3.6 Microlithiasis
- •10.8.4 Inflammation – Orchitis, Ependymitis
- •10.8.5 Scrotal Trauma
- •10.8.6 Torsion
- •10.8.6.1 Torsion of Appendages
- •10.8.6.2 Inguinal Hernia
- •10.8.7 Testicular Tumours
- •10.8.8 Role of US and Additional Imaging
- •10.9 Female Genitals
- •10.9.1 Indications
- •10.9.2 Requisites
- •10.9.3 Transducers
- •10.9.4 How to Perform Investigation
- •10.9.5 Normal Findings
- •10.9.5.1 Sonogenitography
- •10.9.6 Pathologic Findings
- •10.9.6.1 Congenital Malformations
- •Vaginal Septum and Duplications
- •Vaginal Atresia
- •Vaginal Fistula
- •Other Vaginal Malformations
- •Vaginal Aplasia
- •Uterine Malformations
- •Ovarian Malformations
- •10.9.6.2 Inflammatory Conditions of Female Genitalia
- •10.9.6.3 Genital Tumours and Space-Occupying Lesions
- •Cysts
- •Teratoma
- •Other Genital Tumours
- •Rhabdomyosarcoma
- •10.9.6.4 Traumatic Changes
- •Ovarian Torsion
- •Pregnancy
- •10.9.6.6 Role of US/Additional Investigations
- •11: Small Part and Hip Ultrasound
- •11.1 Hip US
- •11.1.1 General Remarks
- •11.1.2 Examination Technique
- •11.1.2.1 Hip US According to Graf
- •11.1.2.2 Modified Graf Classification (Rosendahl)
- •11.1.2.3 Hip US According to Harcke
- •11.1.3 Normal Anatomy
- •11.1.3.1 US Criteria in Graf
- •11.1.3.2 Rosendahl Modification
- •11.1.3.3 Normal Findings During Harcke Investigation
- •11.1.3.5 Hip US in Older Children
- •11.1.4 Pathologic Findings
- •11.1.4.1 Developmental Dysplasia of the Hip (DDH)
- •11.2 Other Conditions of Hip Joint
- •11.2.1 Arthritis and Inflammation of Hip Joint
- •11.2.1.1 Capsular Thickening
- •11.2.1.2 Joint Fluid/Effusion
- •11.2.1.3 Hip Osteoarthritis
- •11.2.3 Perthes Disease
- •11.3 Investigation of Bones, Joints, Tendons
- •11.3.1 Requisites and Technique
- •11.3.2 Typical Normal Findings
- •11.3.3 Pathologic Findings
- •11.3.3.1 Fracture
- •11.3.3.2 Joint Effusion
- •Simple Effusion
- •Complicated Effusion
- •11.3.3.3 Arthritis
- •11.3.3.4 Trauma
- •Haematoma
- •Rupture of Tendon
- •11.3.3.5 Cysts
- •11.3.3.6 Inflammation
- •Myositis
- •Cellulitis
- •Fasciitis
- •Tendinitis – Tendovaginitis/Synovitis
- •Osteomyelitis, Soft Tissue Abscess
- •11.3.3.7 Neoplasia
- •11.3.3.8 Foreign Bodies
- •11.3.3.9 Peripheral Nerves
- •11.4 US for Peripheral Vessels
- •11.5 US-Guided Interventions
- •Index

428
Index
Biliary tract and gall bladder (cont.)
CT/MRI , 253
ERCP/MRCP , 253
general fi ndings , 245
malformations , 252
metabolic disease , 253
postoperative conditions , 253
scintigraphy , 253
sclerosing cholangitis , 249
thickened gall bladder wall , 251
trauma , 253
tumour-like conditions
cholangiocellular tumours
granular cell tumour , 252
polyps , 251
US-guided biopsy , 253
Biologic effects, diagnostic US
mechanical effects , 17
risks
actual indices , 19
guidelines and recommendations , 18
mechanical index , 18
specifi c risk , 17–18
thermal index , 18
thermal effects , 16
Bowel
acquired obstructive pathology
hernia , 307–308
intussusception , 308–309
meconium ileus , 306–307
sigma and midgut-volvulus , 307
tumours , 310
assessment of , 302
congenital anomalies
atresia , 301–302
duplication/diverticula , 304–305
Hirschsprung disease/neuronal
intestinal dysplasia , 304
malrotation , 302–303
Meckel diverticulum , 305–306
volvulus , 303–304
indications , 6
infl ammatory
appendicitis , 313–315
colitis , 317–318
Crohn disease , 315–317
gastroenteritis , 312–313
maldigestion and malabsorption
syndrome , 318
NEC , 310–312
trauma , 319
patient preparation and position , 298–299
transducers , 298–299
ultrasound fi ndings , 300
Brain ultrasound
additional imaging
catheter angiography , 124
CT , 123
fundoscopy , 124
MRI , 124
plain fi lm , 123
cerebral calcifi cations , 122
cerebral cysts , 98–100
cerebral haemorrhage ( see Cerebral
haemorrhage)
hydrocephalus ( see Hydrocephalus)
infl ammation
postnatal , 106–107
prenatal intrauterine infections and
residuals , 105–106
ischemic encephalopathy
in brain hypoxia , 104–105
focal hypoxemia and ischemia ,
102–104
global/diffuse brain oedema , 101–102
periventricular leukencephalomalacia
(PVL) , 100–101
migration and gyration alterations and
disturbances
colpocephaly , 94
holoprosencephaly , 96–97
hydranencephaly , 97
lissencephaly , 94–95
macro/polygyria , 94–95
megalencephaly , 94–95
pachygyria , 94–95
schizencephaly , 95–96
neural tube defects
anencephaly , 92
Arnold Chiari malformation , 92–93
corpus callosum malformations , 93
Dandy-Walker malformations , 93
lipoma , 94
normal fi ndings
CDS ( see Colour Doppler sonography
(CDS))
cisterna magna , 89
mastoid access with sector transducer , 83
periventricular echogenicities ( see
Periventricular echogenicities)
transfontanellar access , 80
vascular variations , 89, 91
ventricular asymmetry , 87
ventriculomegaly , 89
phakomatoses , 98
requisites
indications for, brain US , 79
morphometry and documentation , 81–82

Index
429
patient positioning , 79
transfontanellar access , 80
transtemporal access , 78
transtemporal, transcranial, mastoid
access , 80
skull
fracture , 123
haematoma , 122
space-occupying lesions
and tumours , 123
tumours and space-occupying lesions ,
119–121
Budd-Chiari syndrome , 233
C
Cardiac tumours , 186
Cardiomyopathies , 184
Cartilaginous epiphysis , 408
Cavitation , 17
CCAM. See Congenital cystic adematoid
malformation (CCAM)
CDS. See Colour Doppler sonography (CDS)
Cellulitis , 418
Cerebral haemorrhage
CDS role , 118
in infants and older children ,
118–119
in preterm babies , 114–116
in term infants , 116–118
Cervical cyst , 146, 147
Cervical ectopic thymus , 148
Chest ultrasound
breast
mammography , 198
normal fi ndings , 191
pathology , 197
CDS, normal fi ndings of , 195
chest wall
aplasia, variations of ribs , 195
congential malformations , 195
fi broma/neurofi broma , 196
lipoma , 196
lymphangioma , 196
normal fi ndings , 191
plain fi lm, CT/MRI , 198
rhabdomyosarcoma/Ewing sarcoma ,
196, 197
traumatic changes , 195–196
diaphragm
diaphragmatic hernia , 201–202
diaphragmatic motion disturbance , 202
imaging role and value , 200–201
normal fi ndings , 191–195
indications , 190–191
lung
additional imaging , 211, 212
atelectasis , 204–205
congenital cystic adenomatoid
malformation , 207
cysts , 208
infarction , 208–209
lung abscess , 203, 204
normal fi ndings , 191–195
pneumonia , 203
respiratory distress syndrome/hyaline
membrane syndrome , 205
sequestration , 206–207
tumours and space-occupying
lesions , 200
mediastinum
anterior mediastinum/thymus , 193
middle mediastinum , 193–195
plain fi lm, CT , 198
posterior mediastinum , 195
patient positioning , 190
performance , 191
pleural space
empyema , 198, 199
imaging role and value , 200–201
normal fi ndings , 192
pleural effusion , 198, 199
pleural thickening , 199
tumours , 200
US transducers , 190
Choledochal cyst , 247–248
Chronic pancreatitis , 272
Cirrhotic liver , 227–228
Cisterna magna , 89
Colour Doppler sonography (CDS)
application and restriction , 31
artefacts
aliasing , 34, 35
angle correction , 35
fi ltering artefacts , 35
gain-induced errors , 35
motion artefact , 35
sample volume artefact , 34
scaling problem , 35
spectral broadening , 34
twinkling artefact , 36
arterial fl ow velocities , 85–86
equipment setting and transducer
handling , 37
in neonates , 86
older neonates and infants , 86
in preterms , 87
principle , 30–31

430
Index
Colour Doppler sonography (CDS) (cont.)
transfontanellar , 84, 85
transtemporal , 84, 86
venous system , 84–86
Congenital cystic adematoid malformation
(CCAM) , 206, 207
Congenital heart defect
atrial septal defect , 173–174
atrioventricular septal defects , 173–175
cor triatriatum , 184
double outlet right ventricle , 183
Ebstein anomaly , 183–184
patent ductus arteriosus of Botalli ,
176–177
persistent truncus arteriosus , 177
total anomalous pulmonary venous
return , 181–182
transposition of great arteries ,
181–182
univentricular heart , 183
ventricular septal defect , 174–175
Congenital hiatal hernia , 292
Congential malformations , 195
Contrast-enhanced US
approach , 43–44
basics , 42–43
contrast-enhanced voiding urosonography
basics , 44–45
restriction , 46
technique , 44–45
future development , 51
intravenous ce-US , 47–50
sono-genitography , 46–47
sonographic pyelography , 46–47
Contrast enhanced voiding urosonography
(ce-VUS) , 44–47
benefi ts and limitations , 66–67
bladder and ureter , 66
diagnosis , 66
indications , 64
male urethra , 67
renal appearance , 67
Contusion , 236
Corpus callosum malformations , 93
Crohn disease , 315–317
Cross-beam imaging. See Sono-CT
Cystic dysplasia , 380–381
Cystic fi brosis , 229
Cystic hygroma , 156
Cystic kidneys
acquired cystic kidney disease , 334
complicated cyst(s) , 332
inherited/congenital cystic disease ,
332–334
multicystic dysplastic kidney , 333
multiple cysts , 332
simple cyst , 332
Cysts, lung , 208
D
Dandy-Walker malformations , 93
Dermoid cyst , 146
Developmental hip dysplasia (DDH)
Graf classifi cation
decentered hip , 405, 406
immaturity , 405
luxated hip , 406
normal hip , 404–405
Harcke classifi cation , 407
Diaphragmatic hernia , 201, 202
Diaphragmatic motion disturbance , 202
Dilating (congestive) cardiomyopathy , 184
Doppler sonography , 11
amplitude-coded colour Doppler
sonography , 31–32
colour-coded/colour Doppler sonography
( see Colour Doppler sonography)
continuous wave Doppler (CW) ,
28, 29
Doppler phenomenon , 27–28
duplex-Doppler sonography , 29–30
fl ow-sensitive US technique , 32–33
interpretation , 37–38
limitations , 37
parameters and measurements , 33–34
pulsed wave Doppler (PW) , 28–29
Double outlet right ventricle (DORV) , 183
Duplication cyst , 146–147
E
Embryonal cell sarcoma , 244
Empyema , 198–199
Epiphysiolysis , 408–409
Extended fi eld of view US , 39–40
Eye and orbit ultrasound
normal fi ndings , 124–125
pathology
foreign bodies , 125
papilla congestion , 124
retinal displacement , 125
tumours , 126
F
Fasciitis , 418, 419
Fatty liver/steatosis , 225–226

Index
431
Female genital ultrasound
congenital malformations
cystic change , 390
ovarian malformations , 391
uterine duplication , 389, 391
vaginal aplasia , 390
vaginal atresia , 389
vaginal fi stula , 389–390
vaginal septum and duplications , 388
genital tumours and space-occupying
lesions
cysts , 392–393
ovarian childhood tumours , 393
rhabdomyosarcoma , 393
teratoma , 392–393
indications , 385
infl ammatory conditions , 391–392
investigation procedures , 386
normal fi ndings
developmental stages , 386, 387
neonatal cystic ovary , 387, 388
sonogenitography , 388
ovarian torsion , 394–395
pregnancy , 395
requisites , 386
transducers , 386
traumatic changes , 394
Fibroma/neurofi broma , 196
Focal foveolar hyperplasia , 5
Focal nodular hyperplasia (FNH) , 241–242
Four-dimensional US (4DUS). See also
Three-dimensional US (3DUS)
benefi ts , 55, 56
physics and technique , 50–51
restriction , 56
Fracture
calcifi cation , 412
in reparative phases , 412
skull , 122
subperiosteal haematoma , 413
G
Gastritis , 4
Gastroenteritis , 13
Gastrointestinal (GI) tract
bowel ( see Bowel)
stomach ( see Stomach)
Gastro-oesophageal refl ux (GOER) , 292–294
Glomerulonephritis , 347–348
Glycogen storage disease , 229
GOER. See Gastro-oesophageal refl ux
(GOER)
Granulomatous disease , 146, 147, 225
H
Haemangioma , 148–149, 239–241
Haematoma , 151–152
Haemolytic uremic syndrome (HUS) , 354
Haemorrhagic pancreatitis ,
271–272
Haemosiderosis , 229–230
Harmonic imaging (HI) , 39, 40
Hepatic adenoma , 242
Hepatic leiomyosarcoma , 244
Hepatic sarcomas , 244
Hepatoblastoma , 242–243
Hepatocellular carcinoma , 243
Hernia , 10–11
High-resolution US (HR-US) , 39
Hip joint
arthritis and infl ammation , 407
ephysiolysis , 408–409
normal fi ndings , 411, 412
Perthes disease , 409
US requisites and technique ,
410, 411
Hip ultrasound
bones, joints, tendons
arthritis , 407
cysts , 417
foreign bodies , 422, 424
fracture , 410
indications , 410–411
infl ammation , 417–420
joint effusion , 413–414
neoplasia ( see Neoplasia)
normal fi ndings , 411, 412
peripheral nerves , 422–424
transducers , 410
trauma , 415–417
DDH ( see Developmental hip dysplasia)
device presets , 398
epiphysiolysis , 408
Graf technique
coronal selection, lateral assessment , 399
documentation , 400
dynamic assessment , 399
normal anatomy , 402–404
pathology , 404–407
guidelines , 424–425
Harcke technique , 400, 401
indications , 398
Morin-Terjesen technique
anatomy , 402
degree of lateralisation assessment , 401
pathology , 404–407
in older children , 403–404
patient positioning , 398

432
Index
Hip ultrasound (cont.)
Rosendahl modifi cation
anatomy , 402, 403
objective , 400
transducers , 398
US-guided interventions , 424–426
Hirschsprung disease , 9
HPS. See Hypertrophic pyloric stenosis (HPS)
Hyaline membrane syndrome , 205
Hydrocele , 378–379
Hydrocephalus
causes of , 108
CDS role , 110–111
Doppler in , 111
epidural/subdural differentiation , 109–110
extracranial partition , 112
shunt , 112
task of US , 108
US appearance
aqueductal stenosis , 109, 110
dilated extra-axial CSF space , 108
fourth ventricle obstruction , 109, 110
Hydronephrosis (HN) , 335
Hyperplastic gastric mucosa , 4
Hypertrophic cardiomyopathy , 184
Hypertrophic obstructive cardiomyopathy , 185
Hypertrophic pyloric stenosis (HPS) , 3–4
Hypodysplastic kidney , 331
I
Image compounding , 39
Image documentation , 25–26
Infarction, lung , 208–210
Intracardiac thrombi , 186
Intrahepatic gas , 238–239
K
Kawasaki disease , 185
Kidney ultrasound
adrenal glands ( see Adrenal glands)
biopsy
after VUR treatment , 361
balloon dilatation , 363
drainage/nephrostomy , 360–361
extracorporeal lithotripsy (ESWL) , 363
fi ndings after pyeloplasty , 362–363
post-biopsy , 360
pre-interventional , 359
prone position , 360
infl ammatory renal parenchyma
acute pyelonephritis (aPN)/interstitial
nephritis , 345
glomerulonephritis/nephrotic
syndrome , 347–348
necrosis and abscess formation ,
345, 346
pyelitis , 344, 345
scarring , 346
tuberculosis , 346
xanthogranulomatous pyelonephritis , 347
normal fi ndings , 324–330
normal variants
bladder anomalies , 330
cross-fused dystopia , 330
duplex , 328, 329
ectopic , 328, 329
horseshoe kidney , 330
renal agenesis , 329
retro-aortal left renal vein , 328
parenchymal appearance , 325–327
parenchymal disease
HUS , 354
nephrotic syndrome , 354
scars, cirrhotic kidney , 354–355
pathology
cystic renal disease ( see Cystic
kidneys)
dysplasia/hypoplasia , 330–331
hydronephrosis (HN) , 335
posterior urethral valve (PUV) ,
339–340
secondary obstruction , 343–344
UPJO , 335–338
uretero-vesical junction obstruction
(UVJO)/obstructive megaureter
(POM/MU) , 338–339
vesico-ureteric refl ux (VUR) ,
339, 341
renal failure , 375
renal/urinary tract trauma , 355–357
transplantation
normal fi ndings , 363, 364
pathologic fi ndings , 364–365
tumours
benign , 357
malignant , 357–359
pre/semimalignant , 357
urinary bladder ( see Urinary bladder
ultrasound)
vascular conditions
AVF , 350
infarction , 350–351
neprocalcinosis , 352–353
renal artery stenosis , 348–350
renal vein thrombosis , 351–352
urolithiasis , 353–354

Index
433
L
Laceration , 234
Lipoma , 196
Liver abscess , 223–225
Liver calcifi cations , 238
Liver congestion , 226–227
Liver fi brosis , 227
Liver haematoma , 235
Liver ultrasound
Abernethy malformation , 233
biliary tract and gall bladder ( see Biliary
tract and gall bladder)
congenital changes and normal variance
butterfl y/midline liver , 222
hypoplasia/atrophy , 222
situs inversus , 222
Doppler fi ndings
hepatic artery (HA) , 219–220
hepatic veins (HV) , 219, 220
portal vein (PV) , 219, 221
hepatic vein thrombosis/occlusion/
stenosis , 233
infl ammatory conditions
granulomatous disease , 225
hepatitis , 223
liver abscess , 223–225
normal fi ndings , 216–222
gall bladder , 218, 219
hepatic artery (HA) , 218
hepatic veins (HV) , 217
hepato-choledochal duct , 218–219
intrahepatic bile ducts , 219
ligaments , 217
portal vein (PV) , 217–218
size , 216
parenchymal liver disease
cirrhotic liver , 227–228
hepatopathy , 225–227
liver fi brosis , 227
in systemic disease , 229–230
portal hypertension , 230–231
portal vein and hepatic artery stenosis , 232
portosystemic shunts , 234
requisites and investigation
course of investigation , 215
fasting , 214
standard liver measurements , 216
supine position , 214
transducers , 214–215
space occupying liver lesions , 237–245
angiomyolipoma , 242
complicated cysts , 237–238
focal nodular hyperplasia (FNH) ,
241–242
haemangioma , 239–241
hepatic adenoma , 242
hepatic sarcomas , 244
hepatoblastoma , 242–243
hepatocellular carcinoma , 243
intrahepatic gas , 238–239
liver calcifi cations , 238
mesenchymal hamartoma , 241
metastasis , 244
proliferative disorders , 244
simple cysts , 237, 238
standard liver measurements , 215, 216
transplantation
complications , 255
donor US , 254
intraoperative , 254
postoperative assessment , 254
recipient evaluation , 254
trauma ( see Trauma)
ultrasound transplantation , 254–255
vascular malformations , 232
Lung abscess , 203, 204
Lung sequestration , 206–207
Lymphangioma , 196
Lymphatic malformation , 148–149, 281–282
M
Male genital ultrasound
normal fi ndings , 378
orchitis/ependymitis , 381–383
pathologic fi ndings
cystic dysplasia , 380–381
ependidymal cysts , 381
hydrocele , 378, 380
microlithiasis , 381, 382
spermatocele , 381
testicular and paratesticular cysts , 381
undescended testes , 379
varicocele , 379–380
penile , 378
prostate/seminal vesicle , 377
scintigraphy and MRI , 385
scortum/testis , 377
scrotal trauma , 383
testicular tumours , 384–385
torsion
inguinal hernia , 384
testicular and hydatid torsion , 384
torsion of appendages , 384
Malrotation , 302
Meconium ileus , 306–307
Menetrier disease , 296
Mesenchymal hamartoma , 241

434
Index
Mesenchymal tumours , 149
Mesenteric cystic formation , 281
Mesenteric lymph nodes , 282, 284
Microgastria , 292
Micturition urosonography , 44
Mid-aortic syndrome , 279
(T) M-mode (time-motion-mode) , 9–10
Myositis , 418
N
NEC. See Necrotizing enterocolitis (NEC)
Neck ultrasound
cervical soft tissues
abscess formation , 150, 151
malformations , 146
normal fi ndings , 144
traumatic changes , 151–152
tumours , 148–150
cervical vessels
arteriosclerosis , 158
dissection , 158
examination , 139–140
normal fi ndings , 144–145
stenosis , 158–159
thrombosis and occlusion , 161
vascular anomalies , 159–160
glands
examination , 138
salivary gland (parotid, submandibular
and sublingual glands) ( see Salivary
gland)
thyroid gland ( see Thyroid gland)
intervention , 140
lymph nodes
enlarged nodes , 146
examination , 138
infl ammation , 146
normal fi ndings , 140–141
patient positioning and handling , 138
transducer , 138
Necrosis , 345, 347
Necrotising pancreatitis. See Haemorrhagic
pancreatitis
Necrotizing enterocolitis (NEC) , 310–311
Neoplasia
bone tumours , 420
cartilaginous tumours , 421
echogenic foreign body , 424
haemangioma/vascular malformation , 422
lymphoma/metastasis , 422
osteosarcoma , 422
ultrasound appearance , 421
Nephrotic syndrome. See Glomerulonephritis
Neprocalcinosis , 352–353
Neuroblastoma, neuroma, neurofi broma and
nerve sheath tumours , 150
Neuronal intestinal dysplasia , 304
Nutcracker syndrome , 280
O
Oedematous pancreatitis , 271, 272
Osteomyelitis , 420
P
Paediatric echocardiography
acquired paediatric heart disease
acute (infective) endocarditis , 184
acute myocarditis , 184
cardiac tumours , 186
cardiomyopathies , 184
intracardiac thrombi , 186
Kawasaki disease , 185
pericarditis/pericardial effusion , 185
apical views , 167–169
catherisation and angiography , 186–187
clinical queries , 187
congenital heart defect ( see Congenital
heart defect)
functional parameter
LV systolic function , 171
systolic function , 171
TAPSE , 171
left ventricular outfl ow obstruction
aortic coarctation , 178, 179
aortic valve stenosis , 177, 178
interrupted aortic arch , 178
subaortic stenosis , 177
supravalvular aortic stenosis , 178
MRI and CT , 187
normal values , 172–173
orientating examination , 187
parasternal views
parasternal long axis view , 166–167
parasternal short axis view , 167
patient positioning , 165
right ventricular outfl ow obstruction
isolated pulmonary valve stenosis , 179
subvalvular pulmonary stenosis , 179
supravalvular pulmonary stenosis , 179
TOF and pulmonary atresia ,
180–181
sedation , 165
standardised examination , 166

Index
435
standard planes , 165–166
standard US technique , 165
subcostal views
sagittal subcostal view , 169
subcostal four-chamber view ,
169, 170
suprasternal view , 169–170
techniques
contrast enhanced US , 172
Doppler sonography , 171
M (motion)-mode echocardiography ,
170–171
three-dimensional (3D)
echocardiography , 172
tissue Doppler imaging , 172
transesophageal echocardiography , 172
transducers , 165
trauma and emergency , 188
Paediatric ultrasound. See also Paediatric
echocardiography
device handling , 21–22
measurement
organ size , 24–25
remarks , 23–24
transducer handling , 23
patient positioning , 20–21
requisites
environmental requisites , 19
indications , 19
specifi c needs , 20
three-dimensional US ( see Three-
dimensional US (3DUS))
transducer
abdominal US , 23
chest US , 22–23
neurosonography , 22
small part US , 22
Pancreas divisum , 270
Pancreas ultrasound
indication , 268
investigation course , 268–269
normal fi ndings , 269–270
pancreatitis
chronic , 272
haemorrhagic/necrotising , 271
oedematous/reactive pancreatitis , 271
requisites , 268
space-occupying lesions
CT , 275
cysts/pseudocysts , 274
ERCP , 275
scintigraphy/PET , 275
tumours , 274–275
trauma , 272–274
variations and malformations
annular pancreas , 270
pancreas divisum , 270
Patent ductus arteriosus (PDA) , 176–177
Pelvic congestion syndrome , 278–279
Pericarditis/pericardial effusion , 185, 186
Periventricular echogenicities
embryologic cavities , 87, 90
in preterm infants , 87, 89
Persistent truncus arteriosus , 177
Perthes disease , 409
Pleural effusion , 198, 199
Pleural thickening , 199
Pneumonia , 203
Polysplenia syndrome , 261
Pulmonary atresia (PA) , 180–181
Pulsed wave Doppler (PW) imaging , 28–29
Pyelitis , 344, 345
Pyloric atresia , 292
R
RDS. See Respiratory distress syndrome
(RDS)
Reactive pancreatitis. See Oedematous
pancreatitis
Renal artery stenosis , 348–349
Renal infarction , 350–351
Renal vein thrombosis , 351–352
Report
diagnosis , 26
issue , 26
nomenclature , 27
predefi ned reports , 27
Respiratory distress syndrome (RDS) ,
205–206
Restrictive cardiomyopathy , 184
Retroperitoneal tumours , 287
Retroperitoneum ultrasound
abdominal vessels
investigation , 276
patient positioning , 276
transducers , 276
US fi ndings , 276, 278
variants and malformations , 277–278
abdominal wall , 288
free intraperitoneal air , 283, 284
free intraperitoneal fl uid, ascites , 283–284
mesentery
abscesses , 282–283
cyst , 281–282
lymphatic malformation , 282

436
Index
Retroperitoneum ultrasound (cont.)
lymph nodes , 283, 284
mesenteric (peritoneal) masses ,
281–282
twisted appendices epiploica , 283
soft tissues
lymph nodes , 287
tumours , 287–288
vascular pathology
arteriosclerotic changes and aneurysms ,
280
complementing imaging , 281
embolic thrombus , 280–281
mid-aortic syndrome , 279
nutcracker/SMA syndrome , 280
pelvic congestion syndrome , 278–279
thrombosis/occlusion , 278
US role , 281
Rhabdomyosarcoma , 150, 196, 197, 244, 393
S
Salivary gland
calcifi cations/sialolithiasis , 156
cysts , 156
infl ammation , 155–156
normal fi ndings , 143, 144
tumours , 156
SMA syndrome. See Nutcracker syndrome
Sono-CT , 39
Sonoelastography , 41–42
Spinal canal ultrasound
additional imaging , 135–136
disc pathology , 135
indications , 127
infl ammatory changes , 135
normal fi ndings , 128–130
osteomyelitis , 135
paravertebral structures , 135
pathologic fi ndings
dermal sinus tract , 133
diastematomyelia , 133
dural lipoma , 131, 132
dysraphism , 130–132
fi lum termiale , 132, 134
hydromyelia , 132
periosteal/subperiosteal changes , 135
requisites , 127
transducers and technique , 127
trauma , 134
tumours , 134–135
Spleen ultrasound
indications , 258
investigation course , 258–259
malformations , 260–261
normal anatomy , 259–260
normal variants , 260
patient positioning , 258
requisites , 258
space-occupying lesions
abscess , 266–267
cysts , 265–266
tumours , 267
splenic infarction , 264–265
splenomegaly , 261, 262
trauma , 261–264
Splenic infarction , 264–265
Splenic lobulations , 260
Splenomegaly , 261, 262
Splenunculus (accessory spleen) , 260
Stomach
assessment of , 293
bezoars and foreign bodies , 296
bowel, functional assessment ,
290–291
duplication cysts , 296–297
eosinophilic gastr(oenter)itis , 296
focal foveolar hyperplasia , 297
gastric perforation , 296
gastritis/ulcers , 295
GOER , 292–293
granulomatous disease , 296
HPS , 293–295
hyperplastic gastric mucosa , 296
indications , 289
infl ammatory pseudotumour , 297
malformation , 292
malignant masses , 297
Menetrier disease , 296
myofi broma and polyps , 297
patient preparation and position , 289
teratoma , 297
transducers , 290
ultrasound appearance of , 291, 297
Synovitis. See Tendinitis-tendovaginitis
T
Tendinitis-tendovaginitis , 419–420
Teratoma , 5, 150
Tetralogy of Fallot (TOF) , 180–181
Three-dimensional US (3DUS)
benefi ts , 55, 56
paediatric 3DUS
cardiac US , 54, 55
female genitalia , 54
future development , 57
kidney , 51–53

Index
437
musculoskeleton , 54
neonatal neurosonography , 51
small part imaging , 54–55
urinary bladder , 53–54
physics and technique , 50–51
restriction , 56
Thrombosis and occlusion , 161, 278
Thymic cyst , 148
Thyroid gland
adenoma/carcinoma , 155
amyloid goitre , 155
cystic changes , 152
hypothyroidism , 153
infl ammation , 155–156
malformation , 152, 153
nodular goitre , 154–155
normal fi ndings , 140–143
Tissue heating , 16
Total anomalous pulmonary venous return
(TAPVR) , 181–182
Transposition of great arteries (TGA) ,
181, 182
Trauma
cervical soft tissues , 151–152
chest wall , 196
female genitals , 393
kidney ultrasound , 355–357
liver
contusion , 236
haematoma , 235
haemobilia , 236
herniation , 236
injury grading system , 234
laceration , 234
liver infarction , 236
pancreatic injury
grading , 273
laceration , 274
scrotal , 383
spleen injury
grading system , 234
haematoma , 263
posttraumatic AVF , 264
urinary bladder , 376
urinary tract , 356, 357
Tricuspid annular plane systolic excursion
(TAPSE) , 171
Tuberculosis , 347
Tumours
adrenal adenoma , 367
adrenal cysts , 367
bladder tumours , 372–373
carcinoma , 200, 369
cardiac tumours , 186
cholangiocellular tumours , 251–252
cysts , 392
ganglioneuroma , 366, 369
granular cell tumour , 252
lung , 210
neuroblastoma , 368–369
ovarian childhood tumours ,
392, 393
phaeochromocytoma , 369
pleural space , 200
polyps , 251
retroperitoneum , 287–288
rhabdomyosarcoma , 393
salivary gland , 156
spinal canal , 134
teratoma , 392–393
testicular tumours , 384–385
Twisted appendices epiploica , 283
Tyrosinaemia , 229
U
Ulcers , 295
Ultrasound (US) device
amplifi cation , 4
cooling device with fi lters , 9
emission , 4
gel bottle warming device and transducer
stands , 9
input/output options , 9
keypad and monitor , 9
printer/CD player , 9
reception , 4
signal processing
frame rate/persistence , 6
gain , 6
post-processing , 5
preprocessing , 5
sound energy , 5–6
time gain compensation (TGC) , 5
transducer
curved linear array , 8
intracavitary probes , 9
linear array transducers , 8
matrix 1.5-/2-dimensional array , 8–9
sector transducers , 7–8
transmission , 4
Ultrasound guided interventions
biopsy
after procedure , 70
liver , 69
procedure , 69–71
renal , 69, 71
splenic , 70
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