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Pediatric Ultrasound
Requisites and Applications
Michael Riccabona
Editor
Second Edition
123
Pediatric Ultrasound
Editor
Pediatric Ultrasound
Requisites andApplications
Second Edition
Editor
Michael Riccabona Department of Radiology, Division of Pediatric Radiology Medical University Graz and University Hospital Graz Graz Austria
ISBN 978-3-030-47909-1 ISBN 978-3-030-47910-7 (eBook)
https://doi.org/10.1007/978-3-030-47910-7
© Springer Nature Switzerland AG 2014, 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface for the Second Edition

It is a couple of years that the rst edition has been published. Since then, there have been new developments in ultrasound that also affected paediatric practice; further­more, point-of-care ultrasound (POCUS) has enormously expanded with nearly all specialties performing focused US exams trying to improve their clinical practice.
With this development, the overall expenditure for clinical US has grown remark­ably—in some countries, US is becoming the most expensive imaging modality in terms of total costs to the health care system, simply because so many exams are done. In paediatrics, nearly every ofce has at least a small US device which is used not just for the “traditional” standard indications such as screening but also increas­ingly to improve initial diagnosis trying to streamline further work-up and patient management.
In the light of these developments, the new edition has been restructured and a dedicated chapter on POCUS has been added. All the chapters have been revised and new aspects have been included, particularly remarks on respective and/or new applications of POCUS, US-elastography, and contrast-enhanced US have been addressed. Furthermore, as POCUS often addresses small parts or nerves and not just abdominal queries, these chapters have been redone and a dedicated chapter on US of peripheral nerves has been added. Finally, the new lung US applications have been introduced and illustrated as well.
So I and my (co-)authors hope that this new edition will serve as helpful as the rst edition, still maintaining the same format as a relatively small but comprehen­sive booklet also accessible in electronic format. Reecting the size of the book, more detailed information on some special issues will have nevertheless to be retrieved from established textbooks on paediatric US and paediatric radiology. Again, I want to thank Springer for enabling this new edition, my colleagues at work for their input and suggestions, the work and input and images from my co­authors, and my wife Barbara for her patience and support. I hope that the readers will nd this booklet helpful for their daily needs and it will contribute to improve dedicated paediatric US for all children in need.
Graz, Austria MichaelRiccabona March 2020
v

Acknowledgements

I want to thank my (co-authors) Prof. Brian Coley (Cincinnati, USA) and Dr. Gerolf Schweintzger (Leoben, Austria) for providing additional and new images for the various chapters and especially Prof. Brian Coley for checking my English and edit­ing the booklet for proper use of English language.
vii

Contents

Part I Basics/Theory/Methods
1 US Physics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Michael Riccabona
2 US Methods, Artefacts, Biologic Effects, Practice . . . . . . . . . . . . . . . . . 17
Michael Riccabona
3 (Color) Doppler US: Theory, Artefacts, Typical Applications
in Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Michael Riccabona
4 Contrast-Enhanced US, and Ultrasound Elastography
in Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
M. Riccabona and H. J. Mentzel
5 Paediatric Limited Field of View US/Point of Care US
(POCUS) and Emergency US: When, How and for What . . . . . . . . . . 77
Michael Riccabona, Gerolf Schweintzger, and Brian Coley
Part II Diagnostic Flow Charts, Imaging Algorithms, and Graphs
6 Imaging and Imaging Algorithms for Common Queries
in Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Michael Riccabona
7 Measurements and Volume Calculations: Basic
Considerations, Graphs and Illustrations for Standardisation . . . . . . 103
Michael Riccabona
Part III US Investigations of the Various Organs
8 Neurosonography in Neonates, Infants and Children . . . . . . . . . . . . . . 113
Michael Riccabona
9 US of the Neonatal Spinal Canal and Cord . . . . . . . . . . . . . . . . . . . . . . 167
Michael Riccabona
10 Ultrasound of the Neck in Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Michael Riccabona
ix
x
Contents
11 Basics of Paediatric Echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . 205
Martin Köstenberger, Andreas Gamillscheg, and Michael Riccabona
12 Ultrasound of the Chest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Michael Riccabona
13 Upper Abdominal US in Neonates, Infants and Children:
(Excluding the Kidneys) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Michael Riccabona
14 US of the Gastrointestinal (GI) Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Michael Riccabona
15 Ultrasound of the Urogenital Tract in Neonates, Infants,
and Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
Michael Riccabona
16 Neonatal and Paediatric Hip US . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Gerolf Schweintzger, Brian Coley, and Michael Riccabona
17 Musculoskeletal and Other Small Part US in Childhood . . . . . . . . . . . 487
Michael Riccabona, Gerolf Schweintzger, and Brian Coley
18 US of Peripheral Nerves in Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Jörg Jüngert and Michael Riccabona
Part IV Miscellaneous
19 US-Guided Interventions and Invasive US Procedures
and Respective Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
Brian Coley, Gerolf Schweintzger, and Michael Riccabona
20 Normal Values as Relevant for Paediatric US . . . . . . . . . . . . . . . . . . . . 543
Michael Riccabona, Brian Coley, Martin Köstenberger, Hans- Joachim Mentzel, and Gerolf Schweintzger
Part I
Basics/Theory/Methods

US Physics

MichaelRiccabona

1.1 US Waves

Definition
• Mechanical waves, usually created by electric current applied to piezoelectric
crystal in transducer, used to emit sound waves and receive reected echoes.
• Frequencies used in diagnostic medicine range from 1 to 20MHz.
Sound Velocity
• Depends on material; the higher the density, the higher the sound velocity.
• In air, sound velocity is approximately 330m/s; average sound velocity of human
(soft) tissue=1540m/s.
• Some new devices allow for choosing the respective sound speed, used, e.g., for
tissue analysis/fat quantication.
1
1.2 Propagation andModulation ofUS
US energy emitted into tissue is handled differently between different tissue layers: modulated, partially absorbed, partially transmitted and reected on border of dif­ferent tissue.
The most important principles for propagation phenomena:
M. Riccabona (*) Department of Radiology, Division of Pediatric Radiology, Medical University Graz and University Hospital Graz, Graz, Austria e-mail: michael.riccabona@medunigraz.at
© Springer Nature Switzerland AG 2020 M. Riccabona (ed.), Pediatric Ultrasound,
https://doi.org/10.1007/978-3-030-47910-7_1
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