Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
This page intentionally left blankThis page intentionally left blank
10
UPPER ABDOMEN
Annamaria Deganello, Maria E. Sellars,
and Paul S. Sidhu
Liver (pediatric) 238
Gallbladder (neonatal) 240
Gallbladder (pediatric) 242
Common bile duct (pediatric) 246
Spleen (pediatric) 248
Pancreas (pediatric) 252
Adrenal glands (neonatal) 254
Adrenal glands (infant) 258
Pyloric stenosis 260
Upper abdomen
238
Liver (pediatric)
PREPARATION
None.
POSITION
Supine, right anterior oblique positions to demonstrate the porta hepatis.
TRANSDUCER
4.0–9.0 MHz curvilinear transducer.
METHOD
Longitudinal images of the right lobe are taken in the midclavicular
and midline positions. The length of the liver is measured from the
uppermost portion of the dome of the diaphragm to the inferior tip.
APPEARANCE
Uniform pattern of medium-strength echoes.
MEASUREMENTS
Length of right lobe of liver versus age
Age range (months)
Mean ± SD (mm)
1–3 64 ± 10.4
4–6 73 ± 10.8
7–9 79 ± 8.0
12–30 85 ± 10.0
36–59 86 ± 11.8
60–83 100 ± 13.6
84–107 105 ± 10.6
108–131 105 ± 12.5
132–155 115 ± 14.0
156–179 118 ± 14.6
180–200 121 ± 11.7
Liver (pediatric)
The length of the right lobe of the liver is obtained in the longitudinal plane in the
midclavicular line (cursors).
Length of right lobe of liver versus body weight
Weight (kg)
Mean ± SD (mm)
239
20 105 ± 14
30 112 ± 13
40 116 ± 12
50 119 ± 15
60 123 ± 14
FURTHER READING
Konus OL, Ozdemir A, Akkaya A, Erbas G, Celik H, Isik S. Normal
liver, spleen, and kidney dimensions in neonates, infants, and
children: Evaluation with sonography. AJR Am J Roentgenol.
1998; 171:1693–1698.
Safak AA, Simsek E, Bahcebasi T. Sonographic assessment of the
normal limits and percentile curves of liver, spleen, and kidney
dimensions in healthy school-aged children. J Ultrasound Med.
2005; 24:1359–1364.
Upper abdomen
240
Gallbladder (neonatal)
PREPARATION
Patient should fast prior to the examination.
POSITION
The gallbladder is initially examined in the supine position and may be
turned to right anterior oblique position.
TRANSDUCER
8.0–14.0 MHz linear transducer.
METHOD
Longitudinal and transverse images are obtained from a subcostal or
intercostal approach on deep inspiration in the supine and right anterior oblique positions.
APPEARANCE
On a longitudinal image the gallbladder appears as an echo-free, pearshaped structure. The gallbladder wall is smooth and is seen as a line
of high reectivity.
Longitudinal image through the gallbladder with length and depth measurements in a
2-week-old child (between cursors).
Gallbladder (neonatal)
Transverse image from a subcostal approach on deep inspiration demonstrating the
measurement of width in a 2-week-old child (between cursors).
MEASUREMENTS
241
Newborn Length Width
30–32 mm 1/3 of length
FURTHER READING
Carroll BA, Oppenheimer DA, Muller HH. High-frequency real-
time ultrasound of the neonatal biliary system. Radiology. 1982;
145:437– 440.
Upper abdomen
242
Gallbladder (pediatric)
PREPARATION
Younger patients should fast for 3 hours; older children should fast for
6–8 hours prior to the examination.
POSITION
The gallbladder is initially examined in the supine position, and then
the patient is turned to right anterior oblique position.
TRANSDUCER
4.0–6.0 MHz curvilinear transducer.
METHOD
Longitudinal and transverse images are obtained from a subcostal or
intercostal approach in the supine and right anterior oblique positions.
APPEARANCE
On a longitudinal image the gallbladder appears as an echo-free,
pear-shaped structure.
MEASUREMENTS
Length
Age (years)
<1 3.3 (± 0.8) 0.9 (± 0.4) 1.8 (± 1.7)
1 4.2 (± 0.6) 1.4 (± 0.3) 4.6 (± 2.6)
2 4.5 (± 0.6) 1.5 (± 0.3) 5.9 (± 2.4)
3 4.3 (± 0.6) 1.5 (± 0.2) 4.9 (± 1.7)
4 4.7 (± 1.3) 1.5 (± 0.3) 5.9 (± 2.6)
5 5.0 (± 1.0) 1.7 (± 0.4) 7.8 (± 4.8)
6 4.9 (± 1.0) 1.6 (± 0.3) 7.0 (± 3.6)
7 5.1 (± 0.9) 1.6 (± 0.4) 7.2 (± 3.8)
8 5.3 (± 1.0) 1.7 (± 0.4) 8.5 (± 4.8)
9 5.5 (± 1.0) 1.8 (± 0.5) 10.0 (± 5.9)
10 5.6 (± 0.8) 1.9 (± 0.4) 11.5 (± 5.3)
11 6.0 (± 1.0) 1.9 (± 0.4) 12.6 (± 6.6)
Mean ± SD (cm)
Width
Mean ± SD (cm)
Mean ± SD (cc)
Volume
Gallbladder (pediatric)
Longitudinal image through the gallbladder of a 5-year-old child with length and depth
measurements (between cursors).
243
Transverse image from a subcostal approach on deep inspiration demonstrating the
measurement of width (between cursors).
Upper abdomen
244
Age (years)
Length
Mean ± SD (cm)
Width
Mean ± SD (cm)
Volume
Mean ± SD (cc)
12 6.1 (±0.8) 1.8 (± 0.6) 12.1 (± 7.8)
13 6.6 (±1.3) 1.9 (± 0.6) 14.0 (± 8.4)
14 6.8 (±1.1) 2.0 (± 0.6) 15.2 (± 8.1)
15 6.3 (± 1.3) 1.9 (± 0.6) 13.3 (± 9.5)
16 5.9 (± 1.1) 1.9 (± 0.6) 11.9 (± 6.6)
FURTHER READING
McGahan JP, Phillips HE, Cox KL. Sonography of the normal
pediatric gallbladder and biliary tract. Radiology. 1982;
144:873–875.
Yoo JH, Kwak HJ, Lee MJ, Suh JS, Rhee CS. Sonographic
measurements of normal gallbladder sizes in children. J Clin
Ultrasound. 2003; 31:80–84.
This page intentionally left blankThis page intentionally left blank