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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Upper abdomen
246
Common bile duct (pediatric)
PREPARATION
None.
POSITION
Initially supine, then turn to the right anterior oblique position to demonstrate the common duct.
TRANSDUCER
4.0–6.0 MHz curvilinear transducer.
METHOD
Patient is imaged in a subcostal position in the longitudinal plane or
from an intercostal position. The common bile duct may be identied
by means of the anatomic course within the gastroduodenal ligament,
coursing distally to the head of the pancreas and absence of ow with
Doppler interrogation. The internal diameter of the extrahepatic duct
is measured from inner wall to inner wall.
APPEARANCE
With high-resolution imaging, normal intrahepatic ducts can be visualized as tubular structures with thin high-reective walls. The term
common duct is used, because it is not possible to demonstrate the
entrance of the cystic duct on an ultrasound, and thus be able to differentiate the common hepatic duct from the common bile duct.
MEASUREMENTS
The common duct of neonates and children younger than 1 year
should be 1.6 mm or less in inner wall to inner wall diameter. The size
increases slowly with age. The common duct during childhood and
early adolescence should not measure more than 2.5–3.0 mm in diameter. It is a distensible structure that demonstrates small but statistically
signicant changes in size during daily uctuations in the bile ow.
Common bile duct (pediatric)
The common duct is measured at a point where it passes anterior to the right portal vein
with the hepatic artery seen in cross section between the duct and the vein.
Diameter of common bile duct in children according to age
(in a Chinese population)
Age (years) Minimum size (mm) Maximum size (mm)
Mean ± SD (mm)
247
0–1 0.40 3.2 1.15 (± 0.53)
1–4 0.80 4.00 1.69 (± 0.55)
4–7 0.80 3.50 1.73 (± 0.56)
7–14 1.40 4.40 2.36 (± 0.79)
FURTHER READING
Hernanz–Schulman M, Ambrosino MM, Freeman PC, Quinn
CB. Common bile duct in children. Sonographic dimensions.
Radiology. 1995; 195:193–195.
Zhang Y, Wang KL, Li SX, Bai YZ, Ren WD, Xie LM, Zhang
SC. Ultrasonographic dimensions of the common bile duct in
Chinese children: Results of 343 cases. J Pediatr Surg. 2013;
48:1892–1896.
Upper abdomen
248
Spleen (pediatric)
PREPARATION
None.
POSITION
Left upper abdomen in the mid-axillary line, then turn patient to the
left anterior oblique position as necessary to view the spleen.
TRANSDUCER
2.0–6.0 MHz curvilinear transducer.
METHOD
Splenic length is measured during quiet breathing, obtained from a coronal plane that includes the hilum. The greatest longitudinal distance
between the splenic dome and the tip (splenic length) is measured.
Transverse, longitudinal, and diagonal diameters can be measured
from the image showing the maximum cross-sectional area in a coronal plane.
APPEARANCE
The spleen should show a uniform echo pattern. It is slightly less reective than the liver.
MEASUREMENTS
Measurement of length: A measurement of length and diameter can
be made in the oblique plane at the 10
through the splenic hilum.
th
and 11th intercostal space,
Length of spleen versus body weight
Weight (kg)
Mean ± SD (mm)
20 78 ± 9
30 80 ± 9
40 83 ± 18
50 86 ± 13
60 91 ± 12
Spleen (pediatric)
Measurement of the splenic length (between cursors), taking the greatest longitudinal
distance between the splenic dome and the tip of the spleen.
249
Two further measurements are obtained to calculate the splenic area (between cursors).
Upper abdomen
250
Spleen length versus age and sex
Age range in months
(m) and years (y)
0–3 m 4.6 ± 0.84 4.4 ± 0.57
3–6 m 5.8 ± 0.65 5.2 ± 0.47
6–12 m 6.4 ± 0.78 6.3 ± 0.68
1–2 y 6.8 ± 0.72 6.3 ± 0.69
2–4 y 7.6 ± 1.07 7.5 ± 0.83
4–6 y 8.1± 1.01 8.0 ± 0.74
6–8 y 8.9 ± 0.91 8.2 ± 0.99
8–10 y 9.0 ± 1.02 8.7 ± 0.92
10–12 y 9.8 ± 1.05 9.1 ± 1.09
12–14 y 10.2 ± 0.81 9.8 ± 1.02
14–17 y 10.7 ± 0.90 10.3 ± 0.69
Measurement of area: View the spleen in the longitudinal axis, in deep
inspiration. The interface between the lung and spleen serves as the
transverse diameter, and the longitudinal diameter is measured from
here to the splenic tip. The diagonal diameter is measured from this
lateral spleen–lung interface to the medial spleen margin. The crosssectional area is calculated as follows:
(Transverse2 + Longitudinal2)/2
√
Male
mean ± SD (mm)
Diagonal
Female
mean ± SD (mm)
Normal
Transverse diameter 5.5 ± 1.4
Longitudinal diameter 5.8 ± 1.8
Diagonal diameter 3.7 ± 1.0
FURTHER READING
Megremis SD, Vlachonikolis IG, Tsilimigaki AM. Spleen length
in childhood with US: Normal values based on age, sex, and
somatometric parameters. Radiology. 2004; 231:129–134.
Diameter in cm (mean ± SD)
Spleen (pediatric)
Niederau C, Sonnenberg A, Muller JE, Erckenbrecht JF, Scholten
T, Fritsch WP. Sonographic measurements of the normal
liver, spleen, pancreas, and portal vein. Radiology. 1983;
149:537–540.
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.
251
Upper abdomen
252
Pancreas (pediatric)
PREPARATION
None.
POSITION
Supine, decubitus, and semi-decubitus positions with the left side elevated.
TRANSDUCER
5.0–7.5 MHz curvilinear transducer.
METHOD
Maximum anteroposterior diameters of the head, body, and tail of the
pancreas are measured on transverse/oblique images.
APPEARANCE
The pancreas should be homogenous with a reectivity equal to or
slightly greater than that of the adjacent liver. The pancreatic duct may
be seen as a single high-reective line and usually measures less than
1 mm.
MEASUREMENTS
Normal dimensions of the pancreas as a function of age
Maximum anteroposterior dimensions ± SD (cm)
Patient age Head Body Tail
<1 month 1.0 ± 0.4 0.6 ± 0.2 1.0 ± 0.04
1 month–1 year 1.5 ± 0.5 0.8 ± 0.3 1.2 ± 0.4
1–5 years 1.7 ± 0.3 1.0 ± 0.2 1.8 ± 0.4
5–10 years 1.6 ± 0.4 1.0 ± 0.3 1.8 ± 0.4
10–19 years 1.0 ± 0.5 1.1 ± 0.3 2.0 ± 0.4
FURTHER READING
Siegel MJ, Martin KW, Worthington JL. Normal and abnormal
pancreas in children. Radiology. 1987; 165:15–18.
Pancreas (pediatric)
Transverse image through the pancreas at the level of the conuence of the splenic vein
and the superior mesenteric vein, in a 12-year-old male subject. The three cursors measure
the anteroposterior diameters of the head, body, and tail.
253
Upper abdomen
254
Adrenal glands (neonatal)
PREPARATION
None.
POSITION
Supine.
TRANSDUCER
6.0–7.5 MHz curvilinear transducer.
METHOD
Image from anks in sagittal, coronal, and transverse planes.
APPEARANCE
The adrenals have an oval shape in the transverse plane and an inverted
Y-shape in the longitudinal plane. A rim of low reectivity surrounds
the thin high-reective core. The right gland is seen in 97% and the left
gland in 83%.
MEASUREMENTS
Length is measured as maximum cephalocaudal dimension, from the
apex to the base of the gland. The maximum transverse and anteroposterior diameters are measured in a transverse plane perpendicular
to the length of one of the wings.
Length of the adrenal glands versus gestational age
Gestational age (weeks) Mean ± SD (mm)
16 4.2 ± 0.70
17 4.6 ± 0.70
18 5.0 ± 0.70
19 5.4 ± 0.70
20 5.8 ± 0.70
21 6.2 ± 0.70
22 6.6 ± 0.70
23 6.9 ± 0.71
24 7.3 ± 0.71
Adrenal glands (neonatal)
The adrenal gland is represented by a thin echogenic core (arrow) surrounded by an echopoor rim. Length is measured as a maximum cephalocaudal dimension, and the width is the
maximum dimension perpendicular to the length of one of the wings.
255
Length of the adrenal glands versus gestational age
Gestational age (weeks) Mean ± SD (mm)
25 7.6 ± 0.71
26 8.0 ± 0.71
27 8.3 ± 0.72
28 8.6 ± 0.72
29 8.9 ± 0.72
30 9.1 ± 0.73
31 9.4 ± 0.73
32 9.7 ± 0.73
33 9.9 ± 0.74