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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5802_Библиотеки_им_академика_М_И_Перельмана.pdf
Upper abdomen
256
Length of the adrenal glands versus gestational age
Gestational age (weeks) Mean ± SD (mm)
34 10.2 ± 0.74
35 10.4 ± 0.75
36 10.6 ± 0.75
37 10.8 ± 0.76
38 11.0 ± 0.76
39 11.2 ± 0.77
40 11.3 ± 0.77
41 11.5 ± 0.78
The size of the adrenal gland diminishes rapidly in the rst 6 weeks of
post-natal life.
FURTHER READING
Oppenheimer DA, Carroll BA, Yousem S. Sonography of the normal
neonatal adrenal gland. Radiology. 1983; 146:157–160.
van Vuuren SH, Damen-Elias HA, Stigter RH, van der Doef R,
Goldschmeding R, de Jong TP, Westers P, Visser GH, Pistorius
LR. Size and volume charts of fetal kidney, renal pelvis and
adrenal gland. Ultrasound Obstet Gynecol. 2012; 40:659–664.
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Upper abdomen
258
Adrenal glands (infant)
PREPARATION
None.
POSITION
Supine.
TRANSDUCER
6.0–7.5 MHz curvilinear transducer.
METHOD
Image from anks in sagittal, coronal, and transverse planes.
APPEARANCE
Thin high-reective core representing the cortex, surrounded by a rim
of low reectivity representing the medulla. As the infant grows, at 2
months, the cortex gets smaller and the medulla larger in proportion.
At 5–6 months the whole gland is smaller, and generally of high reectivity. At the age of 12 months, the gland is similar to the adult gland
and becomes low-reective.
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.
Mean (± SD) serial adrenal measurements (mm) in neonates
Day Transverse Anteroposterior Length
1 17.9 (± 2.7) 9.6 (± 2.1) 17.3 (± 1.8)
3 14.8 (± 3.3) 7.5 (± 2.2) 12.8 (± 3.2)
5 13.7 (± 2.1) 6.9 (± 1.6) 11.4 (± 2.7)
11 11.8 (± 2.5) 5.9 (± 1.4) 8.9 (± 2.0)
21 10.8 (± 1.9) 5.6 (± 0.5) 8.2 (± 1.2)
42 |9.5 (± 1.5) 5.7 (± 1.0) 7.7 (± 0.9)
Adrenal glands (infant)
The adrenal gland is represented by a thin echogenic core (arrow) surrounded by an echopoor rim. Length is measured as a maximum cephalocaudal dimension (between cursors),
and the width is the maximum dimension perpendicular to the length of one of the wings.
259
FURTHER READING
Scott EM, Thomas A, McGarrigle HH, Lachelin GC. Serial adrenal
ultrasonography in normal neonates. J Ultrasound Med. 1990;
9:279–283.
Upper abdomen
260
Pyloric stenosis
PREPARATION
No food for at least 2 hours prior to the examination.
POSITION
Supine or right anterior oblique.
TRANSDUCER
5.0–8.0 MHz curvilinear transducer or a 7.0–10.0 MHz linear transducer.
METHOD
Longitudinal and transverse preliminary views right of midline at the
level of subxiphoid space. The infant is usually bottle fed at the time
of the examination. Image with patient right side down and obtain
longitudinal and transverse views as before.
APPEARANCE
Thickened muscle is seen as a low-reective layer, supercial to the
high-reective mucosal layer. In the transverse plane, the canal resembles a “doughnut,” medial to the gallbladder and anterior to the right
kidney. There is an absence of peristalsis distally, whereas the stomach
is distended and shows visible peristaltic wave.
MEASUREMENTS
Pyloric length (b) = ≥ 14 mm
Pyloric muscle thickness (c) = ≥ 3 mm
FURTHER READING
Haller JO, Cohen HL. Hypertrophic pyloric stenosis: Diagnosis
using US. Radiology. 1986; 161:335–339.
Hernanz-Schulman M. Pyloric stenosis: Role of imaging. Pediatr
Radiol. 2009; 39:S134–9.
Hernanz-Schulman M, Sells LL, Ambrosino MM, Heller RM, Stein
SM, Neblett WW III. Hypertrophic pyloric stenosis in the infant
without a palpable olive: Accuracy of sonographic diagnosis.
Radiology. 1994; 193:771–776.
O’Keeffe FN, Stansberry SD, Swischuk LE, Hayden CK Jr.
Antropyloric muscle thickness at US in infants: What is normal?
Radiology. 1991; 178:827–830.
Pyloric stenosis
Axial image through the pylorus demonstrating the “doughnut” appearance (between
cursors); the low echogenic muscle layer is seen (between arrows).
261
Longitudinal measurement of pyloric length in the right decubitus position.
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11
RENAL TRACT
Annamaria Deganello and
MariaE.Sellars
Renal size (pediatric) 264
Renal size (neonates and infants) 268
Renal pelvic diameter (fetus and
neonate) 274
Ureterovesical jets (infants and
children) 278
Renal tract
264
Renal size (pediatric)
PREPARATION
None.
POSITION
The prone position is useful in children.
TRANSDUCER
4.0–6.0 MHz curvilinear transducer.
METHOD
Image the right kidney using the liver as an acoustic window. The left
kidney is usually more difcult to visualize. The left anterior oblique
45° or right decubitus position may help. Both kidneys must be imaged
in both longitudinal and transverse planes.
APPEARANCE
The reectivity of the renal cortex is less than that of the adjacent liver
and spleen. The renal capsule can be identied as a thin, high-reective
rim. The renal pyramids are poorly dened structures seen at the outer
edge of the renal sinus. The renal sinus contains multiple structures—
the pelvis, calyces, vessels, and fat—and is usually of high reectivity.
MEASUREMENTS
Measurements of renal size are taken in the maximum longitudinal
plane. In children, the length of the kidneys correlates best to height,
although charts against age and weight are available. Differences
between the left and right kidney are minimal.
Renal lengths related to body height
Body height
(cm)
48–64 5.0 ± 0.58 5.0 ± 0.55
54–73 5.3 ± 0.53 5.6 ± 0.55
65–78 5.9 ± 0.52 6.1 ± 0.46
71–92 6.1 ± 0.34 6.6 ± 0.53
85–109 6.7 ± 0.51 7.1 ± 0.45
Right kidney
mean ± SD (cm)
Left kidney
mean ± SD (cm)
Renal size (pediatric)
On the longitudinal image two measurements are obtained (between cursors).
265
The width is measured from a transverse image obtained through the renal hilum (between
cursors).