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Renal tract
276
FURTHER READING
Clautice-Engle T, Anderson NG, Allan RB, Abbott GD. Diagnosis
of obstructive hydronephrosis in infants. Comparison
sonograms performed 6 days and 6 weeks after birth. AJR Am J
Roentgenol. 1995; 164;963–967.
Lobo ML, Favorito LA, Abidu-Figueiredo M, Sampaio FJ. Renal
pelvic diameters in human fetuses: Anatomical reference for
diagnosis of fetal hydronephrosis. Urology. 2011; 77:452–457.
Mandell J, Blyth BR, Peters CA, Retik AB, Estroff JA, Benacerraf
BR. Structural genitourinary defects detected in utero.
Radiology. 1991; 178;193–196.
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Renal tract
278
Ureterovesical jets (infants and children)
PREPARATION
Ingest water prior to the examination.
POSITION
Supine.
TRANSDUCER
5.0–7.5 MHz curvilinear transducer.
METHOD
Transverse image through the bladder base. The site of the ureteric
orice is usually lateral and dened as the uretrovesical junction at the
apex of the angle between the bladder oor and the lateral wall, or in
the lateral vertical wall of the bladder, above the bladder oor.
APPEARANCE
The ureteric jet is seen on gray scale when there is a difference of at
least 0.01 g/ml between the specic gravity of urine coming down the
ureter and the urine present in the bladder. When a spectral Doppler
gate is placed onto the jet, a characteristic signal is obtained even when
the jet is not seen on gray scale. Color Doppler ow imaging is more
sensitive in demonstrating ow than gray scale and facilitates location
of the ureteric orice.
MEASUREMENTS
Parameters in children with normal voiding cystourethrogram and
normal renal and bladder US:
• Duration of jet: Right, 2.77 ± 1.5 sec, and left 2.88 ± 1.5 sec.
• Direction of jet: Usually anteromedial and upward
• Spectral analysis: 10–80 cm/sec (mean of 31.6 cm/sec)
Frequency of jets and resultant signals increase with urine produc-
tion; an almost continuous signal is obtained after a large uid load.
Although identication of ureterovesical jets may be made on ultrasound, there are no specic features regarding the jets that reliably
distinguish a normal from an abnormal ureterovesical junction.
Color Doppler image of the
right and left ureteric jets
demonstrating the anteromedial
and upward direction of the jet.
A spectral Doppler gate is placed
over the ureteric jet and a
spectral waveform obtained.
Ureterovesical jets (infants and children)
279
FURTHER READING
Cvitkovic´ Kuzmic´ A, Brkljacic´ B, Rados M, Galesic´ K. Doppler
visualization of ureteric jets in unilateral hydronephrosis in
children and adolescents. Eur J Radiol. 2001; 39:209–214.
Jequier S, Paltiel H, Lafortune M. Uretero-vesical jets in infants and
children: Duplex and color Doppler studies. Radiology. 1990;
175:349–353.
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PEDIATRIC UTERUS,
12
OVARY, AND TESTIS
Induni Douglas, Anthony E. Swartz,
Wui K. Chong, and Paul S. Sidhu
Uterus (transabdominal sonography) 282
Ovarian volume (transabdominal
sonography) 284
Test is 286
Pediatric uterus, ovary, and testis
282
Uterus (transabdominal sonography)
PREPARATION
Full bladder prior to the examination.
POSITION
Supine position.
TRANSDUCER
3.5–6 MHz curvilinear transducer or 7–13 MHz linear transducer.
METHOD
Midsagittal section of the uterus is taken. The total uterine length (L)
is measured from the top of the fundus to the external cervical os. The
maximum anterior-posterior (AP) diameter or thickness is measured perpendicular to the maximum L. The maximum transverse (TRV) diameter or width is taken from a transverse section. In a midsagittal section,
maximum AP diameter of the fundus and maximum AP diameter of the
cervix are taken and divided to get the fundal cervical ratio.
APPEARANCE
• Neonatal uterus: The cervix is larger than the fundus. The endo-
metrial lining is visible and echogenic. Some uid can also be seen
within the endometrial cavity.
• Prepubertal uterus: The cervix is equal to or greater in thickness
than the uterine fundus, and the endometrial lining is relatively
inconspicuous. The uterus presents a tubular conguration or
spade shape if the anteroposterior cervix is larger than the anteroposterior fundus.
• Pubertal uterus: The uterine body is wider than the cervix, pro-
ducing the typical adult pear-shaped uterus.
MEASUREMENT
Age Length (L) Thickness
(AP)
Neonatal 3.5 cm < 1.4 cm 0.5
Prepubertal 2.5–4 cm < 1.5 cm < 1 cm < 1.2
Pubertal 5–8 cm 1.6–3 cm 3.5 cm > 1.2 (2–3)
Width
(TRV)
Fundal–
cervical ratio
Uterus (transabdominal sonography)
A prepubertal uterus in longitudinal length, with the endometrium measured (cursor 1). The
length includes from the fundus to the external cervical os (crosses).
283
A prepubertal uterus in
transverse, with a width
measurement obtained
(cursor 1).
The fundal–cervical ratio is a better marker for pubertal development.
Uterine length shows the best correlation with age.
FURTHER READING
Garel L, Dubois J, Grignon A, Filiatrault D, VanVliet G. US of the
pediatric female pelvis: A clinical perspective. Radiographics,
2001; 21:1393–1407.
Paltiel HJ, Phelps A. US of the pediatric female pelvis. Radiology.
2014; 270: 644–657.
Ziereisen F, Guissard G, Damry N, Avni EF. Sonographic imaging
of the paediatric female pelvis. Eur Radiol. 2005; 15:1296–1309.
Pediatric uterus, ovary, and testis
284
Ovarian volume (transabdominal sonography)
PREPARATION
Full bladder if possible.
POSITION
Supine position on a couch.
TRANSDUCER
3.5–6 MHz curvilinear transducer or 7–13 MHz linear transducer.
METHOD
The longest diameter of the ovary is obtained (d1). Maximum anteroposterior diameter (d2) is obtained perpendicular to d1. The transducer
is then rotated 90 degrees and d3 is measured perpendicular to d2.
APPEARANCE
Ovoid structure between the uterus and muscular pelvic sidewall. The
internal iliac vessels are posterior to the ovaries. It could be homogenous (without follicles), paucicystic (< 5 follicles), multicystic (> 6
follicles), or most frequently with multiple microcystic follicles.
MEASUREMENT
Ovarian volume = d1 × d2 × d3 × 0.523
Age (years)
1 0.26 ± 0.12
2 0.38 ± 0.11
3 0.37 ± 0.11
4 0.46 ± 0.14
5 0.52 ± 0.22
6 0.65 ± 0.23
7 0.59 ± 0.25
8 0.69 ± 0.30
9 0.93 ± 0.23
10 1.15 ± 0.18
11 1.12 ± 0.43
12 1.88 ± 1.56
13 2.94 ± 1.30
Mean volume ± SD (cm3)
Ovarian volume (transabdominal sonography)
A prepubertal ovary with two measurements obtained prior to a volume calculation.
285
Mean ovarian volume is higher in girls with thelarche (onset of breast
development) when compared with age-matched girls without thelarche.
The presence of thelarche is used to distinguish pubertal girls from
prepubertal girls.
FURTHER READING
Herter LD, Golendziner E, Flores JA, Becker E Jr, Spritzer PM.
Ovarian and uterine sonography in healthy girls between 1
and 13 years old: Correlation of ndings with age and pubertal
status. AJR Am J of Roentgenol. 2002; 178:1531–1536.
Paltiel HJ, Phelps A. US of the pediatric female pelvis. Radiology.
2014; 270:644–657.