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Prelims.qxd 9/15/04 6:14 AM Page i Pediatric Ultrasound Prelims.qxd 9/15/04 6:14 AM Page ii For Elsevier: Senior Commissioning Editor: Sarena Wolfaard Project Development Manager: Mairi McCubbin Project Manager: Derek Robertson Designer: Judith Wright Illustrations Manager: Bruce Hogarth Prelims.qxd 9/15/04 6:14 AM Page iii Pediatric Ultrasound How, Why and When Rose de Bruyn MBBCh DMRD FRCR Consultant Pediatric Radiologist, Department of Radiology, Great Ormond Street Hospital For Children NHS Trust, London E D I N B U R G H L O N D O N N E W YO R K O X F O R D P H I L A D E L P H I A S T L O U I S S Y D N E Y T O R O N T O 2005 Prelims.qxd 9/15/04 6:14 AM Page iv CHURCHILL LIVINGSTONE An imprint of Elsevier Limited © 2005, Elsevier Limited. All rights reserved. The right of Rose de Bruyn to be identified as author of this work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, USA: phone: (+1) 215 238 7869, fax: (+1) 215 238 2239, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier Science homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. First published 2005 ISBN 0 443 07275 2 BRITISH LIBRARY CATALOGUING IN PUBLICATION DATA A catalogue record for this book is available from the British Library LIBRARY OF CONGRESS CATALOGING IN PUBLICATION DATA A catalog record for this book is available from the Library of Congress NOTICE Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the author assumes any liability for any injury and/or damage to persons or property arising from this publication. The Publisher The Publisher's policy is to use paper manufactured from sustainable forests Printed in China Prelims.qxd 9/15/04 6:14 AM Page v v Contents Contributors vii Preface ix 1. General issues of methods and equipment 1 Rose de Bruyn 2. Prenatal sonographic diagnosis of congenital anomalies 15 Eva Pajkrt, Lyn S. Chitty 3. The urinary tract 39 Rose de Bruyn 4. The adrenal glands 113 Rose de Bruyn 5. The liver, spleen and pancreas 131 Rose de Bruyn 6. The abdomen and bowel 181 Rose de Bruyn 7. The female reproductive system 207 Rose de Bruyn 8. The scrotum and testes 235 Rose de Bruyn 9. The head, neck and spine 251 Rose de Bruyn 10. The musculoskeletal system 301 Rose de Bruyn 11. Pediatric interventional ultrasound 321 Derek J. Roebuck 12. The chest 341 Rose de Bruyn Recommended reading 353 Glossary 355 Index 361 Prelims.qxd 9/15/04 6:14 AM Page vi This page intentionally left blank Prelims.qxd 9/15/04 6:14 AM Page vii vii Contributors Lyn S. Chitty BSc PhD MRCOG Consultant and Senior Lecturer in Genetics and Fetal Medicine, Institute of Child Health and University College London Hospitals NHS Trust, London Rose de Bruyn MBBCh DMRD FRCR Consultant Pediatric Radiologist, Department of Radiology, Great Ormond Street Hospital For Children NHS Trust, London Eva Pajkrt MD PhD Clinical Fellow in Fetal and Maternal Medicine, Fetal Medicine Unit, Elizabeth Garrett Anderson and Obstetric Hospital, London Derek J. Roebuck FRCR FRANZCR FHKCR Consultant Interventional Radiologist, Great Ormond Street Hospital, London Prelims.qxd 9/15/04 6:14 AM Page viii This page intentionally left blank Prelims.qxd 9/15/04 6:14 AM Page ix ix Preface Ultrasound is one of the most widely used imaging modalities in pediatric radiology and is set to continue to grow and develop as computing and equipment improves and new applications become available. Children are ideally suited to ultrasound, since their low levels of body fat contribute to ultrasound images of exquisite detail. This book is intended as a practical starting point for radiologists, sonographers and other medical healthcare professionals undertaking ultrasound examinations in children, providing all necessary normative charts and guidelines on examining techniques. The book is not a comprehensive text on all the many different pathologies likely to be encountered in children, but it is intended to highlight the strengths and weaknesses of ultrasound in the important conditions. The aim is to provide the sonographer with a framework to use in diagnosis, so that the maximum amount of information can be gained from the ultrasound. It is assumed that the sonographer has a basic understanding of how to operate an ultrasound system, together with a fundamental clinical ultrasound training. The intention is to provide an approach to ultrasound examinations and to emphasize the real value of ultrasound and its place in the broader perspective of the imaging modalities available. Clinical expectations of the diagnostic ability of ultrasound are exceedingly high in pediatrics. The sonographer must strive for a good understanding of what is achievable and for excellence in technique. Working with children can be one of the most challenging and rewarding experiences. The author gratefully acknowledges the help, stimulation and advice of all her colleagues and sonographers in the ultrasound department at Great Ormond Street Hospital for Children NHS Trust. Also thanks to Michelle Le Maire for her patience, encouragement and invaluable help in preparing the manuscript. This book is for all the sick children. R.d.B. London, 2005