Pediatric Ultrasound Requisites and Applications 2nd edition by Michael Riccabona ISBN 3030479099 978-3030479091

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ISBN 10: 3030479099 
ISBN 13:  978-3030479091
Author: Michael Riccabona 

This book, now in a revised and updated second edition, systematically covers the use of ultrasound in all organ systems throughout childhood. After discussing the basics, including physics, ultrasound methods, and artifacts, it elucidates decision-making regarding the use of ultrasound by discussing diagnostic flow charts based on recommended imaging algorithms. The main part of the book addresses ultrasound investigations of the various organs. It documents the indications and prerequisites for specific examinations and offers practical tips and tricks. The normal, age-dependent ultrasound findings and typical appearances in different pathologies are presented in detail and illustrated by numerous high-quality images, with a particular emphasis on those findings that differ from the adult sonographic appearances. And finally, dedicated chapters explore point-of-care and emergency ultrasound, interventional ultrasound, and present orienting tables.

This state-of-the-art book covers modern techniques and applications, like contrast-enhanced ultrasound, ultrasound elastography, and automated-image optimization, as well as all pediatric ultrasound applications from point-of-care ultrasound and orienting assessment also at the intensive care unit/emergency room to more detailed and advanced applications, e.g., in dedicated tertiary referral centers.

Pediatric Ultrasound is an invaluable source of information and an indispensable aid to decision-making and diagnosis for radiology residents, (pediatric) radiologists, sonographers, pediatricians, (pediatric) surgeons, urologists, and all other physicians who deal with children as a part of their daily practice.

Pediatric Ultrasound: Requisites and Applications 2nd Table of contents:

Part I: Basics/Theory/Methods
1: US Physics
1.1 US Waves
1.2 Propagation and Modulation of US
1.2.1 Acoustic Impedance
1.2.2 Impedance Change
1.2.3 Reflection
1.2.4 Absorption
1.2.5 Deflection
1.2.6 Focus
1.2.7 Resolution
1.3 Emission, Transmission, Reception and Amplification
1.3.1 Emission
1.3.2 Transmission
1.3.3 Reception
1.3.4 Amplification
1.4 Signal Processing
1.4.1 Preprocessing
1.4.2 Post-Processing
1.4.3 Time Gain Compensation (TGC)
1.4.4 Sound Energy = Output
1.4.5 Gain
1.4.6 Frame Rate/Persistence
1.5 Components of US Device
1.5.1 Transducers
1.5.2 Other Parts of US Device
1.6 Modern US Techniques
1.6.1 High-Resolution US (HR-US)
1.6.2 Image Compounding
1.6.3 Harmonic Imaging (HI)
1.6.4 Extended Field of View US
1.6.5 US Texture Analysis
1.6.6 Potential Future for Other Modern Paediatric US Applications
2: US Methods, Artefacts, Biologic Effects, Practice
2.1 A (Amplitude)-Mode
2.2 (T)M-Mode (Time-Motion-Mode)
2.3 B (Brightness)-Mode
2.4 Doppler Sonography
2.5 Artefacts
2.5.1 General Remarks
2.5.2 Common Artefacts
2.5.2.1 Side Loop Artefact
2.5.2.2 Bowing Artefact
2.5.2.3 Noise
2.5.2.4 Marginal Shadowing
2.5.2.5 Posterior Enhancement—Increased through Transmission
2.5.2.6 Reverberation Artefact
2.5.2.7 Increment or Slice Thickness/Beam Width Artefact
2.5.2.8 Mirror Image Artefact
2.5.2.9 Shadowing
2.5.2.10 Refraction Artefact
2.5.2.11 Anisotropy
2.6 Biologic Effects
2.6.1 General Remarks
2.6.2 Thermal Effects
2.6.2.1 Tissue Heating
2.6.2.2 Biological Effects, Tissue Heating
2.6.3 Mechanical Effects and Resonance
2.6.3.1 Cavitation
2.6.4 Potential Risks of Diagnostic US
2.6.4.1 Specific Risks
2.6.4.2 Guidelines and Recommendations
2.6.5 Various Methods and Indices that Allow Estimation of Biological Risks
2.6.5.1 Mechanical Index (MI)
2.6.5.2 Thermal Index (TI)
2.6.5.3 Display of Actual Indices
2.7 How to Perform Paediatric US
2.7.1 Requisites
2.7.1.1 Indications
2.7.1.2 Environmental Requisites
2.7.1.3 Specific Needs in Children
2.7.1.4 Specific Needs in Infants and Newborns
2.7.2 Positioning
2.7.3 Device Handling
2.7.3.1 General Remarks
2.7.3.2 Choice of Device and Transducer
2.7.3.3 How to Start Investigation
2.7.4 Transducer Selection
2.7.4.1 General Remarks
2.7.4.2 Neurosonography (See Chap. 8)
2.7.4.3 Small Part and Musculo-Skeletal US (See Respective Chapters)
2.7.4.4 Chest US (See Chap. 12)
2.7.4.5 Abdominal US (See Respective Chapters)
2.7.5 Course of Investigation and Measurements
2.7.5.1 General Remarks
2.7.5.2 Transducer Handling
2.7.5.3 Measurements
2.8 Documentation and Interpretation
2.8.1 Image Documentation
2.8.1.1 Media for Documentation
2.8.2 Report
2.8.2.1 How to Issue a Report
2.8.2.2 Diagnosis
2.8.2.3 Predefined Reports
2.8.2.4 Nomenclature
3: (Color) Doppler US: Theory, Artefacts, Typical Applications in Childhood
3.1 Doppler Sonography
3.1.1 The Doppler Phenomenon
3.1.2 Different Techniques and Applications of Doppler Sonography
3.1.2.1 Continuous Wave Doppler (CW)
3.1.2.2 Pulsed Wave Doppler (PW)
3.1.2.3 Duplex-Doppler Sonography/Spectral Flow Analysis
3.1.2.4 Colour-Coded Doppler Sonography or Colour Doppler Sonography (CDS)
3.1.2.5 Amplitude-Coded Colour Doppler Sonography (aCDS)
3.1.2.6 Other Flow-Sensitive US Techniques
3.1.2.7 Important Parameters and Measurements (Fig. 3.7)
3.2 Artefacts in (Colour) Doppler Sonography
3.2.1 Aliasing
3.2.2 Spectral Broadening
3.2.3 Sample Volume Artefact
3.2.4 Filtering Artefacts
3.2.5 Scaling Problems
3.2.6 Gain-Induced Errors
3.2.7 Angle Correction
3.2.8 Motion Artefact
3.2.9 Twinkling Artefact
3.2.10 Others
3.3 How to Perform (Colour) Doppler Investigations
3.3.1 Limitations
3.3.2 Interpretation
3.4 Three- and Four-Dimensional US (3D-/4DUS)
3.4.1 Physics and Techniques
3.4.2 Typical Paediatric 3DUS Applications
3.4.2.1 Neonatal Neurosonography
3.4.2.2 3DUS of the Kidney
3.4.2.3 Urinary Bladder 3DUS
3.4.2.4 3DUS of the Paediatric (Female) Genitalia
3.4.2.5 Musculoskeletal 3DUS Applications
3.4.2.6 Small Part 3DUS Applications
3.4.2.7 Other Potential 3D-/4DUS Applications
3.4.3 Benefits of 3D-/4DUS
3.4.4 Restrictions of 3D-/4DUS
3.4.5 Potential Future Paediatric 3DUS Applications
4: Contrast-Enhanced US, and Ultrasound Elastography in Childhood
4.1 Contrast-Enhanced Ultrasound (ce-US)
4.1.1 Basics
4.1.2 ce-US Applications-General Remarks
4.1.3 Contrast-Enhanced Voiding Urosonography (ce-VUS)
4.1.4 Other Intracavitary Use of ce-US: Sono-Genitography, Sonographic Pyelography and Many Potential Others
4.1.5 Intravenous ce-US (CEUS)
4.1.5.1 Potential Applications/Indications of CEUS in Neonates, Infants and Children-Summary
4.1.5.2 Dose Recommendations
4.1.6 Future ce-US Potential
4.2 Ultrasound-/Sonoelastography
4.2.1 Methods
4.2.1.1 Strain Elastography
4.2.1.2 Transient Elastography (TE)
4.2.1.3 Shear Wave Elastography (SWE)
4.2.2 Applications
4.2.2.1 Focal Lesions
4.2.2.2 Diffuse Changes
4.2.2.3 Possible Indications—Summary
5: Paediatric Limited Field of View US/Point of Care US (POCUS) and Emergency US: When, How and for What
5.1 Requirements
5.2 Typical Applications
5.3 “FAST” US (Focused Assessment with Sonography for Trauma)
5.4 “(e)RUSH” (Rapid Ultrasound in Shock and Hypoxia)
5.5 Miscellaneous Other Typical POCUS/Sonoscope Applications
5.6 Restrictions, Pitfalls and Risks of Limited Field US
Part II: Diagnostic Flow Charts, Imaging Algorithms, and Graphs
6: Imaging and Imaging Algorithms for Common Queries in Childhood
6.1 Introduction
6.2 How to Approach Common Urogenital Conditions in Childhood
6.2.1 Urinary Tract Infection (UTI)
6.2.2 Foetal and Neonatal Urinary Tract Dilatation
6.2.3 Urinary Tract Dilatation Later in Childhood and Follow-Up of Neonatally Diagnosed PUJO, UVJO, High-Grade VUR, Complicated Duplex Kidney
6.2.3.1 Pelvi-Ureteric Junction Obstruction (PUJO)
6.2.3.2 Uretero-Vesical Junction Obstruction (= UVJO)/“Megaureter” (MU)
6.2.3.3 Gross Vesico-Ureteric Reflux (VUR)
6.2.4 Urolithiasis (and Nephrocalcinosis)
6.2.5 Cystic Kidney Disease (CKD)
6.2.6 Torsion (Ovary, Testis)
6.2.7 Genital Malformations
6.2.8 Renal Hypertension
6.3 US in Other Common Paediatric Abdominal Conditions and Queries
6.3.1 Necrotizing Enterocolitis (NEC)
6.3.2 Vomiting Infants and Children
6.3.3 Acute Abdomen
6.3.4 Acute Appendicitis
6.3.5 Splenomegaly
6.3.6 Cholestasis
6.3.7 Pancreatitis
6.3.8 Biliary Atresia
6.3.9 Abdominal Trauma
6.3.10 Abdominal Tumours
6.4 Miscellaneous Other Common Queries and Assessment for Systemic Conditions
6.4.1 Pneumonia, Pleural Effusion
6.4.2 Enlarged Mediastinum
6.4.3 Painful Hip/Limping Child: Osteomyelitis
6.4.4 US in Systemic and Syndromatous Disease
7: Measurements and Volume Calculations: Basic Considerations, Graphs and Illustrations for Standardisation
7.1 General Considerations
7.2 How to Measure
7.3 Artifacts and Other Aspects that May Impact Measurements
7.3.1 Miscellaneous Other Considerations
Part III: US Investigations of the Various Organs
8: Neurosonography in Neonates, Infants and Children
8.1 Requisites
8.1.1 Equipment and Transducer Needs
8.1.2 Indications for Brain US
8.1.3 How to Investigate
8.2 Normal Findings
8.2.1 Transfontanellar Access
8.2.2 Alternate Access Findings
8.2.3 Colour Doppler Sonography (CDS)
8.2.4 Normal Variances in Preterm Babies
8.2.4.1 Periventricular Echogenicities
8.2.4.2 Ventricular Asymmetry
8.2.4.3 Ventriculomegaly
8.2.4.4 Cisterna Magna
8.2.4.5 Vascular Variations
8.3 Pathologic Findings
8.3.1 Neural Tube Defects
8.3.1.1 Anencephaly
8.3.1.2 Meningomyelocele and Encephalocele
8.3.1.3 Arnold Chiari Malformation
8.3.1.4 Dandy–Walker Malformations/Spectrum
8.3.1.5 Corpus Callosum Malformations
8.3.1.6 Lipoma
8.3.2 Migration and Gyration Alterations and Disturbances
8.3.2.1 Lissencephaly, Pachygyria, Macro- or Polygyria and Colpocephaly
8.3.2.2 Megalencephaly
8.3.2.3 Schizencephaly
8.3.2.4 Holoprosencephaly
Alobar Holoprosencephaly
Semilobar Holoprosencephaly
Lobar Holoprosencephaly
De Morsier Syndrome: Septo-Optic Dysplasia
Agenesis of the Septum Pellucidum
8.3.2.5 Hydranencephaly
8.3.3 Phakomatoses
8.3.4 Cerebral Cysts
8.3.5 Ischemic Encephalopathy
8.3.5.1 Preterm Infant
8.3.5.2 Global or Diffuse Brain Oedema
8.3.5.3 Focal Hypoxemia and Ischemia
8.3.5.4 (C)DS in Brain Hypoxia
8.3.6 Other applications of (C)DS:
8.3.7 Inflammation
8.3.7.1 Prenatal Intrauterine Infections and Residuals
8.3.7.2 Postnatal Inflammation
8.3.8 Dilatation of CSF Spaces: Hydrocephalus
8.3.9 Cerebral Haemorrhage
8.3.9.1 Haemorrhage in Preterm Babies: IVH Grades I–III, PVH (Fig. 8.37)
8.3.9.2 Haemorrhage in Term Infants
8.3.9.3 Role of CDS in Neonatal Haemorrhage
8.3.9.4 Haemorrhage in Infants and Older Children
8.3.10 Tumours and Space-Occupying Lesions
8.3.10.1 Vascular Malformations
8.3.11 Cerebral Calcifications
8.3.11.1 Non-calcifying Vasculopathy (Lenticulostriate Vasculopathy)
8.4 Ultrasound of the Skull
8.4.1 Introduction
8.4.2 Haematoma
8.4.3 Space-Occupying Lesions and Tumours
8.4.4 Skull Fracture
8.5 Additional Imaging
8.5.1 Plain Film
8.5.2 CT
8.5.3 MRI
8.5.4 Catheter Angiography
8.5.5 Additional Supporting Procedures
8.6 Ultrasound of the Eye and the Orbit
8.6.1 Introduction
8.6.2 Normal Findings
8.6.3 Sonographically Depictable Pathology
9: US of the Neonatal Spinal Canal and Cord
9.1 Introduction
9.2 Requisites
9.3 Transducers and Technique
9.4 Indications
9.5 Normal Findings
9.6 Pathologic Findings of the Spinal Cord
9.6.1 Dysraphism
9.6.2 Other Associated Pathology
9.6.3 Other “Occult” Dysraphisms
9.7 Trauma
9.8 Tumours and Miscellaneous Others
9.9 Other Spinal and Vertebral Pathology
9.10 Additional Imaging
9.11 Value of US
10: Ultrasound of the Neck in Childhood
10.1 Indications, Requisites and Techniques
10.1.1 Transducers
10.1.2 Positioning and Handling
10.1.3 Typical Examinations
10.1.3.1 Cervical Lymph Nodes
10.1.3.2 Glands
10.1.3.3 Cervical Arteries
10.1.3.4 Cervical Veins
10.1.3.5 Intervention
10.2 Normal Findings
10.2.1 Lymph Nodes
10.2.2 Cervical Glands
10.2.2.1 Thyroid Gland
10.2.2.2 Parotid, Submandibular and Sublingual Glands
10.2.3 Other Cervical Soft Tissues
10.2.3.1 Muscles
10.2.3.2 Tonsils
10.2.3.3 Tongue
10.2.3.4 Para- and Retropharyngeal Spaces
10.2.3.5 Larynx
10.2.4 Cervical Vessels
10.3 Pathologic Findings
10.3.1 Lymph Nodes
10.3.2 Pathology of Cervical Soft Tissue
10.3.2.1 Malformations
Cervical Cyst
Dermoid Cyst
Duplication Cysts
Thymic Cyst
Cervical Ectopic Thymus
10.3.2.2 Tumours
Haemangioma
Lymphatic Malformation
Other Mesenchymal Tumours
Neuroblastoma, (Ganglio-)Neuroma, Neurofibroma and Other Nerve (Sheath) Tumours
Teratoma
Other Malignant Tumours
Role of US
10.3.2.3 Abscess Formations
10.3.2.4 Traumatic Changes
Haematoma (Including Sternocleidomastoid Muscle “Haematoma”)
10.3.3 Thyroid Gland
10.3.3.1 Cystic Changes
10.3.3.2 Malformations
10.3.3.3 Inflammation
10.3.3.4 Other Conditions
Hypothyroidism/Struma Diffusa/Colloides (Fig. 10.17)
Nodular Goitre
Amyloid Goitre
Adenoma/Carcinoma
10.3.4 Salivary Glands (Parotid, Sublingual, Submandibular Gland)
10.3.4.1 Inflammation
10.3.4.2 Cysts
10.3.4.3 Calcifications/Sialolithiasis
10.3.4.4 Tumours
10.3.5 Cervical Vessels
10.3.5.1 Arteriosclerosis
10.3.5.2 Dissection
10.3.5.3 Stenosis
10.3.5.4 Other Vascular Anomalies
10.3.5.5 Thrombosis and Occlusion
11: Basics of Paediatric Echocardiography
11.1 Introduction
11.2 Equipment Needs and Specific Considerations
11.2.1 Transducers
11.2.2 Standard US Techniques
11.2.3 Patient Position
11.2.4 Sedation
11.3 Standard Planes and Standardised Course of Examination
11.4 Normal 2D Echocardiogram Findings
11.4.1 Parasternal Views
11.4.1.1 Parasternal Long Axis View (Fig. 11.2)
11.4.1.2 Parasternal Short Axis Views (Figs. 11.3 and 11.4)
11.4.1.3 Apical Views
11.4.2 Subcostal Views
11.4.2.1 Sagittal Subcostal View
11.4.2.2 Subcostal Four-Chamber View (Fig. 11.6)
11.4.3 Suprasternal View (Fig. 11.7)
11.5 Other Techniques
11.5.1 M (Motion)-Mode Echocardiography
11.5.2 Doppler Sonography in Echocardiography
11.5.2.1 CDS with 2DUS
11.5.2.2 PW- and CW-Doppler
11.5.2.3 Calculation of Pressure (P) Gradients (P1 Minus P2)
11.5.3 Assessment of LV and RV Function
11.6 Special Echocardiographic Techniques
11.6.1 Transoesophageal Echocardiography (TEE)
11.6.2 Three-/Four-Dimensional (3D/4D) Echocardiography
11.6.3 Tissue Doppler Imaging (TDI)
11.6.4 Contrast-Enhanced US (ce-US/CEUS)
11.7 Normal Values
11.8 Pathologic Findings
11.8.1 Congenital Heart Defects with Left-to-Right Shunt
11.8.1.1 Atrial Septal Defect (ASD)
11.8.1.2 Atrioventricular Septal Defects (AVSD)
11.8.1.3 Ventricular Septal Defects (VSD)
11.8.1.4 Patent Ductus Arteriosus of Botalli (PDA)
11.8.1.5 Persistent Truncus Arteriosus (Truncus Arteriosus Communis)
11.8.2 Obstructions of Left Ventricular Outflow
11.8.2.1 Aortic Valve Stenosis (AS)
11.8.2.2 Subaortic Stenosis (Sub-AS)
11.8.2.3 Supravalvular Aortic Stenosis
11.8.2.4 Aortic Coarctation (CoA)
11.8.2.5 Interrupted Aortic Arch
11.8.3 Obstructions of the Right Ventricular Outflow
11.8.3.1 Isolated Pulmonary Valve Stenosis (PS)
11.8.3.2 Subvalvular Pulmonary Stenosis
11.8.3.3 Supravalvular Pulmonary Stenosis
11.8.3.4 Tetralogy of Fallot (TOF) and Pulmonary Atresia (PA) with VSD
11.8.4 Miscellaneous Congenital Heart Defects
11.8.4.1 Transposition of Great Arteries (TGA)
11.8.4.2 Total Anomalous Pulmonary Venous Return (TAPVR)
11.8.4.3 Univentricular Heart (UVH)
11.8.4.4 Double Outlet Right Ventricle (DORV)
11.8.4.5 Ebstein Anomaly
11.8.4.6 Cor Triatriatum
11.9 Acquired Paediatric Heart Diseases
11.9.1 Cardiomyopathies (CMP)
11.9.1.1 Hypertrophic CMP
11.9.1.2 Hypertrophic Obstructive CMP (HOCMP)
11.9.1.3 Dilated (Congestive) CMP
11.9.1.4 Restrictive CMP
11.9.2 Acute Myocarditis
11.9.3 Acute (Infective) Endocarditis
11.9.4 Pericarditis/Pericardial Effusion
11.9.5 Kawasaki Disease
11.9.6 Intracardiac Thrombi
11.9.7 Cardiac Tumours
11.10 Modern Approaches, Peri-interventional and Postoperatrive Applications
11.11 Complementing Investigations
11.11.1 Cardiac Catheterisation and Angiography
11.11.2 Cardiac MRI and CT
11.12 When to Do What
11.12.1 Imaging in Typical Clinical Scenarios
11.12.1.1 Typical Orientating Examination
11.12.1.2 Typical Clinical Queries
11.12.2 Trauma and Emergency
12: Ultrasound of the Chest
12.1 Requisites
12.1.1 Transducers
12.1.2 Positioning
12.1.3 Indications
12.1.4 How to Perform Chest US
12.2 Normal Findings
12.2.1 Chest Wall
12.2.2 Breast
12.2.3 Pleural Space
12.2.4 Diaphragm
12.2.5 Lung
12.2.6 Mediastinum
12.2.6.1 Anterior Mediastinum/Thymus
12.2.6.2 Middle Mediastinum
12.2.6.3 Posterior Mediastinum
12.2.7 (Colour) Doppler Sonography
12.2.8 Contrast Enhanced US (ce-US)
12.3 Pathology of Chest Wall
12.3.1 Aplasia: Variations of Ribs
12.3.2 Congenital Malformations
12.3.3 Traumatic Changes
12.3.4 Chest Wall Tumours
12.3.4.1 Lymphangioma (Venolymphatic Vascular Malformation)
12.3.4.2 Lipoma
12.3.4.3 Fibroma/Neurofibroma
12.3.4.4 Other Tumours
12.3.5 Breast
12.3.6 Miscellaneous Other Applications
12.3.7 Role of US and Additional Imaging
12.4 Pathology of Pleural Space
12.4.1 Pneumothorax
12.4.2 Pleural Effusion
12.4.2.1 Empyema
12.4.3 Other Pleural Pathology
12.4.3.1 Role of Imaging
12.5 Pathology of Diaphragm
12.5.1 Diaphragmatic Hernia
12.5.2 Diaphragmatic Motion Disturbance
12.5.3 Role and Potential of Imaging
12.6 Lung Pathology
12.6.1 Pneumonia
12.6.2 Lung Abscess
12.6.3 Atelectasis
12.6.4 Respiratory Distress Syndrome (RDS)/Hyaline Membrane Syndrome, Wet lung, Alveolo-interstitial syndrome
12.6.5 Sequestration
12.6.6 Congenital Cystic Adenomatoid Malformation (CCAM)
12.6.7 Cysts
12.6.8 Infarction
12.6.9 Tumours and Space-Occupying Lesions
12.7 Other Miscellaneous and Rare Applications
12.7.1 US for Interstitial Lung Disease/Alveolar-Interstitial Syndrome
12.8 Additional Imaging
13: Upper Abdominal US in Neonates, Infants and Children: (Excluding the Kidneys)
13.1 Introduction
13.2 Requisites and Investigation
13.2.1 Preparation
13.2.2 Positioning
13.2.3 Transducers
13.3 Liver
13.3.1 Course of Investigation
13.3.2 Standard Planes
13.3.3 Normal Findings
13.3.3.1 Structure
13.3.3.2 Ligaments
13.3.3.3 Hepatic Veins (HV)
13.3.3.4 Portal Vein (PV)
13.3.3.5 Hepatic Artery (HA)
13.3.3.6 Gall Bladder
13.3.3.7 Common Bile Duct
13.3.3.8 Intrahepatic Bile Ducts
13.3.3.9 Doppler Findings
13.3.3.10 Special Aspects of Newborns and Infants
13.3.4 Pathology of the Liver
13.3.4.1 Congenital Changes and Normal Variance
Situs Inversus (Abdominalis)
Butterfly or Midline Liver
Hypoplasia/Atrophy of Left Liver Lobe and Other Variations
13.3.4.2 Inflammatory Conditions
Hepatitis
Liver Abscess
Granulomatous Disease
Role of US
13.3.4.3 Other Parenchymal Liver Disease
Hepatopathy
Fatty Liver/Steatosis
Liver Congestion
Liver Fibrosis
Cirrhotic Liver
Liver Involvement in Systemic Disease
Role of US
13.3.4.4 Portal Hypertension and Vascular Problems
Portal Hypertension
Vascular Malformations
Portal Vein and Hepatic Artery Stenosis
Congenital Agenesis or Variants of Portal Vein/Congenital Portocaval Anastomosis/Abernethy Malformations
Hepatic Vein Thrombosis/Occlusion/Stenosis
Portosystemic Shunts
13.3.4.5 Liver Trauma
Liver Haematoma
Contusion
Laceration
Haemobilia
Associated Diaphragmatic Injury
Liver Infarction
Role of US in Liver Trauma
Additional Imaging
13.3.4.6 Space-Occupying Liver Lesions
Simple Cysts
Complicated Cysts
Liver Calcifications
Intrahepatic Gas
Haemangioma
Mesenchymal Hamartoma
Focal Nodular Hyperplasia (FNH)
Hepatic Adenoma
Fatty Tumours
Hepatoblastoma
Hepatocellular Carcinoma
Hepatic Sarcomas
Metastasis
Proliferative Disorders
Role of US
Additional Imaging
13.4 Biliary Tract and Gall Bladder
13.4.1 General Findings
13.4.2 Congenital Conditions and Normal Variants of Biliary Tract
13.4.2.1 Intrahepatic Gall Bladder
13.4.2.2 Hypo-/Aplasia of Gall Bladder/Biliary Atresia/Neonatal Hepatitis Syndrome
13.4.2.3 Choledochal Cyst
13.4.3 Biliary Tract Diseases
13.4.3.1 Aerobilia
13.4.3.2 Cholestatic Changes/Inspissated Bile/Gallstone
13.4.3.3 Sclerosing Cholangitis
13.4.3.4 Other Forms of Cholangitis and Cholecystitis
13.4.3.5 Tumour-like Conditions
Polyps
Tumours
13.4.3.6 Role of US
13.4.3.7 Additional Imaging
13.5 US in Liver Transplantation
13.5.1 Pretransplant US
13.5.1.1 Recipient Evaluation
13.5.1.2 Donor US (Split Liver Transplant, Related Living Donor—Deceased Donor)
13.5.2 Intraoperative US
13.5.3 Postoperative Assessment
13.5.4 Typical Complications
13.6 Spleen
13.6.1 Requisites
13.6.2 Positioning
13.6.3 Indications
13.6.4 Course of Investigation
13.6.5 Normal Anatomy
13.6.6 Normal Variants
13.6.6.1 Splenunculus (Accessory Spleen)
13.6.6.2 Splenic Lobulations and Clefts
13.6.7 Malformations
13.6.7.1 Asplenia
13.6.7.2 Polysplenia Syndrome
13.6.7.3 Wandering Spleen
13.6.8 Splenomegaly
13.6.9 Trauma
13.6.10 Splenic Infarction
13.6.11 Space-Occupying Lesions of the Spleen
13.6.11.1 Cysts
13.6.11.2 Inflammation and Abscess
13.6.11.3 Tumours and Space-Occupying Lesions
13.6.11.4 Role of US
13.7 Pancreas
13.7.1 Requisites
13.7.2 Indication
13.7.3 Course of Investigation
13.7.4 Normal Findings
13.7.5 Variations and Malformations
13.7.5.1 Annular Pancreas
13.7.5.2 Pancreas Divisum
13.7.6 Inflammation: Pancreatitis
13.7.6.1 Oedematous or Reactive Pancreatitis
13.7.6.2 Haemorrhagic or Necrotising Pancreatitis
13.7.6.3 Chronic Pancreatitis
13.7.7 Trauma
13.7.8 Space-Occupying Lesions
13.7.8.1 Cysts/Pseudocysts
13.7.8.2 Tumours
13.7.9 Role of US
13.7.10 Additional Imaging
13.8 Retroperitoneum and Retroperitoneal Structures: Abdominal Vessels and Abdominal Wall
13.8.1 Abdominal Vessels
13.8.1.1 Positioning
13.8.1.2 Transducers
13.8.1.3 How to Investigate
13.8.1.4 US Findings
13.8.1.5 Important Variants and Malformations
13.8.2 Vascular Pathology
13.8.2.1 Thrombosis/Occlusion
13.8.2.2 Pelvic Congestion Syndrome
13.8.2.3 Mid-Aortic Syndrome
13.8.2.4 Retroaortic Left Renal Vein: Nutcracker Syndrome
13.8.2.5 Compression by Superior Mesenteric Artery (Also Called Nutcracker or SMA Syndrome)
13.8.2.6 Arteriosclerotic Changes and Aneurysms
13.8.2.7 Embolic Thrombus to Abdominal Aorta
13.8.2.8 Role of US
13.8.2.9 Complementing Imaging
13.8.3 Retroperitoneal Soft Tissues
13.8.3.1 Lymph Nodes
13.8.3.2 Retroperitoneal Tumours
13.8.3.3 Abdominal Wall
14: US of the Gastrointestinal (GI) Tract
14.1 Stomach
14.1.1 Requisites
14.1.2 How to Investigate
14.1.2.1 Access
14.1.2.2 Functional Assessment of Bowel and Stomach
14.1.3 Normal Findings
14.1.4 Normal Variants
14.1.5 Malformations
14.1.5.1 Microgastria
14.1.5.2 Pyloric Atresia
14.1.5.3 Congenital Hiatal Hernia
14.1.6 Pathologic Findings
14.1.6.1 Gastro-Oesophageal Reflux (GOER)
14.1.6.2 Hypertrophic Pyloric Stenosis (HPSt)
14.1.6.3 Other Stomach Conditions
14.1.7 Role of US
14.2 Bowel
14.2.1 Preparation and Requisites
14.2.2 Course of Investigation
14.2.3 Normal US Findings
14.2.4 Pathology
14.2.4.1 Congenital Anomalies
14.2.5 Acquired Obstructive Pathology
14.2.5.1 Meconium Ileus
14.2.5.2 Midgut Volvulus
14.2.5.3 Sigma Volvulus
14.2.5.4 Hernia
14.2.5.5 Intussusception
14.2.5.6 Masses and Tumours
14.2.6 Inflammatory Conditions
14.2.6.1 Necrotising Enterocolitis (NEC)
14.2.6.2 Gastroenteritis
14.2.6.3 Henoch–Schönlein Purpura
14.2.6.4 Appendicitis
14.2.6.5 Crohn’s Disease
14.2.6.6 Colitis
14.2.6.7 Other Inflammatory Bowel Conditions
14.2.6.8 Bowel Trauma
14.2.7 Mesentery
14.2.7.1 Mesenteric (Peritoneal) Masses
14.2.7.2 Abscesses
14.2.7.3 Twisted Appendices Epiploica
14.2.8 Mesenteric Lymph Nodes
14.2.9 Free Intraperitoneal Air
14.2.10 Free Intraperitoneal Fluid: Ascites
14.2.11 Mesenteric Vessels
15: Ultrasound of the Urogenital Tract in Neonates, Infants, and Children
15.1 Requisites
15.1.1 Indications
15.1.2 Preparation
15.1.3 Transducers
15.1.4 Positioning
15.1.5 How to Investigate
15.1.5.1 Diuretic US
15.1.6 Contrast-Enhanced Voiding Urosonography (ce-VUS)
15.2 Normal Findings
15.2.1 Bladder
15.2.2 Kidney
15.2.2.1 Normal Variants
Duplex Kidney
Ectopic Kidneys
Renal Agenesis
Fusion Anomalies and Other Rare Findings
15.3 Pathology of the Kidney
15.3.1 Congenital Conditions
15.3.1.1 Dysplasia/Hypoplasia
15.3.1.2 Cystic Renal Disease
Inherited/Congenital Cystic Disease
Acquired Cystic Kidney Disease
15.3.1.3 Alteration of Urinary Drainage
Urinary Tract Dilatation (UTD) or Pelvicalyceal Dilatation/Distention (PCD)
Pelvi-ureteric Junction Obstruction (PUJO)
Uretero-Vesical Junction Obstruction (UVJO)/Obstructive Megaureter (POM/MU)
Posterior Urethral Valve (PUV)
Vesico-Ureteric Reflux (VUR)
Secondary Obstruction
15.3.2 Inflammatory Renal Parenchymal Conditions
15.3.2.1 Pyelitis
15.3.2.2 Acute Pyelonephritis (aPN)/Interstitial Nephritis
15.3.2.3 Necrosis and Abscess Formation
15.3.2.4 Scarring
15.3.2.5 Tuberculosis
15.3.2.6 Xanthogranulomatous Pyelonephritis
15.3.2.7 Glomerulonephritis/Nephrotic Syndrome
15.3.3 Vascular Conditions
15.3.3.1 Renal Artery Stenosis
15.3.3.2 Arteriovenous Fistula (AVF)
15.3.3.3 Infarction
15.3.3.4 Renal Vein Thrombosis
15.3.4 Nephrocalcinosis
15.3.5 Urolithiasis
15.3.6 Other Important Renal Parenchymal Disease
15.3.6.1 Haemolytic Uremic Syndrome (HUS)
15.3.6.2 Glomerulonephritis/Nephrotic Syndrome
15.3.6.3 Scars, Cirrhotic Kidney
15.3.7 Renal Failure (RF)
15.3.8 Renal/Urinary Tract Trauma
15.3.9 Renal Tumours
15.3.9.1 Benign Tumours
15.3.9.2 Pre- or Semi-Malignant Tumours
15.3.9.3 Malignant Tumours
15.4 Renal Biopsy and Interventions
15.4.1 Renal Biopsy
15.4.2 Drainage/Nephrostomy
15.4.3 Postoperative Imaging
15.4.3.1 After VUR Treatment
Cystoscopic Treatment
Antireflux Surgery
15.4.3.2 Findings after Pyeloplasty
15.4.3.3 After Various Interventions
15.5 Renal Transplant
15.5.1 Normal US Findings in Renal Transplant
15.5.2 Pathologic US Findings
15.6 Adrenal Glands and Pararenal Space
15.6.1 General Remarks
15.6.2 Typical Normal US Finding
15.6.3 Pathologic Findings
15.6.3.1 Adrenal Gland Haemorrhage
15.6.3.2 Inflammatory Condition
15.6.3.3 Tumours
Adrenal Cysts
Adrenal Adenoma
Neuroblastoma
Ganglioneuroma
Phaeochromocytoma
Adrenal Carcinoma
Role of US
15.7 US of Urinary Bladder
15.7.1 Requisites
15.7.2 Pathologic Findings
15.7.2.1 Atypical Shape (Neurogenic Bladder, “Valve Bladder”)
15.7.2.2 Polyps
15.7.2.3 Bladder Tumours
15.7.2.4 Calcification in/of Bladder
15.7.2.5 Ureterocele
15.7.2.6 Persisting Urachus
15.7.2.7 Megaureter
15.7.2.8 Infravesical Obstruction and Urethra
15.7.2.9 Inflammation
15.7.2.10 Traumatic Changes
15.7.2.11 Vesico-Ureteric Reflux
15.7.3 Paravesical Changes
15.7.3.1 Abscess Formations
15.7.3.2 Tumours of Paravesical Region
15.7.3.3 Cystic Perivesical Structures
15.7.4 Role of US
15.8 US of Male Genitals
15.8.1 US Technique
15.8.2 Normal Findings
15.8.3 Common Pathologic Findings
15.8.3.1 Hydrocele
15.8.3.2 Undescended Testes
15.8.3.3 Varicocele
15.8.3.4 Cystic Dysplasia of Rete Testis and Seminal Vesicles
15.8.3.5 Testicular and Paratesticular/Epididymal Cysts/Spermatocele
15.8.3.6 Microlithiasis
15.8.4 Inflammation—Orchitis, Ependymitis
15.8.5 Scrotal Trauma
15.8.6 Torsion
15.8.6.1 Torsion of Appendages
15.8.6.2 Inguinal Hernia
15.8.7 Testicular Tumours
15.8.8 Role of US and Additional Imaging
15.9 Female Genitals
15.9.1 Indications
15.9.2 Requisites
15.9.3 Transducers
15.9.4 How to Perform Investigation
15.9.5 Normal Findings
15.9.5.1 Sonogenitography
15.9.6 Pathologic Findings
15.9.6.1 Congenital Malformations
Vaginal Septum and Duplications
Vaginal Atresia
Vaginal Fistula
Other Vaginal Malformations
Vaginal Aplasia
Uterine Malformations
Ovarian Malformations
15.9.6.2 Inflammatory Conditions of Female Genitalia
15.9.6.3 Genital Tumours and Space Occupying Lesions
Cysts
Teratoma
Other Genital Tumours
Rhabdomyosarcoma
15.9.6.4 Traumatic Changes
15.9.6.5 Other Specific Important Entities of Female Genitalia in Childhood
Ovarian Torsion
Pregnancy
15.9.6.6 Role of US/Additional Investigations
16: Neonatal and Paediatric Hip US
16.1 General Remarks
16.2 Examination Technique
16.2.1 Hip US According to Graf
16.2.2 Modified Graf Classification (Rosendahl)
16.2.3 Hip US According to Harcke
16.2.4 Femoral Head Coverage According to Morin (and Modified Morin-Terjesen)
16.2.5 3DUS for DDH Assessment
16.2.6 Assessment of Joint Effusion, Capsular Thickening, Perthes, Arthritis and Others
16.3 Normal Anatomy
16.3.1 US Criteria in Graf
16.3.2 Rosendahl Modification
16.3.3 Normal Findings During Harcke Investigation
16.3.4 Anatomic Landmarks and Normal Limits for Measuring Femoral Coverage
16.4 Hip US in Older Children
16.5 Pathologic Findings
16.5.1 Developmental Dysplasia of the Hip (DDH)
16.6 Other Conditions of Hip Joint
16.6.1 Arthritis and Inflammation of Hip Joint
16.6.1.1 Capsular Thickening
16.6.1.2 Joint Fluid/Effusion
16.6.2 Hip Osteoarthritis
16.6.3 (Femoral Head) Epiphysiolysis/Slipped (Capital Femoral) Epiphysis
16.6.4 Perthes Disease
17: Musculoskeletal and Other Small Part US in Childhood
17.1 Investigation of Bones, Joints, Tendons
17.1.1 Requisites and Technique
17.1.2 Typical Normal Findings
17.1.3 Pathologic Findings
17.1.3.1 Fracture
17.1.3.2 Joint Effusion
17.1.3.3 Arthritis
17.1.3.4 Trauma
17.1.3.5 Cysts
17.1.3.6 Inflammation
17.1.3.7 Neoplasia
17.2 Other Small Part Applications
17.2.1 General Remarks
17.2.2 Foreign Bodies
17.2.3 US of “Lumps and Bumps”
17.2.4 US for Peripheral Vessels
17.2.5 US of the Paediatric Breast
17.2.6 US of Muscles
17.2.6.1 Traumatic Changes: Haematoma/Tear/Rupture
17.2.6.2 Inflammatory Myositis
17.2.6.3 Other Structural Changes: Fibro-Dystrophic or Atrophic Muscles
17.2.7 Miscellaneous Other Applications
18: US of Peripheral Nerves in Childhood
18.1 General Remarks
18.2 US Technique
18.3 Nerve Anatomy/Structure
18.3.1 Normal US Findings
18.3.2 Most Important Clinical Questions in Children
18.4 Cranial Nerve US
18.4.1 Optic Nerve (Cranial Nerve II)
18.4.2 Facial Nerve (Cranial Nerve VII)
18.4.3 Vagal Nerve (Cranial Nerve X)
18.5 Cervical and Brachial Plexus
18.6 US of Peripheral Nerves of Extremities
18.6.1 Median Nerve
18.6.2 Ulnar Nerve
18.6.3 Radial Nerve
18.6.4 Femoral Nerve
18.6.5 Sciatic Nerve
18.7 Nerve Trauma
18.8 Peripheral Nerve Tumors
18.8.1 Neur(in-)oma
18.8.2 Benign Peripheral Nerve Tumors
18.8.3 Schwannoma
18.8.4 Neurofibroma
18.8.5 Nerve Sheath Ganglion
18.8.6 Malignant Peripheral Nerve Tumors
Part IV: Miscellaneous
19: US-Guided Interventions and Invasive US Procedures and Respective Follow-Up
19.1 General Aspects
19.1.1 Requisites
19.1.2 Other Important Needs
19.1.3 Precautions and Preparations
19.2 US-Guided Filling of Structures for Diagnostic or Therapeutic Purpose
19.2.1 General Remarks for Assessing Physiologic Cavities (For Example, Bladder, Vagina, Intestines, Stomach, etc.)
19.2.2 Diagnostic Sonographic Enema
19.2.3 Therapeutic Sonographic Enema
19.2.4 US Genitography
19.2.5 Contrast-Enhanced Voiding Urosonography (ce-VUS)
19.2.6 Other Intracavitary Contrast Applications
19.2.7 Intravenous ce-US
19.3 Biopsies and Punctures
19.4 Drainage
19.5 Vascular Access
19.6 Lumbar Puncture
19.7 Foreign Body Removal
19.8 US Guidance for Local Anaesthesia
20: Normal Values as Relevant for Paediatric US
20.1 Introduction
20.2 Normal Values in Paediatric Neurosonography
20.3 Normal Values in US of the Paediatric Neck, Including Also Lymph Nodes
20.4 Normal Values in Paediatric Echocardiology
20.5 5. Normal Values in the Paediatric Abdomen (Excluding Urogenital Tract)
20.6 Normal Values in the Paediatric Urogenital System
20.7 Normal Values for US of Paediatric Small Parts and Musculoskeletal System
20.8 Additional Reading

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