Pediatric

A free gallery of high-resolution, ultrasound, color doppler and 3D images
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Pediatric abdomen

Ultrasound images of diseases affecting the child:

 

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1) Inguinal hernia in neonate containing ovary:

neonatal hernia       ultrasound image of hernia of ovary

This 6 week old female child had a swelling in the right inguinal region. Ultrasound images reveal a hypoechoic elongated mass (the processus vaginalis) with an oval structure showing cystic areas. This suggests a right inguinal hernia containing the right ovary. Such hernias usually do not resolve spontaneously. Images courtesy of Dr. Nirmali Dutta, UAE. Ultrasound machine used is the Philips HDI 5000.

 

Another case of inguinal hernia with ovary in infant:

herniated right ovary in processus vaginalis      showing the hernia with defect in abdominal wall

Inguinal hernia on right side in female infant     normal left ovary seen

The above  ultrasound images show a female neonate with right inguinal hernia containing the right ovary. The right ovary is seen as an oval structure with multiple small cystic areas (follicles). The defect in the abdominal wall is also visualized in these ultrasound images. The image on bottom right shows the normal left ovary located posterior to the urinary bladder. These ultrasound images are courtesy of Dr. Ravi Kadasne, UAE.

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Reference: http://www.jultrasoundmed.org/cgi/reprint/26/7/985.pdf

 

2) Intraventricular adhesions- in the lateral ventricles:   

lateral ventricle showing adhesions     ultrasound image of the adhesions

sonography of neonatal brain     ultrasound image of lateral ventricles showing adhesions

neonatal lateral ventriculitis

Sonography of the brain in this neonate reveal multiple septae or adhesions within the lateral ventricles. There is no evidence of hydrocephalus or intracranial hematoma. These ultrasound images suggest some form of ventriculitis, causes of which include 1) old intraventricular hemorrhage 2) any form of encephalitis (eg: cytomegalovirus infections). Ultrasound images taken by Dr. Joe Antony, using a Toshiba Xario ultrasound machine.

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3) Pulmonary consolidation with pleural effusion:

 

ultrasound image of consolidation     ultrasound image of pleural effusion

pleural effusion in child    ultrasound image shows pleural effusion and consolidation

This young child shows an anechoic collection (of fluid) in the left pleural cavity. The left lung (lower lobe) shows echogenicity and texture similar to that of the liver (hepatisation). The spleen is seen below the left hemidiaphragm. These ultrasound images suggest left pulmonary consolidation with left pleural effusion.  Images taken using a Toshiba Xario ultrasound machine, by Dr. Joe Antony, Cochin.

Reference:

http://www.jultrasoundmed.org/cgi/content/full/26/7/985 (an excellent free article with images).

 

4) Intracranial hemorrhage:

 

(Germinal matrix hemorrhage/ Hypoxic-ischemic events in neonates):

a) Germinal matrix hemorrhage-Grade-1: Subependymal hemorrhage:

neonatal brain sonography      coronal ultrasound section showing intracranial hemorrhage

sagittal section section neonatal brain     ultrasound image showing germinal matrix hemorrhage

These sonographic images of neonatal brain show echogenic material in the caudothalamic groove, the region of the germinal matrix. These ultrasound images suggest grade-1 germinal matrix hemorrhage. The ventricles are of normal size and show no hemorrhage. Images taken by Dr. Joe Antony, using a Toshiba Xario machine.

b) Germinal matrix hemorrhage- Grade-3:

ultrasound image of grade-3 hemorrhage    massive IVH in neonate

sagittal section ultrasound image of IVH

Ultrasound images of this neonatal brain shows massive IVH (intraventricular hemorrhage) from the germinal matrix. The IVH (bleed) is seen as intensely hyperechoic material exteding into both lateral ventricles from the frontal to the occipital horns. The choroid plexus is obscured by the IVH. There is no significant intracerebral extension of the hematoma. However, early hydrocephalus is present. This suggests grade-3 germinal matrix hemorrhage in this neonate. Germinal matrix hemorrhage is graded from 1 to 4 as follows:

GRADE-1: There is subependymal hemorrhage

GRADE-2: There is IVH without hydrocephalus

GRADE-3: There is IVH with hydrocephalus

GRADE-4: There is IVH with intraparenchymal hemorrhage. (Hydrocephalus may or may not be present).

c) Germinal matrix hemorrhage- Grade 4:

sonography of neonatal brain    image shows grade 4 germinal matrix hematoma

subependymal cyst    

The above 3 ultrasound images (Toshiba Xario machine) show- grade 4 germinal matrix hemorrhage- subependymal bleed with intraventricular hemorrhage (IVH) and intraparenchymal extension. There is also a small subependymal cyst.

Follow -up scan 1 week later:

partial resolution of the germinal matrix bleed    ultrasound image of intracranial bleed

resolving intracranial hematoma

Follow up ultrasound scan (1 week later) show partial resolution of the hematoma and the IVH.

5) Complications of intraparenchymal hemorrhage- porencephalic cyst of brain:

 ultrasound image of cystic lesion of the brain     an ultrasound image of porencephlic cyst

sonographic image show porencephalic cyst      sonography of porencephalic cyst in neonate

an example of subependymal cyst   

Sonography of the brain in this neonate shows a cystic lesion in the periventricular region of the cerebral hemisphere. Measuring 10 x 14 mm., it appears thin walled and may have a communication with the lateral ventricle. These ultrasound images are highly suggestive of a porencephalic cyst of the brain. These are formed after resolution of a hematoma originating from the germinal matrix, with parenchymal extension. The lowermost image shows an associated subependymal cyst.

Reference: http://www.ajronline.org/cgi/reprint/138/3/467.pdf (free- excellent article and images).

Another complication of subependymal hemorrhage- subependymal cysts:

ultrasound image of subependymal cyst     ultrasound image shows subependymal cyst with hemorrhage

sagittal section of the cyst

Sonography of the neonatal brain reveals a large subpendymal cyst of 3.5 mm. in the left caudato-thalamic groove. Sagittal section image also shows the true extent of the cyst. Such subpendymal cysts are a known complication of subependymal hemorrhage in neonates. Other causes of such cysts are intracranial infections. These are known to resolve spontaneously. The right side shows evidence of subependymal hemorrhage.

Reference: http://www.ajronline.org/cgi/reprint/162/4/953

6) Hydrocephalus:

ultrasound image showing hydrocephalus     sonography of hydrocephalus in neonate

In this neonate, there is evidence of considerable enlargement of the lateral ventricles. Measurement at the atria are more than 12 mm. on both sides. These ultrasound images suggest hydrocephalus. Images taken by Joe Antony, MD, using a Toshiba Xario ultrasound machine.

Another case of Hydrocephalus in neonate:

ultrasound image of hydrocephalus     coronal view of neonatal brain -hydrocephalus

coronal ultrasound image of neonatal brain    sagittal section (oblique) shows dilatation of the entire lateral ventricle

Sonography of this neonatal brain shows severe dilatation of both lateral ventricles, the 3rd ventricle and also the fourth ventricle. The lateral ventricles measure 2.3 cms. at the atria. There is evidence of thinning of the cerebral tissue. The echogenic choroid plexus is seen within the lateral ventricles, near the thalami. There was no evidence of spinal dysraphism or extra- CNS anomalies. These ultrasound images are suggestive of communicating or extraventricular obstructive hydrocephalus. Here, the site of obstruction appears to be outside the ventricular system or failure of absorption of the CSF.

Reference: http://emedicine.medscape.com/article/1135286-overview (free article).

7) Basal ganglia calcification in neonate with Down syndrome:

neonatal intracranial calcification    ultrasound image coronal section of neonatal brain

sagittal section shows the linear calcification    sagittal section (color doppler) shows no flow in the linear echoes

This male neonate showed evidence of Down's syndrome. Sonography of the brain showed linear calcific lesions in the basal ganglia, bilaterally. Color doppler imaging showed the linear echoes not to be of vascular nature. Such linear calcific lesions are known to occur in Down's syndrome, as well as other common conditions as prematurity, cerebral anoxia and intrauterine infections. Upper 2 ultrasound images show coronal section through the brain. Lower 2 ultrasound images show linear calcification in sagittal section. All images were taken by Joe Antony, MD, using a Toshiba Xario ultrasound machine.

References: 1) http://journals.elsevierhealth.com/periodicals/ymai/medline/record/MDLN.157246

2) http://www.ncbi.nlm.nih.gov/pubmed/7094616

8) Sacral meningocele in neonate:

sacral meningocele    low tethering of cord is seen

spinal cord is well seen    the sac is visualized

color doppler image of sacral meningocele  

This neonate had a small swelling on the dorsum of the sacral region. Sonography of the swelling revealed:

1) a sac measuring 1.0 x 3.2 cms. posterior to the sacrum, containing clear fluid (CSF), 2) communicating with the spinal canal through a defect (spinal dysraphism), measuring 1.1 cms. 3) low tethering of the spinal cord. These ultrasound images of the neonatal spine are diagnostic of sacrococcygeal meningocele. Note that the sac does not contain neural tissue. Images taken by Dr. Joe Antony, MD, using a Toshiba Xario machine.

Reference: http://bjr.birjournals.org/cgi/content/full/75/892/384 (free article and images) .. excellent

9) Sacral myelomeningocele in neonate:

normal brain    hydronephrotic kidney in sacral myelomeningocele

bilateral hydronephrosis    sac within the sac

the sacral bony defect is seen with the myelomeningocele    meningocele in neonate

This neonate showed a large sac on the dorsal aspect of the sacrum, extending to the coccyx. Sonography of the sac revealed a large fluid filled mass with a sac like structure (sac) within the main sac. A defect is seen in the sacral vertebrae. The inner sac measures 5.2 cms. approximately while the outer one measures 8 cms. The defect is 1.5 cms. in width. These ultrasound images favor a diagnosis of sacral myelomeingocele (with the inner sac being the herniated, expanded spinal cord). The neonatal brain showed normal ultrasound appearance whilst the kidneys appeared hydronephrotic (possibly due to a neurogenic urinary bladder, a consequence of the myelomeningocele).

Images by Joe Antony, MD using a Toshiba Xario ultrasound machine.

Reference: http://bjr.birjournals.org/cgi/content/full/75/892/384 (free article and images) .. excellent

10) AGENESIS OF THE CORPUS CALLOSUM in AICARDI SYNDROME:

neonate with aicardi syndrome    ultrasound image shows the Probst bundle

showing ventricles in Corpus callosum agenesis    coronal image of agenesis of corpus callosum

showing the posterior fossa in Agenesis of corpus callosum    Dandy walker malformation

This young female neonate presented with infantile spasms and anophthalmia. Sonography of the brain revealed a) absence of the corpus callosum b) prominent, dilated and elevated 3rd ventricle c) sharply angled lateral peaks of the lateral ventricles which lie far apart d) colpocephaly- prominence of the occipital horns of the lateral ventricles e) echogenic mass in the medial part of the lateral ventricles (Probst bundles)  f) posterior fossa cyst which communicates with the dilated 4th ventricle with agenesis of the cerebellar vermis (DANDY WALKER MALFORMATION). These ultrasound images suggest agenesis of the corpus callosum, as part of the AICARDI syndrome. Ultrasound images by Joe Antony, MD, using a Toshiba Xario ultrasound machine.

Reference: 1) http://emedicine.medscape.com/article/941426-overview (free article on Aicardi syndrome).

                     2) Agenesis of the corpus callosum (free article). 

11) Lobar Holoprosencephaly with partial agenesis of corpus callosum:

coronal section through the fused anterior horns    Oblique coronal section of the lateral ventricles

sagittal section showing partial agenesis of the corpus callosum    Power Doppler image showing the relation of the cerebral vessels

Sonography of this neonatal brain shows- fusion of the anterior horns of both lateral ventricles with absent cavum septum pellucidum. The corpus callosum is partially deficient. These ultrasound images suggest partial agenesis of the corpus callosum in a case of Lobar Holoprosencephaly. The cerebral hemispheres are otherwise well preserved. Images were taken using a Toshiba Xario Ultrasound and Color Doppler system by Joe Antony, MD.

Reference: http://emedicine.medscape.com/article/409265-overview  

12) Periventricular leukomalacia in neonate:

Multiple minute cystic lesions in white matter:

coronal section showing minute cystic lesion    parasagittal section of neonatal brain

ultrasound image periventricular leukomalacia   multiple cystic lesions in periventricular white matter

Color Doppler image of leukomalacia   COoronal section through white matter and lateral ventricles

This preterm neonate underwent sonography of the brain. Ultrasound images of the infant's brain revealed multiple small cystic lesions (2 to 3mm. size) the periventricular part of the deep white matter. Color Doppler image did not show any specific findings. These ultrasound appearances are diagnostic of Periventricular leukomalacia in the neonate's cerebral hemispheres. Periventricular leukomalacia can also present as markedly hyperechoic white matter. This condition is the result of chronic ischemic insult (chronic ischemia) of the infant's brain during immediate postnatal period (in preterm neonates).

Reference: http://emedicine.medscape.com/article/975728-overview (free article and images)

                http://emedicine.medscape.com/article/416016-imaging (free article and images)

13) Cerebral edema in neonate:

A) Coronal section of normal neonatal brain:

normal neonatal brain -coronal section  

The normal neonatal brain is seen in coronal section using high resolution ultrasound (image above). The image shows the lateral ventricles, the cavum septum pellucidum (the anechoic space between the frontal horns of lateral ventricles) and the interhemispheric fissure. Note the normal width of all these structures.

B) Severe cerebral edema in neonate:

severe cerebral edema- effaced interhemispheric fissure    coronal section ultrasound image -slit like lateral ventricles

sagittal section ultrasound image showing edematous brain  

This neonate (ultrasound images above) shows typical features of severe cerebral edema. These include effacement of the cerebral sulci and gyral pattern, effacement of the interhemispheric fissure (between the cerebral hemispheres) and slit-like lateral ventricles due to expansion (edematous) of the cerebral hemispheres. The cerebral echogenicity also shows diffuse increase. (Please compare with normal neonatal brain- see coronal section -A).

C) Mild cerebral edema in neonate:

mild cerebral edema -neonate

The above ultrasound image shows mild cerebral edema. This neonate shows partial compression of the lateral ventricles. All the features described in section B (severe edema) are seen in a milder form in this image. The interhemispheric fissure is seen but is compressed.

Reference: http://www.ajronline.org/cgi/reprint/176/4/995 (free article and images-  excellent)

 

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  This page was last edited on: Thursday December 17, 2009 03:50 PM  

Copyright ©   2007- All rights reserved- www.ultrasound-images.com Dr. Joe Antony, MD, Cochin- 20, India.

Scan centre: ULTRASCAN CENTRE, AL-FIA Building, Opp. Reserve Bank of India, ERNAKULAM,

COCHIN (KOCHI)- 682018, KERALA.

Ph: (Off.) 91-484-2403058, (Residence) 91-484-2311416, (Cell) 91- 93886-23088

Contact: joe@ultrasound-images.com or drjoea (at) gmail.com