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An asymptomatic 5-year-old male was diagnosed with severe coarctation of the aorta despite normal peak flow velocity with pathology identified on the basis of Doppler flow profile.

A 5-year-old previously healthy boy presents to the emergency department (ED) with a 2-week history of intermittent left groin pain, usually occurring later in the day. Pain is not related to eating, movement, urination, or stooling. There is no report of trauma or precipitating event. He screams and refuses to stand up during pain episodes, which occur suddenly and last approximately 1 to 2 hours at a time. He otherwise has normal gait and activity when pain free. He does not wake up at night in pain. No recent illnesses or fevers are reported. Review of systems and his examination findings are unremarkable. Two days prior, he was evaluated in the ED for the same issue and had normal urinalysis, urine culture, and scrotal ultrasonogram results. The consulting urologist did not suspect a urologic process. He was discharged home with pain medication. Today, he returns to the ED because of the intense pain. The patient is admitted for further evaluation and pain management. Complete blood cell (CBC) count, C-reactive protein level, urinalysis results, and plain radiographs of the hips are unremarkable. Computed tomography of the abdomen and pelvis reveals a trace amount of nonspecific free fluid in the pelvis. His pain appears to be alleviated with ibuprofen and bed rest. The following day, he has another episode of intense groin pain after returning from the play room. Physical examination at this time demonstrates only point tenderness on palpation over his symphysis pubis area. No swelling, erythema, or increased warmth was noted in that area. An additional imaging study reveals the diagnosis. A 15-year-old girl presents to the clinic with an itchy rash, fever, headache, nausea, and dizziness. A few days earlier she was evaluated for rash on her back and low-grade fevers. She was prescribed amoxicillin clavulanate for suspected streptococcal …

Neurosonography is used as a primary imaging modality worldwide for visualization of the developing brain and spinal cord in fetuses, infants and children. During the entire process of brain development, there is rapid cell turnover, a condition that is favorable for genetic mutations once external stimuli are applied. No clinical studies in humans have been performed specifically to discuss the long-term impact of postnatal ultrasound exposure of the central nervous system. Currently published studies concerning the prenatal and postnatal use of Doppler or of ultrasound contrast agent use and the developing central nervous system are insufficient to draw meaningful conclusions regarding safety. By instituting a standardized examination and following appropriate patient handling guidelines, the risk of an adverse outcome associated with neurosonography is minimized. This paper recommends adoption of the ALARA principle and offers suggestions as to how to minimize the risk of adverse effects in neurosonography.

Objective: Catheter-related thrombosis is a common problem in the pediatric intensive care unit. Strategies that reduce the incidence of thrombosis may have significant clinical advantage. Nitroglycerin (NTG) infusions release nitric oxide (NO). NO is responsible for much of the vasodilating and antithrombotic properties of the vasculature. We hypothesized that an intracatheter NTG infusion would reduce the incidence of catheter-related thrombosis. Design: Prospective, randomized, controlled trial. Setting: Pediatric intensive care unit. Patients and participants: Children of 6 years or less with femoral venous catheters who were not on antithrombotic therapy. Interventions: Subjects were randomly assigned to NTG or control groups. NTG group patients received NTG at 0.1 mcg·kg·min in 5% dextrose; control group patients received only 5% dextrose. Infusions were delivered continuously through the catheter until the catheter was removed. Demographic data, physical and laboratory findings, catheter insertion attempts and infusate composition were recorded. Clinical evidence of vascular thrombosis or catheter malfunction was noted. Ultrasound examinations were performed within 2 days of catheter insertion and within 2 days after removal. Measurements and results: Forty-four patients (age 12.0±2.6 months) completed the study, 21 in the NTG group and 23 in the control group. Duration of catheter placement was 7.5±0.7 days. Twelve of 44 patients (27%) had thrombi: 7/21 in the NTG group; 5/23 in the control group (p= NS). There were no significant differences between children with and without thrombi in age, gender, number of insertion attempts, duration of catheter placement, clinical signs of thrombosis or infections. Conclusions: Catheter-related thrombosis is common after placement of femoral venous catheters in children. Low dose intracatheter NTG infusion does not protect against catheter-related venous thrombosis in children.

Background. Pelvocalyceal dilatation (PCD) is often detected by sonography during the prenatal period. Prenatal detection of PCD should affect the prevalence of PCD in children with urinary tract infection (UTI).¶Purpose. To determine the prevalence of abnormal sonographic findings in a population of children undergoing first imaging evaluations after UTI and to determine if the prevalence has changed from an earlier study at the same institution.¶Materials and methods. The findings on consecutive first renal and bladder sonographic examinations in 844 children (745 girls, 99 boys) with UTI were retrospectively reviewed. Cystograms were performed in 743/844 (494 nuclear, 249 fluoroscopic). Only children with known congenital malformations or other significant disease were excluded.¶Results. Sonography was abnormal in 141/844 (16.7 %). PCD was noted in 27/844 (3.2 %), with mild PCD in 18/844 (2.1 %) and moderate or severe PCD in 9/844 (1.1 %). Hydroureter without PCD was noted in 6/844 (0.7 %). Parenchymal abnormalities were present in 42/844 (5.0 %) and bladder wall thickening in 43/844 (5.1 %). Vesicoureteral reflux was present in 186/743 (25.0 %). When compared to historical controls, PCD and hydroureter were significantly less prevalent than 1 decade earlier (P < 0.0001).¶Conclusion. The prevalence of PCD in children under first imaging evaluation for UTI declined significantly during the last decade. These data may be useful in the design of imaging strategies for children with UTI.

Neonatal cranial ultrasound continues to be a popular initial imaging modality because of the safety, low-cost, and portability of the examination. The higher frequency transducers and enhanced ability for signal processing that is possible with current ultrasound machines improves visualization of complex congenital anomalies, complications of pregnancy, and birth and neoplastic processes. This article reviews these conditions so that the reader will have a baseline knowledge of the ultrasound findings. With the use of neonatal cranial ultrasound, recognition of the maximum diagnostic information available on the sonogram and appropriate use of other cross-sectional imaging modalities are improved.

Rationale and Objectives. We examined whether the intravenous (IV) Doppler ultrasound contrast agent SHU 508 would improve the detection of reduced perfusion of rabbit testes when normal flow was otherwise difficult to detect. Methods. Seventeen anesthetized prepubertal rabbits underwent ran dom unilateral spermatic cord ligation and a contralateral sham operation. Immediate, blinded, and systematic color Doppler examination of each pair of testes was recorded before and after IV administration of 1 ml (300 mg) SHU 508, a gas-containing microparticle. Recorded examinations were reviewed by two pediatric radiologists who were unaware of experimental conditions and who graded intratesticular flow. Results. For 34 pairs of observations (17 animals × 2 observers), intratesticular flow was absent in the sham-operated testes in 18 precontrast and two postcontrast images. The false-positive rate in this group decreased from 53% to 6%. This improvement in the detection of normal blood flow was statistically significant. The absence of flow in the ischemic testis was not significantly different before or after contrast agent administration. Conclusion. IV SHU 508 enhances color Doppler ultrasound detection of flow not otherwise evident in prepubertal rabbit testes. Doppler ultra-sound contrast agents may be used in a setting of suspected torsion when routine Doppler sonography is indeterminate.

In vivo evaluation of Doppler contrast agent (DCA) enhancement has been principally qualitative. To quantitate the enhancement of the Doppler signal by perflubron emulsion, an investigational DCA, the audio-Doppler signal from the rabbit carotid artery was recorded during 0.5-ml/kg incremental doses to a total dose of 2.5 ml/kg. A representation of the recorded signal intensity, the Doppler power spectrum (DPS), was determined using a personal computer and commercially available software package. The dose related enhancement from perflubron emulsion was linear (r = 0.986, p = 0.0124) with a 710% (8.5 dB) overall enhancement at 2.5 ml/kg (p = 0.0001). Significant differences in enhancement could be detected with doses as low as 1.0 ml/kg and compared favorably with observer assessment of dose-related enhancement. This relatively simple method of computer analysis can quantify in vivo Doppler signal intensity and enhancement by perflubron emulsion and may enable quantitative comparisons between different DCAs.

Ultrasound imaging has become a common method for intraoperative evaluation of the central nervous system. Real-time monitoring aids in guidance for aspiration of fluid collections and placement of catheters as well as the localization and evaluation of masses, and confirmation of their complete removal. Color Doppler is useful in the evaluation of blood flow in arteriovenous malformations, aneurysms, and neoplasms. Consultation among the ultrasound staff, neuroradiologists, and neurosurgeons before the operative procedure maximizes the usefulness of ultrasound, thus aiding in the success of surgery.

The sonogram is a reliable diagnostic tool in the evaluation of acute abdomital disorders in infants and children. Portability, noninvasiveness, and ease of examination make sonography an invaluable diagnostic method. This article considers the principle acute disorders of infancy and childhood that are minimal to sonographic diagnosis. Included are pyloric stenosis, appendicitis, necrotizing enterocolitis, intussusception, as well as unexplained abdominal distention and acutely presenting masses. Although some of these entities have nonspecific sonographic appearances, consideration of age, symptoms, and laboratory results usually permits a specific diagnosis.

While the clinical symptomatology and radiographic findings of acute suppurative infection of the epitrochlear lymph nodes of the arm have been previously described [1], ultrasonographic findings have not been reported. This case report demonstrates that sonograpic identification of enlarged epitrochlear lymph nodes immediately confirms the diagnosis. We summarize the clinical, radiological, and sonographic findings of acute suppurative infection of the epitrochlear lymphnodes.

Experience with color Doppler imaging (CDI) during 16 pediatric intraoperative and one percutaneous neuro-radiologic procedures was reviewed to assess whether CDI increased the success rate or decreased the procedure time, thus contributing substantially to procedure performance. Intraoperative CDI was used to rapidly identify abnormal vessels or displacement of normal vessels and correlated with preoperative studies. In six cases (four vascular malformations, one mycotic aneurysm, and one hamartoma), surgical resection was altered on the basis of flow information obtained. In one case of percutaneous embolization of a Galenic malformation, CDI provided information contributing to the cessation of the procedure. In six cases (debulking of three gliomas, resection of one vascular malformation, and two biopsies of nonneoplastic conditions), information was added but did not alter the surgical approach. In the remaining four cases (three cerebrospinal fluid drainage procedures, one posterior fossa decompression), no additional information was obtained. Consultation among the ultrasound staff, neuroradiologists, and neurosurgeons before the operative procedure maximized the usefulness of CDI, thus aiding in the success of surgery.

Sonography was performed in 30 normal patients, neonatal to 45 years old, to illustrate our technique for complete and rapid examination of the elbow joint. Sonography is an easy, noninvasive method of evaluating the articulating surfaces, tendinous insertions, and supporting soft tissues of the elbow joint. Reliable identification of both normal and diseased anatomy is possible at all ages. Familiarization with the sonographic appearance of the six elbow ossification centers aids in sonographic interpretation.

Ectopic pancreas is the most common congenital anomaly in the gastric antrum. In some patients, there is a distinct tendency for this lesion to produce intermittent crampy abdominal pain by provoking gastroduodenal prolapse. This condition should be considered after a more distal prolapse from intussusception is excluded. An upper gastrointestinal series performed during an episode of symptoms may be diagnostic of this entity.