ABSTRACT
Ultrasound is the basic first-line investigation for an enormous variety of abdominal symptoms in pediatric patients, This is because it is non-invasive and because of its accessible nature, and its success in terms of diagnosis depending on the skill of the operator, The objective of this prospective study is to further elucidate the role of abdominal ultrasonography for screening purposes as well as investigating the relevance of sonographic findings in patients with clinical problems related to the abdomen. This work was conducted on 10114 infants and children [4900 males and 5214 females], ranging in age from 1 day to 12 years. They were referred to the various outpatients' clinics, Cairo University Children's Hospital. Proper history taking, thorough clinical examination, and ultrasonography of the abdomen and basal parts of the thorax were done for all patients. Other investigations were done for certain cases to reach the final diagnosis. Patients were divided into 2 groups: Group I consisted of 2668 patients [26.4%] without specific symptoms in the abdomen, it represented the screening group. Group II consisted of 7446 patients [73.6%] with abdominal symptoms and therefore well-defined sonographic requests. The results revealed that 60% of the whole group had pathologic sonographic findings. Pathological findings were discovered in 61.7%, 59.3% of group I and group II patients respectively. According to their individual influence on the patient's disease course, sonographic findings were subdivided into 3 categories: Relevant, prospectively relevant and irrelevant findings. In each of group I, and group I1 patients these findings constituted 47.8%, 76% and 36%, 10.6% and 16.2%, 13.3% of total findings in each group respectively, The difference between both groups was statistically significant, Most of relevant findings [81%] were detected in group I1 patients as compared to 19% in group I, The nephrology clinic was ranked as the No 1 clinic regarding the frequency of pathologic findings discovered in patients referred from it [27%]. Also, the highest frequency of relevant findings was detected in patients from the hepatology [87%] and nephrology [82%] clinics
Conclusion: abdominal ultrasonography can detect various relevant findings in asymptomatic out- patients as well as in patients with a clinical problem related to the abdomen. Also, ultrasonography completes the physical examination, adding a substantial amount of clinically important information to the patient's medical record and physician's report
ABSTRACT
According to a large number of studies, there is a frequent association of congenital heart disease [CHD] and urinary tract anomalies [UTA]. The purpose of this study is to evaluate the advisability of sonographic screening of uropathy in patients with malformative heart disease. The study comprised 180 children. All of these children were investigated for CUD but none were symptomatic in terms of the urinary tract diseases. The patients were divided into 2 groups, group I included 107 patients [59.4%] with a cyanotic CHD and group II included 73 patients [40.5%] with cyanotic CHD. All patients in the study were subjected to echocardiography and sonographic screening for associated uropathy. Out of 180 children, the incidence of UTA detected by sonography was 24/180 [73.3%]. There was no significant difference in the incidence of UTA between those with a cyanotic CHD 14/107 [13.1%] and those with cyanotic CHD 10/73 [13.7%], p=0.15. However, no association between a specific CUD and a particular UTA could be found
Conclusion: sonography should be routinely performed to screen for previously undetected or silent but potentially serious UTA in children with CHD
ABSTRACT
Viral hepatitis is a major health problem allover the world. Perihepatic lymph nodes [LN] enlargement detected by ultrasonography [US] has been observed in acute and chronic hepatitis; a correlation has been found between hepatic inflammatory activity and total LN volume. Ultrasonography can detect many other changes in patients with acute viral hepatitis. This study included 35 patients with viral hepatitis; 20 with acute viral A hepatitis [11 males and 9 females, their age ranged from 2.5-7 years [yr]], and 15 with chronic viral hepatitis [10 HCV and 5 HBV] [9 males 8. 6 females, their age ranged from 3-16 yr]. Patients were taken from the hepatology clinic, Cairo University Children's Hospital. Another 15 children were taken as controls. History taking, thorough clinical examination, investigations [CBC, liver function tests, and serologic liver markers], and liver biopsy [for some chronic cases] with histopathologic examination were done for patients. Abdominal US was done for patients and controls. Results revealed that in chronic hepatitis patients, the most frequent risk factors for acquisition of hepatitis include dental extraction [60%], blood transfusion [40%], and surgical operation [33%]. Also, there was a low HB vaccination coverage among chronic hepatitis patients [33%]. Anorexia, malaise, jaundice, and dark-colored urine were the main symptoms present in all patients with acute viral A hepatitis. On examination, jaundice and tender hepatomegaly were detected in 65% of cases. In patients with chronic viral hepatitis, malaise was present in all cases while anorexia and abdominal pain were present in 65% of cases. On examination, firm hepatomegaly was detected in 50% of cases whilejaundice and splenomegaly were detected in 33% of cases. No evidence of fulminant hepatitis or liver cell failure was found in all patients. Concerning laboratory parameters, serum transaminases were significantly elevated in patients with acute viral A hepatitis compared to those with chronic viral hepatitis. Also, chronic hepatitis patients were significantly anemic [mean HB concentration = 10.6g/dl] and thrombocytopenic [mean platelets count = 202 x 10 3/mm3] compared to patients with acute viral hepatitis [anemia was detected in 33% and thrombocytopenia was detected in 25% of chronic cases]. Abdominal US revealed that LN at the hepatoduodenal ligament [HDL] were found in 90% of patients with acute viral A hepatitis compared to 53% of patients with chronic viral hepatitis [B, C], and this difference was significant. Of importance, a direct positive relationship was found between total LN volume and liver function tests in patients with acute and chronic hepatitis, but this relationship was significant only for serum bilirubin [total, direct] of acute hepatitis patients
Conclusion: Abdominal US being an easy to perform, safe, and non-invasive diagnostic tool is recommended to be used for the evaluation and lollow-up of patients with acute and chronic viral hepatitis