The use of ultrasonography in infantile hypertrophic pyloric stenosis: does the patient's age and weight affect pyloric size and pyloric ratio?

AIMS: We aimed to obtain pyloric measurements of our patients with infantile hypertrophic pyloric stenosis (IHPS) using ultrasonography (US) and to evaluate the correlations between age, weight and pyloric size, pyloric ratio (PR). MATERIAL AND METHODS: We designed a retrospective study including 20 term infants with surgically proven IHPS and studied the ultrasonographically obtained pyloric muscle thickness (PMT), pyloric diameter (width) (PD), pyloric length (PL) and PR (PMT/PD) to determine if there were statistically significant associations between patient age/weight and pyloric measurements. RESULTS: The mean age of the infants was 38.7+/-17.3 days (range, 9-76 days) and their mean weight was 3688.5+/-772.7 g (range, 2810-6000 g), at referral. Mean PMT was 4.98+/-1.04 mm (range, 3.5-6.8 mm). Mean PD was 14.04+/-2.39 mm (range, 10-18 mm). Mean PL was 22.16+/-4.02 mm (range, 16-31.5 mm) and mean PR was 0.35+/-0.04 (range, 0.29-0.42). The correlation between age and PMT (r=0.654, p<0.05) and the correlation between age and PD (r=0.747, p <0.05) were significant. Age and weight were not significantly correlated with PR (p>0.05). CONCLUSIONS: The PMT and PD are age dependent parameters. The PR is age and weight independent and therefore, when combined with PMT, PD and PL, it can be useful in the diagnosis of IHPS in infants with early onset disease and/or in those with a lower weight.

Ultrasonographic and scintigraphic findings of thyroid hemiagenesis in a child: report of a rare male case.

Thyroid hemiagenesis is a rare congenital anomaly in which one lobe of thyroid gland fails to develop. It is much rarer in males. There is a higher incidence of associated thyroid disorders in patients with thyroid hemiagenesis; therefore early and prompt diagnosis is important for children. We present the ultrasonographic and scintigraphic findings of thyroid hemiagenesis in an eight-year-old-boy. On ultrasonography (US), left lobe of the thyroid gland could not be demonstrated and the right lobe showed minimal hyperplasia. Its echogenicity was normal and no nodule was seen. On thyroid scintigraphy, left lobe of thyroid gland or any ectopic thyroid tissue could not be demonstrated, while the right lobe showed minimal hyperplasia. Without performing any invasive procedure, we enrolled the child in a follow-up program with the guidance of US and scintigraphy, which were effective both in making the final diagnosis of thyroid hemiagenesis and in evaluating the current status of the present thyroid tissue. In conclusion, if only one thyroid lobe is detected in a pediatric case initially with US or scintigraphy, the diagnosis of thyroid hemiagenesis should be suggested and, before any unnecessary or invasive attempt, the other complementary method (scintigraphy/US) should be performed.

Ultrasonographic evaluation of ureteral stones in children: can we use stone width as a predictor of spontaneous passage?

AIMS: We aimed to obtain the maximum transverse diameters (widths) of ultrasonographically detectable ureteral stones in children and to evaluate the effect of widths on the rate of spontaneous discharge and on the degree of ipsilateral hydronephrosis. MATERIAL AND METHODS: We retrospectively evaluated 52 ultrasonographically detected ureteral stones in 51 consecutive patients (32 males, 19 females) with a median age of 9 years (range, 6 months-17 years). RESULTS: In group 1, in which the stones passed spontaneously (n=29), sonographically measured median and mean widths of ureteral stones were 3.8 mm (range, 2.3-7.3 mm) and 4.1+/-1.3 mm, respectively. In group 2, in which the stones required surgical procedures (n=23), median and mean widths were 5.9 mm (range, 3.9-10.0 mm) and 5.9+/-1.8 mm, respectively. The difference between widths in group 1 and group 2 was significant (p=0.001). With regard to the whole study group (n=52), the majority of the stones below 4.0 mm (88.9%, n=16/18) were passed spontaneously and 2/3 of the stones above 5.0 mm required intervention (66.7%, n=12/18). The width range of 4.0-5.0 mm can be accepted as "range of transition" for spontaneous passage and surgical procedures. The stone width was different in patients with mild and severe pelvicaliectasis (p=0.0001). CONCLUSIONS: In children, measuring the width of an ultrasonographically detectable ureteral stone can be useful for assessing its possibility to be passed spontaneously. Pelvicaliectasis should be an alerting sign for the presence of an occult ipsilateral ureteral stone in a symptomatic patient.

Wandering spleen in a child with symptoms of acute abdomen: ultrasonographic diagnosis. Case report.

We report the initial and follow-up ultrasonography (US) findings in a pediatric case of wandering spleen with symptoms of acute abdomen, as a rare entity. A four-year-old boy was referred with complaints of blunt abdominal pain, vomiting and fatigue. US detected an oval- shaped, mildly enlarged spleen with inferomedial displacement. In right lateral decubitus, the spleen showed further medial displacement. Five months later, control US revealed further enlargement of the displaced spleen. Seven months later, due to acute torsion of the spleen, splenectomy was performed.

Ultrasonographic findings of intussusception in pediatric cases.

PURPOSE: We aimed to characterize, by ultrasonography (US), the aspects, locations and the dimensions of intussusceptions in pediatric cases and to compare these data with the clinical findings and therapeutical outcomes. MATERIALS AND METHODS: We retrospectively evaluated abdominal US examinations and clinical data of 13 consecutive pediatric patients with intussusceptions. Patients are grouped according to the type of intussusceptions (ileocolic intussusceptions and intussusceptions with colocolic involvement) and according to the modality of treatment (surgical and non-surgical). RESULTS: Median age was 24 months (range 5-108 months). Eleven cases were surgically treated because of delayed referral. For all cases the mean diameter+/-SD of intussusception was 30+/-5 mm and mean length+/-SD was 59+/-21 mm. For ileocolic intussusceptions (n=9/11), mean diameter+/-SD was 29.1+/-4.4 mm and mean length+/-SD was 61.7+/-18.1 mm. The right upper quadrant of abdomen was the most common location for ileocolic intussusceptions (n=7/9), the rest were located in paraumbilical regions (n=2/9). For two cases of intussusceptions with colocolic involvement (ileocolocolic and colocolic intussusceptions located in right upper quadrant and left lower quadrant, respectively), mean diameter+/-SD was 37.5+/-0.7 mm and mean length+/-SD was 75.5+/-21.9 mm. The difference between mean diameters of ileocolic intussusceptions and intussusceptions with colocolic involvement was statistically significant (p =0.03), whereas the difference between mean lengths of these two groups was not statistically significant (p=0.36). For surgically treated cases (n=11/13), mean diameter+/-SD of intussusception was 30.6+/-5.2 mm and the mean length +/-SD was 64.2+/-18.5 mm. For non-surgically treated cases (n=2/13), with intussusceptions located in right lower quadrant, mean diameter+/-SD of intussusception was 27+/-4.2 mm and the mean length+/-SD was 32.5+/-10.6 mm. The difference between mean diameters of surgically and non-surgically treated cases was not statistically significant (p=0.37), whereas the difference between mean lengths of these two groups was statistically significant (p=0.04). CONCLUSIONS: A very good correlation between US and surgical findings was obtained. US should be used in all pediatric patients clinically suspected for intussusception. A relatively large, target-like and sandwich-like, incompressible intraabdominal bowel mass having the above mentioned dimensions should be looked for on US examination.

Giant mesenteric cyst of gastric origin: a case report with imaging findings.

We present a very rare case of a giant gastric mesenteric cyst with ultrasonography (US) and computed tomography (CT) findings. An eight-year-old boy was referred for treatment of an intraabdominal cyst, known to exist for six years. On abdominal US, a giant, thin-walled, unilocular intraabdominal cyst was demonstrated, extending from the epigastric region to the pelvis and measuring 18 x 15 x 6 cm. In contrast-enhanced abdominal CT, the cyst was demonstrated as a giant, unilocular, hypodense, non-enhancing structure, located dominantly on the right side of the abdomen. During open surgery, the cyst was found to originate from the mesentery-serosa of the gastric antrum and was filled with serous fluid. The cyst was excised totally. Both surgery and pathology confirmed the diagnosis of mesenteric cyst, originating from the stomach. The patient was discharged in good health. US and CT were effective in defining the features of the giant gastric mesenteric cyst and in narrowing the differential diagnosis in favor of mesenteric cyst.

Ultrasonographic diagnosis of congenital hydrometrocolpos in prenatal and newborn period: a case report.

Our purpose is to present the ultrasonographic findings of a rare case of prenatally and postnatally congenital hydrometrocolpos secondary to imperforate hymen. By ultrasonography (US) at 38 weeks of gestation, a retrovesical, 60 x 43 mm pelvic cystic mass, was demonstrated in a female fetus. After delivery, US of the newborn revealed a 77 x 60 mm retrovesical, pear-shaped cystic structure with internal echoes, interpreted as congenital hydrometrocolpos. Mild pelvicaliectasis in the left kidney was associated. At physical examination imperforate hymen was detected and a hymenotomy was done. After the hymenotomy, complete regression of the hydrometrocolpos and of the left renal pelvicaliectasis was demonstrated sonographically.

Induction of fetal diuresis with intraamniotic furosemide increases the clearance of intraamniotic substances: An alternative therapy aimed at reducing intraamniotic meconium concentration.

BACKGROUND/PURPOSE: Contact with amniotic fluid (AF) causes intestinal damage in gastroschisis. Intraamniotic meconium has been shown to be responsible for intestinal damage, and occurrence of this damage has been shown to depend on the concentration of intraamniotic meconium. When intraamniotic meconium concentration is lowered below threshold level by exchanging AF with saline in gastroschisis, intestinal damage can be prevented. Theoretically, induction of fetal diuresis with intraamniotic furosemide may increase AF volume and fetal swallowing rate, thus, increase absorption of AF by intestines; therefore, the clearance of meconium from the AF may increase. An experimental study was planned to investigate the effects of intraamniotic diuretic injection on the clearance of intraamniotic substances. METHODS: Pregnant rabbits on the 23rd to 25th gestational day were divided into 2 groups as furosemide and control. Technetium tc99m labeled "tin colloid" was injected into the amniotic cavity, and AF sample was taken 10 minutes later. Furosemide was injected into the amniotic cavity afterwards. Two and 6 hours later, AF samples were obtained. Intestines were harvested at the end of the study. Control group received intraamniotic saline instead of furosemide. Radioactivities of the AF samples and intestines were determined by gamma counter. Clearance of the radioisotope from AF and intestinal accumulation were calculated. RESULTS: The clearance of the radioisotope from AF was increased significantly in the furosemide group (n = 10) compared with the control group (n = 8; P <.01). Gastrointestinal accumulation of the radioisotope in the furosemide group was 4-fold higher than that the control group (P <.01). CONCLUSIONS: Induction of fetal diuresis with intraamniotic furosemide accelerates the clearance of intraamniotic substances. This is probably caused by increased urinary output rate, which increases AF volume and consequently results in increased fetal swallowing of AF. In the diseases like gastroschisis and myelomeningocele, in which the contact with AF causes tissue damage, the elimination of meconium from AF in a somewhat natural manner like this method, should be studied further because it may be an alternative minimal invasive in utero treatment modality.