Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux.

OBJECTIVE: Our aim was to provide exact sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux (GER) and to investigate its diagnostic value. GER severity and hiatal hernia presence were also evaluated and correlated with esophageal length. MATERIALS AND METHODS: This retrospective case-control study comprised 258 neonates and infants (150 without reflux and 108 with reflux). There were 50 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 42 were less than 1 month old; 34, 1-6 months; and 32, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. The number of refluxes during a 10-min period were recorded; GER was categorized as mild, one to three refluxes; moderate, three to six refluxes; and severe, more than six refluxes. Presence of hiatal hernia was recorded. RESULTS: Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.8 mm; 1-6 months, 4.5 mm; 6-12 months, 3.4 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. In contrast, children with reflux associated with hiatal hernia had a significantly shorter esophagus compared with children with mild reflux in all three age groups. Sonographic sensitivity was 94%. CONCLUSION: Sonographic measurement of the abdominal esophagus length is highly diagnostic for GER in neonates and infants. In neonates, it can also indicate GER severity. Hiatal hernia is associated with a significantly shorter abdominal esophagus.

Hemorrhage in the cavum septi pellucidi, and a brief review of the literature.

The aim of this study is to present the cases of four neonates with hemorrhage within the cavum septi pellucidi (CSP). The sonographic findings of this rare location of intracranial hemorrhage, the related pathology and the possible underlying mechanisms are discussed, with a brief review of the literature. Three out of four of the neonates were premature and the fourth was a full-term infant with Down's syndrome. In all the patients the hemorrhage in the CSP was associated with severe intracranial hemorrhage.

Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction.

OBJECTIVE: Our aim was to assess the sonographic appearance of enlarged lymph nodes in the intussusception in infants and young children and to investigate whether the enlarged lymph nodes affect the hydrostatic reduction rate of intussusception. MATERIALS AND METHODS: This retrospective case control study included a total of 65 children with intussusception, consisting of two groups: a study group of 28 patients with lymph nodes detected in intussusception and a reference group of 37 patients of similar age without lymph nodes in intussusception. The selection criterion for the study group was the presence of a minimum of two lymph nodes, of which at least one had a long axis of 11 mm or greater. The intussusception patterns, target or doughnut-like, and the presence of trapped fluid in the intussusception were also evaluated. Clinical records were reviewed for associated disease. The reducibility of both study and reference groups was assessed and correlated with all the sonographic features mentioned. RESULTS: Twenty-two of the 28 patients in the study group and none in the reference group had a recent or a current history of gastroenteritis. The overall hydrostatic reduction rate was 46.4% in patients with enlarged lymph nodes in the intussusception and 81.1% (p < 0.005) in patients without enlarged lymph nodes in the intussusception. Larger rather than numerous lymph nodes significantly affected the reducibility rate. Most of the reference group patients had a hydrostatic reduction at first attempt, whereas a second attempt at hydrostatic reduction was required in most of the study group patients. CONCLUSION: Enlarged lymph nodes in the intussusception are mainly found in patients with a current or recent history of gastroenteritis and decrease the overall hydrostatic reduction rate.

Sonographic features indicative of hydrostatic reducibility of intestinal intussusception in infancy and early childhood.

The aim of the study was to investigate the various sonographic patterns of intussusception, which may be indicative of its reducibility by hydrostatic reduction. Seventy-one infants and children clinically suspected of having intussusception were studied sonographically and given barium enemas. Sonographic patterns of intussusception were correlated with its reducibility. When the head of intussusception appeared as a target-like mass the hydrostatic reduction rate was 100%. When demonstrated as a doughnut-like mass, the intussusception reducibility depended on the thickness of the hypoechoic external ring of the "doughnut". With a thickness equal to, or less than, 7.2 mm the reduction rate was 100%, with a thickness ranged between 7.5 and 11.2 mm the reduction rate was 68.9% and with a thickness measured 14 to 14.2 mm a surgical resection of bowel was required. When a small amount of fluid appeared within the head of intussusception, like a crescent hypoechoic area, the hydrostatic reduction was unsuccessful, regardless of the sonographic pattern of intussusception (target- or doughnut-like mass). The presence of a small amount of free peritoneal fluid did not affect the reducibility of intussusception. In conclusion, sonographic patterns of intussusception identify good and poor prognostic features for the success of hydrostatic reduction.

Appendiceal and appendiceal-ileocolic intussusception: sonographic and radiographic evaluation.

The sonographic appearances of two children with appendiceal intussusception and two others with appendiceal-intestinal intussusception are described. All the cases were documented by barium enema and surgically confirmed.

Cystic dysplasia of the testis: a rare cause of painless hemiscrotal enlargement in childhood.

Cystic dysplasia of the testis is a rare, benign cause of painless hemiscrotal enlargement in children. We present two cases of cystic dysplasia of the testis presenting with scrotal enlargement. The diagnosis was based on its specific sonographic findings and on the coexistence of a multicystic dysplastic kidney in one case.

Scrotal hematocele as an unusual presentation of blunt abdominal trauma in three male infants.

Three infants presented with bluish discoloration and swelling of the scrotum with no history of scrotal trauma. Sonography revealed unilateral hematoceles in 2 cases and bilateral hematoceles in the third. All 3 infants had intact testes. The communicating hematoceles were the result of hemoperitoneum due to splanchnic hematoma.

Perforation of multiple gastric duplication cysts: diagnosis by sonography.

A case of perforation of multiple gastric duplication cysts is presented. The rarity of this case is based on its multiplicity, its small size, its perforation into peritoneal cavity, as well as on the detection of tiny foci of ectopic pancreatic tissue at the site of perforation. The sonographic appearance and the clinical manifestations are discussed.

New sonographic appearance of hepatic mesenchymal hamartoma in childhood.

We present clinical, radiographic, and sonographic findings in 3 children with hepatic mesenchymal hamartoma, a rare benign tumor of childhood. The presence of round hyperechoic parietal nodules within the cystic spaces of the hamartomas is a new sonographic finding.

Torsion of an accessory hepatic lobe in a child: ultrasound, computed tomographic, and magnetic resonance imaging findings.

A case of acute epigastric pain resulting from torsion of an accessory hepatic lobe is reported. Sonographic, computerized tomographic, and magnetic resonance findings are illustrated and the surgical management is discussed.

Aberrant thymus in infants: sonographic evaluation.

We report five children with aberrant thymus, four of whom presented with an upper suprasternal mass and one with a lateral neck mass. Awareness of this entity, together with knowledge of its variable presentation, is essential for unnecessary surgery to be avoided. US should be the initial diagnostic approach and occasionally leads to the correct diagnosis.