Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US.

PURPOSE: To describe the diagnostic features, appearance, and vascularization pattern of venous malformations (VMs) at Doppler ultrasonography (US). MATERIALS AND METHODS: Between February 1991 and May 1997, 51 soft-tissue VMs were studied with Doppler US in patients between 1 day and 21 years of age (mean age, 9 years). These VMs were located in the maxillofacial region (n = 19), trunk (n = 5), and upper (n = 10) and lower (n = 17) extremities. Twenty-three VMs had venographic confirmation, seven had only histologic confirmation, and 21 had both venographic and histologic confirmation. US was performed with 7.5- or 7-10-MHz linear transducers, a low pulse repetition frequency (mean, 1,680 Hz), and the lowest wall filter (25-50 Hz). RESULTS: At gray-scale US, VMs appeared as hypoechoic, heterogeneous lesions in 82% of cases. All lesions displayed compressibility. In eight lesions (16%), phleboliths were identified, thus confirming the diagnosis of VM. Analysis of vascular flow revealed monophasic, low-velocity flow in 40 VMs (78%), with an average flow velocity of 0.22 kHz. Biphasic flow was noted at the periphery of three lesions, which is indicative of a mixed capillary-venous malformation. The remaining eight lesions did not display any flow. CONCLUSION: In pediatric patients, Doppler US is a noninvasive, easily available, and rapid mode of investigation of vascular lesions and can help confirm the diagnosis of VM when it shows a characteristic flow pattern.

Percutaneous cholecystography in children.

Percutaneous cholecystography was performed on 13 children who had biliary system abnormalities: two had biliary hypoplasia, five had sclerosing cholangitis, three had cirrhosis, two had distal choledochal obstruction, and one had an obstructed portoenterostomy. In 12 patients transcholecystic cholangiography showed, without significant complications, the intra-and extrahepatic bile ducts. In one patient with primary sclerosing cholangitis, the intrahepatic bile ducts were not opacified satisfactorily; dilatation of the gallbladder required surgical drainage. The transcholecystic technique is indicated when the intrahepatic bile ducts are either mildly dilated or not dilated.

Liver involvement in chronic granulomatous disease: the role of ultrasound in diagnosis and treatment.

Ultrasonic features of liver involvement in six children with chronic granulomatous disease (CGD) are reported. Hepatic granulomas appeared as hypoechoic, poorly marginated areas without posterior enhancement. In two cases, the diagnosis of CGD was suggested by this sonographic pattern. Ultrasound follow-up of the granulomas was used to plan therapy: in three cases, the granulomas subsided with antibiotic treatment alone; three patients underwent surgery because of the persistence of the granuloma and/or its modification into a fluid-filled abscess with good sound transmission throughout. Percutaneous biopsy and aspiration under sonographic guidance were performed in the two cases where CGD had not been diagnosed previously; such procedures permitted recognition of the disease based on histologic study, drainage of a defined abscess, and identification of the infecting organism. Healing of the hepatic lesions was documented in all six patients.

The dotted corticomedullary junction: a sonographic indicator of small-vessel disease in hypertensive children.

Six children with hypertension are reported where ultrasound showed a striking increase in the intrarenal vascular echoes. This pattern, the dotted corticomedullary junction, appears to represent a diffuse calcifying process involving the elastic fibers of the wall of small arteries.

Juvenile nephronophthisis: sonographic appearance in children with severe uremia.

The authors reviewed the sonograms in 15 cases of juvenile nephronophthisis. Medullary cysts were demonstrated in 13 children with terminal uremia. The diagnostic value of ultrasound is stressed because in many cases relevant genetic and pathological data are not available.