ultrasound images of The paediatric abdomen

Ultrasound of the paediatric abdomen requires different techniques and skills from those used in the adult. Although there are a few situations in which knowledge of adult pathology can be applied to the paediatric patient, the child cannot simply be considered a mini-version of an adult.
The presenting symptoms and pathological processes in the child are generally quite different from those in adults and the operator must be fully aware of the special considerations of the paediatric patient in terms of both diagnosis and technique. This chapter addresses only the most common paediatric situations likely to be encountered in a general department, and further specialist paediatric reading is recommended.
Techniques
The operator can minimize any distress to the child, and make the examination considerably easier and quicker, in numerous ways.
● The ultrasound environment should be as friendly as possible, with appropriate decorations and toys, and should always be kept warm (nothing is more likely to make your patient uncooperative than cold gel). Minimize the time the child spends in the scanning room by having everything ready first. Small children may
benefit from seeing a video of a scan beforehand and being reassured that it will not hurt. 
● Most children find it reassuring to be accompanied by their carer during the examination Separate facilities, such as a dedicated children’s waiting area, are preferable and more reassuring for the child.
● The equipment should incorporate a range of high-frequency (5–15 MHz) transducers with small as well as conventional footprints. A small curvilinear transducer is useful for most abdominal work and a  high-frequency linear probe is essential for bowel sonography and assessment of the acute abdomen. Transducers with a dynamic frequency facility are an excellent choice, as it is easy to switch to the
highest possible frequency without having to change the transducer. The use of more than one transducer, that is, both curvilinear and linear, may be necessary, particularly in the assessment of the acute abdomen.
● A cine facility on the ultrasound machine is invaluable, and cuts down scanning time. Colour Doppler is essential in the assessment of hepatobiliary problems and the examination of the acute abdomen.
● Generally speaking it is necessary to employ a fast frame rate. (The smaller field of view needed for children allows the line density to remain high, maintaining adequate resolution.)
disease. Annual ultrasound examination is recommended as sonographic changes may be identified in the absence of abnormality on biochemical assessment. The liver may be hyperechoic and the texture becomes coarse and nodular as fibrosis develops (Fig. ultrasound images below). Increased periportal echogenicity may be demonstrated. Eventually cirrhosis develops, causing portal hypertension.
Assessment of the portal venous system with colour and spectral Doppler is useful, providing a baseline with which to compare progression of the disease.
image
ultrasound images of The gallbladder is small in up to one-third of patients3 (Fig.ultrasound images below). This microgallbladder measures less than 3 × 1 × 1 cm after fasting and is filled with mucus. Up to 10% of patients with CF may have gallstones; cholecystitis and biliary strictures may occur.
image
Ultrasound images of Microgallbladder. The gallbladder
is thick-walled and small, despite fasting.
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