1. Optimize the sonographic equipment to investigate properly children. 2. Identify the best indications and the limits of ultrasound in acute conditions in children. 3. Recognize characteristic and less characteristic features of the most common acute conditions encountered in children. 4. Provide a clear report of the examination and propose complementary examinations.
For most of abdominal emergencies in children, ultrasound is the imaging technique of choice and will be performed just after the clinical examination. Also, in order to be efficient, the technique should be optimized to the body shape of the child. Both sectorial and linear high resolution transducers should be used. Color and duplex Doppler are useful complementary tools in selected indications. Harmonic imaging can be used in obese patients.The spectrum of indications is wide.
In newborns, digestive diseases tend to be congenital rather than acquired. They might induce abdominal obstruction. Ultrasound should be able to detect the presence of masses, obstructed digestive tract and sometimes to differentiate between the different types of obstruction. Acute acquired conditions are usually related to necrotizing enterocolitis that will typically display hyperechoic air within the colonic walls or the portal veins. In older children, emergency conditions are most commonly related to appendicitis and intussuception. Ultrasound should be able to differentiate between appendicitis and other conditions leading to right flank pain. The technique is also most sensitive and specific for diagnosing acute intestinal intussuception. Another field of application of emergency abdominal ultrasound is the urinary tract that can be affected by various acute conditions. Ultrasound should be able to diagnose congenital and acquired urinary tract obstructions, to determine the level and the cause of obstruction. The role of ultrasound for the assessment of acute urinary tract infection and trauma is more controversial. Positive examinations are surely helpful but negative ones are of limited use and complementary examinations will be necessary.
Ultrasound is also the method of choice for investigating acute biliary tract obstruction and gallbladder diseases in children. In case of abdominal trauma, the same limitation aplies as for renal trauma
Avni, F,
Ultrasound in Pediatric Abdominal Emergencies. Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL.
http://archive.rsna.org/2007/5000652.html
