Urachal remnants: sonographic demonstration in children

On 62 of 100 pediatric bladder sonograms a small, elliptical, hypoechoic structure was observed on the middle of the anterosuperior surface of the urinary bladder. One of the these structures was removed surgically, and pathologic examination disclosed a normal urachal remnant. Since it is a common sonographic finding in children, it should not be mistaken for a pathologic process unless it is accompanied by signs and symptoms of infection or bladder obstruction.     

Investigation of vesicoureteral reflux with colour Doppler sonography in adult patients with spinal cord injury

The aim of the study was to evaluate prospectively the performances of colour Doppler sonography for detection of vesicoureteral reflux in adult patients with neurogenic bladder due to spinal cord injury. One hundred eighty-seven adult patients who had developed neurogenic bladder due to spinal cord injury underwent retrograde cystography and sonographic evaluation by B-mode and colour flow Doppler sonography (CFDS). Results of both examinations were analyzed independently by two radiologists. Representative images of the sonographic evaluations were recorded on videotape and CD-Rom. CFDS detected reflux in 20 ureters while retrograde cystography revealed vesicoureteral reflux (VUR) in 25 ureters of a total of 374 ureters, which were examined by both methods. Sonography detected all cases of grades IV and V of reflux, 7 of 8 (87.5%) of grade III, 5 of 6 (83.3%) of grade II, and 4 of 7 (57.14%) of grade I. There were 6 false-positive and 5 false-negative findings with Doppler examination compared with retrograde cystography. Therefore, sensitivity and specificity of sonographic examination were 80 and 98.28%, respectively, with a positive predictive value of 76.92%. Colour flow Doppler sonography can play an important role in detection of VUR in spinally injured adult patients with neurogenic bladder and can be an effective imaging tool for follow-up.     

Sonography of the lower urinary tract

According to literature and to our experiences sonography should be the first investigation of the lower urinary tract in children, if there is suspicion of obstruction or malformation. In many cases the localisation of obstruction or the diagnosis of malformation can be found. Furthermore by sonographic follow-up studies of ureter obstructions by tumors, by concrements or after surgery, the normal radiographic investigations like urography or retrograde pyelography can be reduced. Sonography is a valuable enrichment for investigations of functional and morphological changes of the urinary bladder, especially for the classification of bladder tumors: whereas the diagnosis of urethral diseases still is found by clinical investigations and conventional radiological procedures.     

Intramural Teflon injection of the ureter for treatment of vesicoureteral reflux: sonographic appearance

Endoscopic injection of Teflon paste under the submucosal portion of the ureter in the bladder is a new treatment for vesicoureteral reflux. Twenty-one children at The Montreal Children's Hospital and at St. Justine Hospital were treated with this technique over a 2-year period. In 15 children, abdominal sonography was performed 1-5 days after Teflon paste injections. Follow-up sonograms performed 5 weeks to 1 year after the procedure are available in nine children. Sonographically, the Teflon paste at the injection site appears as a hyperechoic focus within the bladder wall with distal shadowing seen postoperatively and on follow-up examinations. This finding occurred in 22 (88%) of 25 treated ureters. The location of Teflon paste after injection as viewed via cystoscopy is correlated with the sonographic appearance. This preliminary report suggests that sonography is useful in determining the location and size of the Teflon mass, in evaluating surrounding soft tissues at various time intervals after injection, and in assessing possible complications such as obstruction.     

Sonography of the normal female urethra

This report of the sonographic appearance of the normal adult female urethra includes discussion of the anatomy and four representative cases. Six sonograms are shown that demonstrate normal urethras in both sagittal and transverse sections of pregnant and nonpregnant women. This anatomy is easily demonstrated with a sonographic B scanner. Insufficient knowledge of the sonographic appearance of the normal female urethra may lead to the erroneous diagnosis of a urinary bladder tumor.     

小儿卵巢肿瘤的超声诊断

目的:探讨彩色多普勒超声诊断小儿卵巢肿瘤的价值。材料和方法:回顾性分析24例超声诊断为小儿卵巢肿瘤的超声声像图表现并与手术、病理结果对照。结果:1例膀胱横纹肌肉瘤误诊为卵巢实质性肿瘤。23例经手术确诊为小儿卵巢肿瘤的病例中,4例超声诊断与病理不符,其中1例卵巢囊肿伴扭转坏死误诊为卵巢成熟畸胎瘤;1例卵巢成熟畸胎瘤伴扭转坏死及2例卵巢上皮性肿瘤伴扭转坏死误诊为卵巢囊肿伴扭转。超声诊断9例卵巢肿瘤伴扭转,术中证实扭转7例,6例坏死。结论:超声诊断小儿卵巢肿瘤及其是否扭转准确性较高,可作为首选影像学检查方法。     

Transitional cell carcinoma of the bladder in children: radiologic appearance and differential diagnosis

Primary epithelial tumors of the bladder are rare in children. We report a case of transitional cell carcinoma (TCCa) of the bladder in a 10-year-old boy who was evaluated with intravenous urography, ultrasonography, and computed tomography (CT). The radiographic appearance and a differential diagnosis are discussed. The literature of TCCa of the bladder in children is reviewed.     

Transitional cell carcinoma of the bladder in children: Radiologic appearance and differential diagnosis

Primary epithelial tumors of the bladder are rare in children. We report a case of transitional cell carcinoma (TCCa) of the bladder in a 10-year-old boy who was evaluated with intravenous urography, ultrasonography, and computed tomography (CT). The radiographic appearance and a differential diagnosis are discussed. The literature of TCCa of the bladder in children is reviewed.     

Sonographic demonstration of intestinal involvement in Henoch-Schönlein syndrome

We evaluated the efficacy of intestinal sonography in the diagnosis of gastrointestinal involvement of Henoch-Schönlein syndrome (HSS). Intestinal sonography was performed in 20 children who were clinically diagnosed as HSS and sonographic findings of the intestinal system were reviewed. Out of 20 patients, 10 who suffered from abdominal pain demonstrated sonographic findings consistent with small intestinal involvement (dilatation of intestinal segments, hypomotility, and eccentric thickening of the intestinal wall). Our results reveal that sonography of the intestine may be useful in the evaluation of the involvement of HSS.     

Spontaneous extraperitoneal rupture of the urinary bladder in children

The authors describe two children who had spontaneous extraperitoneal rupture of the urinary bladder into the retropubic space secondary to acute urinary retention following lower urinary tract surgery. One also had urinary ascites. In one, the urinoma was initially mistaken for the bladder during ultrasonography. In both cases, the diagnosis of bladder rupture was not considered initially because of a lack of familiarity with the occurrence of this entity in children.     

Sonographic findings of ectopic prostatic tissue in the bladder: a case report and review of the literature

Ectopic prostatic tissue in the bladder has rarely been reported, and there is currently no report about the sonographic findings of this entity. In this study, we present the imaging findings of ectopic prostatic tissue in the bladder on transrectal ultrasonography.     

The hyperechogenic liver in children: cause and sonographic appearance

The clinical records of 28 patients seen in one institution during a recent 2 year period who, on sonography, had been identified as having a hyperechogenic (bright) liver were reviewed. Seven children were diagnosed as having metabolic diseases, four were malnourished, four were receiving hyperalimentation, 10 were receiving chemotherapy, and three were undiagnosed. The sonograms of all the patients and the histologic sections on those who had biopsies, were reevaluated in order to assess the sonographic pattern in greater detail, and these findings were correlated with fatty infiltration and fibrosis of the liver. The bright liver corresponded to the pathologic finding of fatty change. This sonographic finding in children is important, as further evaluation (hepatic biopsy with fat stain, enzymatic analyses, amino acid screens) can be suggested to identify underlying metabolic disorders in those not on therapy. Often the complications of metabolic diseases can be prevented or delayed by early diagnosis and appropriate therapy.     

Type 1 primary hyperoxaluria in pediatric patients: renal sonographic patterns

OBJECTIVE: Our aim was to review the sonographic features of type I primary hyperoxaluria in children and to correlate the sonographic patterns with the clinical development of end-stage renal disease (ESRD). MATERIALS AND METHODS: We performed a retrospective analysis of the clinical and imaging files of 13 patients with type I primary hyperoxaluria who were treated in one institution and of the sonographic patterns and the clinical follow-up reports. RESULTS: We encountered the following two sonographic patterns: medullary nephrocalcinosis in eight patients and cortical nephrocalcinosis in five patients. The sonographic appearance of cortical nephrocalcinosis is quite specific: a hyperechoic peripheral renal cortex with acoustic shadowing behind it. Medullary nephrocalcinosis is less specific because there are many other causes of hyperechoic pyramids. All patients with medullary nephrocalcinosis developed lithiasis during the course of the disease. All patients with cortical nephrocalcinosis but only two of eight with medullary nephrocalcinosis developed ESRD. CONCLUSION: Sonography can be used differentiate the two patterns of type 1 primary hyperoxaluria. The cortical nephrocalcinosis type carries a higher risk of developing ESRD.     

Virtual endoscopy using perspective volume-rendered three-dimensional sonographic data: technique and clinical applications

OBJECTIVE: We present a technique for obtaining three-dimensional external and virtual endoscopy views of organs using perspective volume-rendered gray-scale and Doppler sonographic data, and we explore potential clinical applications in the carotid artery, the female pelvis, and the bladder. CONCLUSION: Using the proposed methods, radiologists will find it possible to create virtual endoscopy and external perspective views using sonographic data. The technique works well for revealing the interior of fluid-filled structures and cavities. However, expected improvements in computer performance and integration with existing sonographic equipment will be necessary for the technique to become practical in the clinical environment.     

Cholestatic syndromes in infancy and childhood

Of 33 children with various cholestatic syndromes who were studies with sonography, 19 also had 131I rose bengal scintigraphy, and 12 also had 99mTc sulfur colloid scintigraphy. Patients were categorized into intra- or extrahepatic etiologies for their cholestasis. Of 19 children in the extrahepatic category, 17 had abnormal sonographic studies; two with biliary atresia appeared normal. All 14 patients in the intrahepatic category had normal sonographic studies. Rose bengal was most useful when demonstrating biliary patency. Some cases of biliary atresia with normal sonography and lack of rose bengal excretion into the intestinal tract could not be separated from cases of neonatal hepatitis using a similar combination of studies. Radiocolloid studies were less valuable than other examinations except when demonstrating diffuse hepatic reticuloendothelial dysfunction as found in two cases of congenital syphilitic hepatitis.     

Bladder pheochromocytoma encountered on sonography

Pheochromocytomas of the bladder are rare neoplasms, constituting < 0.06% of all vesical tumours. Common presenting features of this tumour include episodes of sweating, hypertension, haematuria and postmicturition syncope. We describe a case of bladder pheochromocytoma in a 66-year-old man whose only symptom of macroscopic haematuria was initially assessed with ultrasonography. Clinical presentation highlights the need for a high index of suspicion during sonographic evaluation of bladder neoplasms because such tumours might present without symptoms of adrenergic excess.     

Arnold-Chiari malformation. Contribution of cerebral echography in the pretherapeutic evaluation]

From August 1988 to August 1989, we performed pre-operative sonographic examinations on eleven children who had Arnold-Chiari malformation (ACM). All children presented with myelomeningocele. ACM was the leading cause of hydrocephalus in infants and newborns. For eight children, hydrocephaly was particular by the discrepancy between the dilated atrium and the relatively small temporal horns. Two children have associated extra-neurologic malformations. Five patients were operated upon, with poor results in four. In our experience, ultrasonography was found very useful in patients presenting with myelomeningocele.     

Large amounts of debris in the neuropathic bladder in persons with spinal cord injury; value of ultrasound scan in detection and management of vesical debris

Persons with spinal cord injury are at risk for developing debris in the neuropathic bladder. Ultrasound scan of the urinary bladder helps to (1) detect debris, (2) differentiate debris from other bladder lesions, (3) alert the spinal cord physician to review bladder management, and (4) monitor the effect of various treatment regime to clear the debris. We present 4 cases to illustrate the sonographic appearances of debris in the neuropathic bladder and how treatment plans tailored to the needs of the individual patient helped to clear the debris.     

Value of transrectal and transvaginal ultrasonic tomography using an electronic linear scanner in staging bladder tumors

The results of sonographic studies of 48 patients with carcinoma of the urinary bladder are discussed. The value of longitudinal intracavitary sonography for assessment of the local extent of malignant tumors of the bladder was studied. This method is thought to be extremely useful when tumors are localized on the neck, base and front wall of the bladder, whereas transabdominal sonography gives valuable diagnostic information if the lateral and back walls are involved. Combined sonography must be used for assessment of the local extent of carcinoma of the urinary bladder as it is of high accuracy, non-invasive and safe.     

Contrast-enhanced harmonic imaging for the diagnosis of vesicoureteral reflux in pediatric patients.

OBJECTIVE: Harmonic imaging using phase or pulse inversion technology is a new sonographic diagnostic modality that has the potential to produce images of a higher quality than can be obtained with the conventional method. The aim of this study was to compare both types of harmonic modalities--tissue and contrast harmonic imaging--with the fundamental imaging mode in contrast-enhanced B-mode sonographic diagnosis of vesicoureteral reflux. SUBJECTS AND METHODS: Fifty-four children presenting for diagnostic examination of vesicoureteral reflux underwent standard sonography of the urinary tract in the fundamental mode, followed by intravesical administration of a galactose-based contrast medium containing microbubbles. The contrast-enhanced sonography was conducted by scanning the bladder and each kidney in transverse and longitudinal planes, from ventral and dorsal views, consecutively in B-mode using fundamental, contrast harmonic, and tissue harmonic imaging modalities. Soft-touch buttons on the console screen were used to alternate between the three imaging options, so that switching from one modality to the other could be done almost instantaneously. For comparison, in each patient, we selected one set of contrast-enhanced images of the bladder and two sets, one ventral and one dorsal, of the kidney. In a series, the images were compared and ranked from 1 to 3, with 1 being the best, with regard to sonomorphology (demarcation of the retrovesical space and renal pelvis as the potential sites to look for vesicoureteral reflux) and reflux detection and conspicuity, if present. RESULTS: In all, 248 sets of images were available for comparison. The delineation of both the retrovesical space and the renal pelvis was found to be best with tissue harmonic imaging in 84% and 96% of the image sets, respectively (p < 0.01). Forty-one sets of images were compared from 27 kidney-ureter image units of 22 children (41%) with reflux. The refluxing microbubbles were much more conspicuous in the harmonic imaging mode (tissue harmonic, 100%; contrast harmonic, 93%) than in the fundamental mode (p < 0.01). In eight kidney-ureter units, the reflux was detected only by using the harmonic imaging modalities. CONCLUSION: Visualization of the urinary tract and detection of ultrasound contrast media is significantly improved by the use of the harmonic imaging modalities. When both fundamental and harmonic imaging options are available, we recommend harmonic imaging for contrast-enhanced sonographic diagnosis of vesicoureteral reflux.