Ultrasonographic assessment of Salmonella enterocolitis in children

Background. Salmonella enterocolitis (SE) is one of the important causes of acute infectious diarrhoea. Imaging studies are rarely performed on these patients. Consequently, ultrasound (US) features of SE are controversial. Objective. To identify the clinical significance of US in the evaluation of SE. Material and methods. Abdominal US was performed in 15 patients with SE and 9 patients with Rotavirus enterocolitis (RE). Results. Ascites was present in 60 % and mural thickening of the colon in 40 % of patients with SE on abdominal US, whereas we could not identify these features in patients with RE. In patients with SE, colonic wall thickening; and ascites, the levels of C-reactive protein (CRP) were significantly higher as compared to patients with SE and no colonic wall thickening or ascites. Also, the stool occult blood test was positive more often in patients with colonic wall thickening and ascites on US than in patients without these findings. The colonic wall thickness significantly correlated with CRP and stool occult blood level. Conclusions. US is able to identify pathological changes in bowel and intra-abdominal spaces. The US findings of ascites and colonic wall thickening may be useful for determining the severity of SE. Received: 3 July 1998 Accepted: 30 November 1998     

Normal thyroid volume by ultrasonography in healthy children

With the objective of creating standards for the volume of the thyroid gland by ultrasonography in the 0-16-year age group, thyroid volumes of 302 healthy children (150 boys, 152 girls) were measured by ultrasonography. The transverse (x), sagittal (y) and anteroposterior (z) lengths of the right and left lobes and isthmus were measured. Volumes of these were calculated by the ellipsoid volume formula [V = (pi/6) x x x y x z]. Statistical analysis was done using the Kruskal-Wallis and Student t tests. The cases were divided into six and eight groups by age and height, respectively. There was a significant positive correlation between thyroid volume, age, height and weight. Thyroid volumes in children of 12 years and over were significantly different from those in the younger age groups.     

Ultrasonographically determined thyroid gland volume in children]

The size of the thyroid was evaluated by sonography in 199 boys and 237 girls age one month to 17 years. The volume is 1.2/1.06 ml in boys/girls during the first month, 1.2/1.6 ml at the end of the first year of life, 1.7/2.4 ml at age four, 3.2/3.4 ml with eight years and up to the age of 12 years 5.7/5.7 ml. In juveniles older than 12 years the average volume is 8 ml, sex independently. However, the range appears to be rather wide (1.5-14.5 ml). The right lobe is usually larger than the left one. The rates of the length of the right lobe and the body length, of the total volume and the body weight, and of the total volume and the body surface area are almost independent of age for schoolchildren. There is no significant difference of the thyroid volume between the sexes.     

Sonographic assessment of renal volume in Indian children

In an attempt to making norms of renal volume (RV) in Indian children, 240 children (137 boys and 103 girls) below 5 years of age were subjected to sonographic examination in supine position. Left RV in female children increased from 18.04 mm³ in early infancy to 48.36 mm³ in 4–5 year age group. Similar increase was observed in the right RV. There was no significant left vs. right difference in RV in boys and girls (p>0.05). Similarly, the RV did not differ significantly in both sexes (p>0.05, in all age groups except 4–5 years, p=0.04).     

Ultrasonographic assessment of the gallbladder in 21 children with portal vein thrombosis

Background: Portal vein thrombosis (PVT) is one of the most frequent causes of portal hypertension (PH) during childhood. Portal systemic collateral vessels occur at several locations, including the gallbladder (GB). Objective: To evaluate the GB in patients with PVT using US to assess GB wall thickness and its function, and the incidence of lithiasis and varices. Materials and methods: A prospective study was done on 21 children and young adults whose ages ranged from 17 months to 20 years and 10 months (mean age: 11 years and 7 months). A control group was matched for age and sex. All of the patients and controls fasted for at least 6 h prior to the US examination. The GB measurements included anterior wall thickness. These measurements were obtained before the ingestion and then 30 and 60 min after the ingestion of a meal containing at least 25 g of fat. The rate of GB contractility was calculated based on these results. The presence of varices in the GB wall was detected by the characteristic serpentine shape of the intramural vessels and by the venous flow using pulse duplex and color Doppler imaging. The presence of biliary lithiasis was confirmed by shadowing. The chi-square test, the exact Fisher test and the Mann–Whitney test were used to compare the results. Results: Biliary lithiasis occurred in 3 (14.2%) of the 21 patients. The GB wall was thickened in 13 (61.9%) of the 21 patients, which corresponded with the number of patients with GB varices. The wall dimensions of all the controls were within normal limits. In patients with PVT; GB contractility was lower than in the 21 patients used as control and resulted in a significant difference in all of the measurements. Conclusion: GB varices are very common in children with PVT, and it is noted especially in patients whose GB wall was thickened and in whom the GB contractility was reduced. Lithiasis could be a consequence of the decreased contractility of GB.     

Ultrasonographic assessment of intragastric volume in neonates: Factors affecting the relationship between intragastric volume and antral cross-sectional area

Measuring antral crosssectional area by ultrasonography can be an ideal way to evaluate intragastric milk volume in infants. Technical details, however, remain to be established before its clinical application. We investigated the effects of posture and ultrasonographic plane on the correlation between milk volume and antral cross-sectional area. After gastric aspiration through a nasogastric tube, healthy newborns were fed 0, 10, 20, and 40 ml of milk cumulatively, and antral cross-sectional area was measured in either upright, sitting, or right lateral position. To determine the best sonographic plane, subjects were put in the right lateral position and antral cross-sectional area was measured in the plane of the aorta and either the superior mesenteric artery, the superior mesenteric vein, the midline of the abdominal surface, 1 cm right of midline, or 2 cm right of midline. The results showed that antral cross-sectional area reflects intragastric milk volume most accurately, with minimal gas interference when measured in the right lateral position. The area correlates well with milk volume in the plane of the aorta and either the superior mesenteric artery, the superior mesenteric vein, or the midline. Next, we studied the effect of intragastric gas on the antral cross-sectional area in subjects who were given 40 ml of milk followed by an injection of air. More than 20 ml of intragastric gas increases antral cross-sectional area significantly. Ultrasonographic evaluation of intragastric volume requires attention to the above factors.     

Ultrasonic assessment of the lingual thyroid gland in children

Demonstration of ectopic thyroid tissue is diagnostic of thyroid dysgenesis. Delineating the lingual thyroid is, therefore, one of the important issues in ultrasonic imaging. We delineated the lingual thyroid in eight patients with congenital hypothyroidism using two basic scanning positions: the midline sagittal and the posterior coronal views of the floor of the mouth. All the lingual thyroids were located close to the hyoid bone. This location correlated well with the observations on radioisotope scanning. We emphasise the importance of a knowledge of the sonographic anatomy of the floor of the mouth in obtaining satisfactory results in this examination. Received: 3 February 1997 Accepted: 3 October 1997     

Cholera gastroenteritis amongst children in Delhi

Cholera gastroenteritis amongst 3595 children under twelve years suffering from acute watery diarrhea was studied for a period of five years (1982–86).V. cholerae 01 could be isolated from 31·7% of total specimens studies. Distribution in different age groups out of total gastroenteritis cases was 7·5% in <2 years, 13·1% in 2–5 years and 11·1% in >5–12 years. Out of total cholera cases (1141 isolate) 23·4% occurred in the age group <2 yrs., 41·4% in 2–5 yrs. and 35·1% in > 5–12 yrs. Infection occurred more often in males in all the age groups. Throughout the study, cholera was observed during summer monsoon season with Ogawa being predominant serotype.     

Physical growth of school children in Delhi

Summary In a cross sectional and semilongitudinal anthropometric study of 550 healthy school age children from class 1 socio-economic group, it was observed that given appropriate nutritional and health support in a good environment, Indian children were capable of achieving better standards of growth than their counterparts in not so good a milieu. The data were recorded meticulously within a week of the exact points in age. The velocity of growth was nearly identical in boys and girls from the age of 5 to 7 1/2 years. Thereafter the growth in girls was higher than in boys till the age of 11–11 1/2 years and was nearly equal between 12–12 1/2 years. Subsequently the boys gained weight and height more rapidly. The maximum weight gain in both boys and girls occurred between 12–12 1/2 years. Gain in height was most marked between 12–12 1/2 years in girls and 13–13 1/2 years in boys. Pubertal spurt occurred earlier in girls. From the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi-16.     

Ultrasonographic spectrum of choledochal cysts in children

Four different sonographic patterns which may be encountered in choledochal cyst are described. The most common form is concentric dilatation of the common bile duct (Type I). Rarely eccentric dilatation of the common bile duct, diverticulum, may be seen (Type II). Both forms of the disease may (Types IB and IIB) or may not (Types IA and IIA) be associated with intrahepatic biliary dilatation.     

Ultrasonographic evaluation of abdominal masses in children

Ultrasonography is a recently acquired diagnostic modality in our sub-continent. The initial experiences with this technique in 55 children with abdominal masses are presented. In 15 children ultrasonography merely confirmed the diagnosis which was arrived at by other means; a positive contribution towards the final diagnosis was made in 33 children, while in 7, ultrasonography did not contribute towards the diagnosis. The scope, advantages and pitfalls of ultrasonography are briefly discussed.     

Ultrasonographic evaluation of abdominal masses in children

Ultrasonography is a recently acquired diagnostic modality in our sub-continent. The initial experiences with this technique in 55 children with abdominal masses are presented. In 15 children ultrasonography merely confirmed the diagnosis which was arrived at by other means; a positive contribution towards the final diagnosis was made in 33 children, while in 7, ultrasonography did not contribute towards the diagnosis. The scope, advantages and pitfalls of ultrasonography are briefly discussed.     

Ultrasonographic diagnosis of inguinal hernia in children

During the past 2 years, 124 children with inguinal hernias diagnosed clinically and confirmed at operation were managed at our clinic. The processus vaginalis in the inguinal canal was examined preoperatively in all children by ultrasonography with a 10-MHz transducer (SSD-650CL, ASU-35WL-10, Aloka, Tokyo) as the intra-abdominal pressure increased and decreased. The ultrasonograms were divided into four types; type I, the intestine is observed in the inguinal canal; type II, the cystic pattern is seen at the internal ring of inguinal canal; type III, the patent processus vaginalis (PPV) enlarges when abdominal presure increases; and type IV, the PPV contains moving material without enlargement. Type I was observed in 17 children (11 males and 6 females), type II in 26 (6 males and 20 females), type III in 74 (60 males and 14 females), and type IV in 7 males; 71% of the male children showed type III and 50% of the females type II. All children with type IV had a communicating hydrocele. These results indicate that children showing one of the four ultrasonographic types have an inguinal hernia.