Abdominal and pelvic ultrasound examination (sonography) in childhood

If an abdominal disorder occurs, in most cases the ultrasound examination provides a fast, effective and painless solution for the detection of the cause of the dysfunction. Since sonographic screening has no harmful effects at all, it can be performed at any age and repeated as many times as required. Ultrasound testing is also an important diagnostic method to clarify the possible causes behind uncertain abdominal complaints and abdominal pains. By means of the ultrasound examination certain abdominal organs can be screened during their operation too, both from the anatomical and the functional sides.

Injuries and serious or urgent conditions, which are in the background of acute abdominal pains (like appendicitis, bowel obstruction, intestinal invagination, lymph node enlargement – lymphadenitis – due to infection, ovarian torsion), can be well diagnosed by the help of the abdominal sonography too.

What can we examine with an abdominal ultrasound?


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  • By the ultrasound scan of the liver and the biliary tract, the radiologist examines the so-called circumscribed abnormalities, like cysts, globular structures of entwined blood vessels, benign or malignant tumors and blood vessels of the liver’s blood supply. Then the radiologist continues the screening with the check-up of the gallbladder looking for gallstones or signs of inflammation and scans the bile ducts in- and outside the liver as well. If the bile ducts are broader than normal, this can suggest a bile duct obstruction, which may have underlying causes like gallstones, inflammatory diseases or congenital developmental disorders. Visible symptoms of bile duct obstruction is jaundice (yellow skin colour) and yellowy eyes. If such symptoms appear, the execution of an ultrasound examination is inevitable.
  • Ultrasound scan of the stomach: if children at the age of 2-8 weeks produce projectile vomiting, that occurs even after repeated feeding, then in any case a suspicion may arise that there prevails a stomach stenosis disorder, which is practically the narrowing of the opening from the stomach to the first part of the small intestine (its Latin name is pylorus stenosis). The muscle that regulates the emptying of the stomach thickens and blocks the short duct between the stomach and the duodenum (first, horseshoe shaped segment of the small intestine). This disorder brings about the frequent vomiting after feeding and the consequent weight loss. Ultrasound examination of the pylorus muscle (muscular valve) makes the fast diagnosis of the disease possible.

It is important to mention that owing to the air content other diseases of the stomach cannot be practically examined by ultrasound technique.

  • Kidneys and the urinary tract: position, size and structure of the kindneys can be accurately observed during the ultrasound check-up.

In the background of children’s complaints related to the kidney there may also be kidney stones, or in case of a urinary tract infection an inflammation of the renal pelvis. In the case of inflammation of the renal pelvis, the specialist, with the help of ultrasound scanning, should rule out or detect any developmental disorders (which may be predisposition factors for this problem) as well as  the complications of the infection. Ultrasound examination can also detect abnormalities, such as dilatation of the renal pelvis and the ureter, which may be produced by kidney stones that by getting out of the kidneys got stuck in the next part of the urinary tract, in the ureter. In the presence of certain developmental disorders the radiologist may also observe a wider renal pelvis. These are, for example the constrictions (narrowings) at different segments of the urinary tract, which make urination difficult. Vesicoureteral reflux disease can cause similar abnormality. This disease is when urine flows back from the bladder in the direction of the kindneys.

Due to the extensive dilatations and the vesicoureteral (urinary) reflux, the pressure in the kidneys increases, which can lead to the destruction of kidney tissues. This is why it is utmost important to detect urinary tract disorders in due time because in the long run these conditions may cause recurrent infections and kidney damage as well.

  • Spleen: spleen enlargement can be a symptom of different pathological (abnormal) conditions. During an ultrasound screening we can observe such enlargement as the appearance of certain infectious diseases (viral infections, mostly mononucleosis sepsis), disorders of the hematogenic system and other less common diseases with genetic abnormality background. This condition can also be associated with liver diseases.
  • Bowels: inflammation of the bowels can be precisely examined by ultrasound technique. Presence of an intestinal wall thickening disorder indicates an active inflammation. Ultrasound scanning plays an essential role in the diagnosis and follow-up of severe intestinal infections or inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)

In children, ultrasound scanning is also the principal examination method to detect acute intestinal conditions like intestinal twisting (volvulus) or intestinal invagination, which can both lead to bowel necrosis though the disturbance of the intestinal blood supply.

  • Appendicitis: since this inflammation can have a number of different symptoms, which are often far to be typical at all, in case of any type of abdominal pain an appendicitis must be considered as a possible cause behind. In fact, it is not the inflammation of the appendix (intestinum caecum), but that of the attached vermiform appendix (appendix vermiforis), a worm-shaped structure that protrudes from the caecum. Ultrasound scanning can show the thickened vermiform appendix reflecting an inflammation, which is sensitive to the doctor’s pressure during an examination. Inflammatory fluid and enlarged lymph nodes can be often observed in the surrounding area. Appendicitis may lead to peritonitis (inflammation of the lining of the inner wall of the abdomen), appearance of an abscess or sepsis, therefore the early identification of the disease is very important. Ultrasound examination plays a crucial role in making a diagnosis.

Ultrasound examination of the lesser pelvis

  • Uterus and ovaries: nowadays, the accurate diagnostic examination of hormonal abnormalities and bleeding disorders cannot be imagined without pelvic ultrasound. If a patient suffers from lower abdominal pain, besides the possibility of appendicitis, gynecological reasons should always be taken into consideration, like ovarian torsion or inflammation of the ovarian tubes. These diseases require fast diagnosis, since they may lead to serious consequences as well.

Being a part of the general screening test, sonography (ultrasound scan) can play a very important role in maintaining the health of our children. That is why it is one of the most important imaging techniques which we use in pediatrics.


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