Intestinal ultrasound in pediatrics. / Ecografía intestinal en pediatría.

Ultrasonography is the imaging technique of choice for studying the digestive tract in pediatric patients from the neonatal period to adolescence. Its dynamic character, absence of radiation, and scant preparation required make ultrasonography preferable to contrast-enhanced fluoroscopy, computed tomography, or magnetic resonance imaging. Technical advances in ultrasound, including high-resolution multifrequency probes, panoramic studies, color Doppler, Doppler with microvascularization, elastography, and contrast agents for use in children, have increased the sensitivity and specificity of this technique. Intestinal ultrasound is indicated for conditions with diverse etiologies and pathogenesis: congenital, infectious, inflammatory, tumor-related, and vascular. Knowledge of embryological development and the normal characteristics of the digestive tract help in identifying, recognizing, and interpreting the ultrasound findings of the different conditions in pediatric patients. This paper aims to show the indications for ultrasound studies of the digestive tract in children, the findings on these studies, and the management of the most common gastrointestinal conditions in pediatric patients.

Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management. / Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo.

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria.

Intrapericardial diaphragmatic hernia following cardiac surgery - A case report. / Hernia diafragmática intrapericárdica tras cirugía cardiaca. A propósito de un caso.

INTRODUCTION: Intrapericardial diaphragmatic hernia is an abdominal organ prolapse inside the pericardium. It is one of the less frequent instances within the diaphragmatic hernia group. CLINICAL CASE: This is the case of a 4-month-old infant undergoing surgery for interventricular communication (IVC). Postoperatively, pulmonary auscultation detected air-fluid sounds, and thoracic radiological control showed an atypical pneumopericardium. Given clinical and radiological findings, and in the absence of additional abdominal symptoms, gastrointestinal transit (GIT) was performed, demonstrating intrapericardial herniation of the intestinal loops. The patient was discharged following abdominal surgical repair, with no further complications. DISCUSSION: Intrapericardial diaphragmatic hernia is an infrequent instance within the diaphragmatic hernia group, with cardiac surgery being a rare potential iatrogenic factor. Clinical suspicion and imaging findings are key to perform early diagnosis and surgical treatment.

INTRODUCCION: La hernia diafragmática intrapericárdica consiste en un prolapso de las estructuras abdominales dentro del pericardio, representando una de las entidades menos frecuentes dentro del conjunto de las hernias diafragmáticas. CASO CLINICO: Se presenta el caso de un lactante de 4 meses intervenido de comunicación interventricular (CIV) que, en el postoperatorio, la auscultación cardiopulmonar detecta ruidos hidroaéreos y el control radiológico de tórax muestra un neumopericardio atípico. Ante los hallazgos clínico-radiológicos, y sin sintomatología abdominal sobreañadida objetivable, se solicita un tránsito gastrointestinal (TGI) donde se pone de manifiesto la herniación intrapericárdica de asas intestinales. Tras la intervención quirúrgica abdominal reparadora, el paciente fue dado de alta, sin otras complicaciones. COMENTARIOS: Se realiza un breve recordatorio de las hernias diafragmáticas intrapericárdicas como una entidad de escasa incidencia dentro del conjunto de hernias diafragmáticas, siendo la cirugía cardiaca un posible factor iatrogénico poco frecuente. La sospecha clínica, junto con los hallazgos de imagen, son fundamentales para llegar a un diagnóstico y tratamiento quirúrgico precoz.

Evaluation of the fetal cerebellum by magnetic resonance imaging. / Valoración del cerebelo fetal mediante resonancia magnética.

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa.

Value of brain MRI when sonography raises suspicion of agenesis of the corpus callosum in fetuses. / Valor de la resonancia magnética cerebral en fetos con sospecha ecográfica de agenesia del cuerpo calloso.

OBJECTIVE: To evaluate the role of magnetic resonance imaging (MRI) in fetuses with a previous sonographic suspicion of agenesis of the corpus callosum (ACC) to confirm the diagnosis and to detect associated intracranial anomalies. MATERIAL AND METHODS: Single-center retrospective and descriptive observational study of the brain MRI performed in 78 fetuses with ACC sonographic suspicion between January 2006 and December 2015. Two experts in fetal imaging reviewed the MRI findings to evaluate the presence and morphology of the corpus callosum. When ACC was detected the whole fetal brain anatomy was thoroughly studied to determine the presence of associated anomalies. Prenatal MR imaging findings were compared to postnatal brain MRI or necropsy findings when available. RESULTS: Fetal MRI diagnosed 45 cases of ACC, 12 were partial (26.7%) and 33 complete (73.3%). In 28 cases (62,2%) associated intracranial anomalies were identified. The most often abnormality was ventriculomegaly (78,6%), followed by cortical malformations (53,6%), posterior fossa (25%) and midline anomalies (10,7%). CONCLUSION: Fetal brain MRI has an important role in the diagnosis of ACC and detection of associated anomalies. To perform a fetal brain MRI is important in fetuses with sonographic suspicion of ACC.

Perinatal testicular torsion: ultrasound assessment and differential diagnosis. / Torsión testicular perinatal. Valoración ecográfica y diagnóstico diferencial.

Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.

Neonatal ovarian cysts: ultrasound assessment and differential diagnosis. / Quistes de ovario neonatales. Valoración ecográfica y diagnóstico diferencial.

Ovarian cysts are the most common abdominal cysts in female fetuses and newborn girls. Ultrasonography is the imaging technique of choice for diagnosing ovarian cysts because it makes it possible to differentiate them from other cystic lesions. Although most neonatal ovarian cysts regress in the first few months after birth, complications can occur during gestation or after birth. The manifestations of ovarian cysts on ultrasonography will depend on the complications. The management is controversial, although the current trend favors watchful waiting. We describe the different presentations of neonatal ovarian cysts with their complications and their patterns of findings on ultrasonography. We also discuss the differential diagnosis with other cystic abdominal lesions, and finally we discuss the therapeutic management of neonatal ovarian cysts.

Low-dose computed tomography to diagnose fetal bone dysplasias. / Tomografía computarizada fetal de baja dosis para diagnosticar displasias óseas.

We present a case of cleidocranial dysplasia diagnosed by low-dose fetal computed tomography (CT) in the 25th week of gestation. Severe bone dysplasia was suspected because of the fetus' low percentile in long bones length and the appearance of craniosynostosis on sonography. CT found no abnormalities incompatible with life. The effective dose was 5 mSv, within the recommended range for this type of examination. Low-dose fetal CT is a new technique that makes precision study of the bony structures possible from the second trimester of pregnancy. In Spain, abortion is legal even after the 22nd week of gestation in cases of severe fetal malformations. Therefore, in cases in which severe bone dysplasia is suspected, radiologists must know the strategies for reducing the dose of radiation while maintaining sufficient diagnostic quality, and they must also know which bony structures to evaluate.

The ABCs of transfontanellar ultrasound and more. / El ABC de la ecografía transfontanelar y más.

Transfontanellar ultrasound is widely used to study neonatal neuroanatomy and disease. This technique has many advantages, such as the absence of ionizing radiation and its wide availability, portability, and low cost. The development of more powerful ultrasound scanners and improved microcurved and linear probes of different frequencies have resulted in improved image quality. To take full advantage of this technique, it is important to know the normal and pathologic anatomy in neonates. Transfontanellar ultrasound is the first-line technique for studying short-term and mid-term complications in premature newborns. In full-term newborns, it is very useful in many clinical situations, making it possible to select which patients will benefit from other techniques that are more invasive or more expensive, or that require sedation, such as MRI. The disadvantages of the technique are that it is operator dependent and that an appropriate acoustic window is necessary. It also has limitations in the study of obstetric trauma, in the evaluation of complex malformations, and in the assessment of damage to white matter. With a basic understanding of neonatal neurology, the appropriate equipment, and a careful technique taking advantage of the different fontanels, transfontanellar ultrasound is a reliable method that makes it possible to diagnose and follow up both congenital and acquired conditions in neonates.