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PEDIATRIC ULTRASOUNDS

Acute appendicitis is the most common cause of acute surgical abdomen. Although the diagnosis is made through clinical signs and symptoms, images play an important role, especially in doubtful or suspected cases of non-appendicular abdominal pathology. Ultrasound is the first diagnostic tool and is widely available in medical centers, it is cheap, it does not have ionizing radiation and it does not require the administration of iodinated contrast media. However, there are technical factors that limit this study, such as the absence of fasting, the marked interposition of intestinal loops and the presence of an abundant adipose pad, since it attenuates the ultrasound, making the visualization of the appendix inaccessible for a proper diagnosis. Because of this, ultrasound should not be considered a first-line diagnostic tool in overweight and obese patients.

Appendix Ultrasound

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Doctors order a hip ultrasound when they suspect a problem called "progressive hip dysplasia" (DEC). Evolutionary hip dysplasia is a malformation that can occur before, during, or weeks or months after birth.

The probability of developing progressive hip dysplasia increases in the following circumstances:

- Pregnancies where the fetus is compressed within the uterus (due to a reduction in the amount of amniotic fluid or "oligohydramnios")
- Abnormal position of the baby inside the womb (when it comes from the breech)
- Babies with a family history of progressive hip dysplasia

Likewise, developmental hip dysplasia occurs more frequently in girls than in boys and in first-borns.

Doctors will take all of these factors into account when deciding whether to evaluate a baby's hip using ultrasound. In addition, the baby will undergo an ultrasound if the doctor detects any abnormalities in the hip during the physical exam, such as the following:

- At birth, inability to move the thigh out from the hip as far as is usually possible
- The doctor notices a clicking sound or hears a "click" when moving the baby's thigh outward during the routine exam
- Difference in length or appearance between the baby's legs

Hip Ultrasound

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Clinical ultrasound is an accessible and feasible diagnostic test at the point of patient care that for a relatively short time has been spreading in the different areas of assistance to pediatric patients.

An abdominal ultrasound may be done to evaluate the size and appearance of:
-The appendix
- The stomach / pylorus
- The liver
- Gallbladder
- The spleen
- The pancreas
- The intestines
- The kidneys
- The bladder
- The testicles
- The ovaries
- The uterus

Abdominal ultrasound can also:
- Help determine the origin of abdominal pain, such as gallstones, kidney stones, abscesses or an inflamed appendix due to appendicitis
- Help detect the presence and causes of an apparently enlarged abdominal organ
- Identify the location of abnormal fluids in the abdomen
- Help determine the causes of vomiting in young children

Doppler ultrasound images can help the doctor see and evaluate:
- Blockages in blood flow (such as clots)
- Narrowing of blood vessels
- Congenital vascular tumors or malformations
- Reduced or absent blood flow in various organs such as the testes and ovaries
- Increased blood flow. which may indicate the presence of an infection.

Doppler ultrasound can also help the doctor evaluate for abnormal twisting (twisting) of a testicle or ovary. Torsion can limit adequate blood flow into the testicle or ovary, resulting in abdominal or scrotal pain.

Since ultrasound provides real-time images, doctors can use it to guide procedures such as aspiration biopsy. Biopsies use needles to remove tissue samples for laboratory analysis. Ultrasound can also be used to guide the insertion of a catheter or other drainage device. This helps ensure safe and accurate placement.

Pediatric Abdomen Ultrasound

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Kidney ultrasound is a safe and painless test in which sound waves are used to obtain images of the kidneys, ureters, and bladder.

Doctors may order kidney ultrasounds when they suspect kidney or bladder problems.

Renal ultrasound can show the size of the kidneys, signs of kidney damage, abnormalities present from birth, the presence of kidney stones or obstructions, complications from a urinary tract infection, cysts, tumors, etc.

INDICATIONS:
- PRENATAL SKIN ECTASIA: Post-hospital controls of mild ectasia (anteroposterior diameter of the renal pelvis greater than 7mm and less than 10mm without dilation of the calyces, in the 3rd trimester prenatal checkup)

- Detection of KIDNEY MALFORMATIONS associated with: Malformations of the pinna, it is only recommended when associated with other malformations, a family history of deafness or gestational diabetes.
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BROTHERS AND CHILDREN OF PATIENTS WITH VESICO-URETERAL REFLUX.

URINARY INFECTION (UTI):
- Recurrent UTI at any age.
- Febrile UTI at any age. .
- Affebrile or lower tract UTI in patients with risk factors: urinary flow
low, low urinary concentrating capacity, microorganism other than
E.Colli, gross hematuria, low weight gain, symptoms of
lower urinary tract dysfunction (bladder dysfunction)

- Inside the PROTEINURIA study

- Persistent symptoms of OBSTRUCTIVE LOWER URINARY TRACT OR
IRRITATIVE.

- Inside the HEMATURIA study

- FAMILY STUDIES of patients with hereditary kidney disease
(depending on the disease requires high resolution techniques)

- NEPHRITIC COLIC, HYPERCALCIURIA (if there is suspicion of nephrocalcinosis
requires high resolution imaging tests).

- Recurrent ABDOMINAL PAIN (within full abdominal ultrasound)

- Study of ARTERIAL HYPERTENSION (within the complete abdominal ultrasound and of the great vessels).

Pediatric Renal Ultrasound

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Congenital Hypertrophic Pylorus Stenosis (EHCP) is one of the most frequent causes of persistent vomiting, which has received renewed attention in recent years.

It is the most important gastric injury, during the first weeks of life. Walgreen estimated that it occurs in 1: 150 males and 1: 775 females, with a 5: 1 boy-girl ratio. This predilection for males has not yet been established. Hypertrophic pyloric stenosis is a congenital anomaly, characterized by hypertrophy of the circular muscular layer of the stomach in the pyloric region, which requires compulsory surgery for its correction. The usual age in which the picture appears is from the third to the sixth week, with a non-bilious emetic picture, progressively continuous until reaching the state of permanent and uncontrollable vomiting.

Pyloric Hypertrophy Ultrasound

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It is a diagnostic technique widely used in the study of neuroanatomy and pathology of the neonatal brain thanks to its many advantages, such as the absence of radiation, availability and portability. The development of more powerful equipment together with the improvement of micro-curved and linear probes of different frequencies has allowed a marked improvement in the quality of the ultrasound image of the neonatal brain.

Indications:
◦ Assess the presence of abundant brain fluid known as hydrocephalus.
◦ Detect bleeding within brain tissue or ventricles. This is called intraventricular hemorrhage.
◦ Assess for damage to the brain tissue that surrounds the edges of the ventricles, a condition known as periventricular leukomalacia.
◦ Assess the existence of congenital abnormalities.
◦ Locate the presence of an infection or tumor.

Requirements:
The study does not hurt, does not require anesthesia or special preparation.
It can be done from birth to 12 months (depending on the closure of the fontanelles).

Transfontanellar Ultrasound

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