Ultrasound in Pediatric Emergencies

Gaurav Saigal, MD, Jennifer Runco Therrien, MD, and Frank Kuo, BS


Appl Radiol. 2014;43(8) 

In This Article

Pancreaticobiliary Pathology

The pancreas and biliary system are well evaluated with US in the acute setting. Imaging findings in pancreatitis are similar to adults and include diffuse or focal, often hypoechoic, pancreatic enlargement and dilatation of the pancreatic duct.[26–28] Pseudocyst, pancreatic abscess, necrosis and hemorrhage are the main complications. However, the causes differ in the pediatric setting and are usually idiopathic or related to trauma or congenital structural anomalies such as pancreatic divisum and choledochal cysts. Choledochal cysts are congenital cystic malformations of the biliary tree. Patients typically present with episodic pain, jaundice, a right upper quadrant mass or clinical pancreatitis.[26] US can easily localize and measure the degree of biliary dilatation and differentiate among the five types of biliary congenital choledochal cysts (Figures 14 and 15).

Figure 14.

A 2-year-old presented with severe colicky abdominal pain lasting a few minutes then resolving without treatment. Intussusception was suspected clinically. Gray-scale sonographic image of the right upper quadrant (A) demonstrates tortuous and fusiform dilation of the common bile duct (solid white arrow. Subsequent MRCP (B) nicely illustrates the fusiform common bile duct dilation without intrahepatic or extrahepatic dilatation or obstruction. Findings were consistent with a choledochal cyst type 1.

Figure 15.

A 12-year-old with severe abdominal pain and elevated amylase. Gray-scale ultrasound (A) demonstrates a markedly and diffusely enlarged common bile duct (solid white arrow). Gallbladder appeared normal (dashed white arrow). Image through the left hepatic lobe (B) demonstrates a cystic structure with posterior acoustic enhancement (solid red arrow). Subsequent MRCP (C) nicely illustrates the diffuse marked dilatation of the common bile duct and cystic structure in the left hepatic lobe. At surgery, this was as a confirmed type 4a choledochal cyst.