Pediatric Imaging Conditions

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Questions and Answers

What is the primary modality for evaluating the pediatric pelvis?

Sonography (correct)

X-ray

MRI

CT scan

At what age does the endometrial thickness typically become pencil thin in prepuberty?

9-10 years

2-3 years

Under 1 year

7-8 years (correct)

What is the average uterine size for a newborn?

5 cm

2.5 cm

8 cm

3.5 cm (correct)

Which frequency transducer can often be used for transabdominal sonography in pediatrics?

Up to 9 MHz Signup and view all the answers

What is one factor that can affect the visualization of pediatric ovaries during a sonography?

Location, size & age of the patient Signup and view all the answers

Which type of ovarian cyst is typically characterized by being 3-20 cm in size?

Follicular cyst Signup and view all the answers

What is a common symptom of ovarian torsion?

Acute onset of lower abdominal pain Signup and view all the answers

What percentage of ovarian neoplasms in children do germ cell tumors account for?

60% Signup and view all the answers

What sonographic appearance is associated with acute ovarian torsion?

Ovarian enlargement with fluid in the pelvis Signup and view all the answers

Which of the following neoplasms is recognized as the most common malignant germ cell tumor?

Dysgerminoma Signup and view all the answers

What is the most common type of germ cell tumor found in childhood?

Benign teratomas Signup and view all the answers

What is the most common congenital uterine abnormality seen in the pediatric population?

Bicornuate uterus Signup and view all the answers

In the context of ovarian neoplasms, which percentage of germ cell tumors in girls under 10 are malignant?

84% Signup and view all the answers

What indicates a possible partial or intermittent torsion as seen via ultrasound?

Massive ovarian edema and hypoechoic mass Signup and view all the answers

In children over age 9, which complication is NOT considered an increased risk of pregnancy?

Ovarian torsion Signup and view all the answers

What condition must abdominal ovarian cysts be differentiated from?

Mesenteric or omental cysts Signup and view all the answers

What is the sonographic appearance of a rhabdomyosarcoma?

Solid, homogeneous mass that fills the vaginal cavity Signup and view all the answers

What is the most common foreign body that causes vaginitis in children?

Wad of toilet paper Signup and view all the answers

Which factor increases the likelihood of ovarian torsion?

Presence of a mass on the ovary Signup and view all the answers

Which of the following is NOT a common associated condition with Mayer-Rokitansky-Kuster-Hauser Syndrome?

Ovarian cysts Signup and view all the answers

What distinguishes benign from malignant tumors regarding Doppler flow characteristics?

Benign tumors exhibit peripheral, high resistance Doppler flow Signup and view all the answers

Study Notes

Pediatric Conditions & Considerations

This topic covers pediatric conditions and considerations, specifically focusing on imaging techniques and abnormalities in the pelvis.

Outline

Sonographic techniques
Review of normal anatomy
Ovarian abnormalities
Uterine and vaginal abnormalities
Infections

Sonographic Technique

Sonography is the primary modality for evaluating the pediatric pelvis.
Transabdominal or transvaginal scans are used, with transvaginal scans used in sexually active adolescents or older teens.
Higher frequency transducers (up to 9 MHz for transabdominal scans) are often used.
Linear transducers are common.
Patient preparation includes ensuring the patient has a full bladder (may require catheterization in infants), bowel preparation, and hydration.
Potential findings include bowel, peritoneum, and superficial lesions.

Pediatric Anatomy

Uterus: Newborn uterus is typically 3.5 cm, prepubescent is 2.5-3 cm and postpubescent 5-8 cm. The newborn uterine endometrium is thick due to maternal hormonal stimulation. Prepubescent endometrium is thin. Postpubescent endometrium goes through cyclic changes.
Ovaries: Ovarian volumes vary by age. Neonates have larger volumes than older children.
- 0-5 years old: ~1 mL
- 6-8 years old: ~1.2 mL
- 9-10 years old: ~2.1 mL
- 11 years old: ~2.5 mL
- Menstruating: up to 9.8 mL

Pediatric Ovaries

Ovaries may not be visualized due to patient size, age, or location.
Ovaries are located between the lower pole of the kidneys and the true pelvis in neonates.
Ovaries often appear heterogeneous in neonates due to factors like a long pedicle and a small pelvis.
Small cysts may be seen.

Ovarian Abnormalities

Ovarian cysts are more common than previously thought, often intra-abdominal in location in newborns.
Cysts associated with cystic fibrosis and congenital juvenile hypothyroidism.
Abdominal ovarian cysts can be differentiated from mesenteric or omental cysts.
Common cyst types include follicular (>3 cm), corpus luteum, hemorrhagic, and parovarian cysts.
Some cysts can be detected prenatally during the second and third trimester.

Ovarian Torsion

Can occur in normal ovaries but is more common in ovaries with a mass.
More prevalent in children.
Fallopian tubes are relatively longer.
Ovaries are more mobile.
Symptoms include acute lower abdominal pain, nausea, vomiting, and leukocytosis.
Sonographic Appearance: Ovarian enlargement, pelvic fluid, ovarian mass, and sometimes a whirlpool sign. Doppler ultrasound isn't always reliable. Multiple follicles (8-12mm) in the periphery of an enlarged ovary might indicate vascular congestion, and a possible torsion.

Partial / Intermittent Torsion

Characterized by massive ovarian edema, marked ovarian enlargement, and a solid, hypoechoic mass.
There is enhanced transmission through the area due to compromised venous and lymphatic drainage.
Ovaries can enlarge up to 35 cm.
Refer to specific chapters (e.g., Chapter 54 in Rumack) for further information.

Ovarian Neoplasms

Account for 1% of childhood tumors and 10-30% of all malignant tumors.
Common during puberty
Often present with abdominal pain and palpable mass.
May undergo torsion or hemorrhage.
In children under 10, 84% of germ cell tumors are malignant.
Germ cell tumors account for 60% of ovarian neoplasms. 75-95% of germ cell tumors are benign teratomas.
Types include teratoma, dysgerminoma, cystadenoma/cystadenocarcinoma, granulosa-theca cell tumor (precocious puberty), and arrhenoblastoma (masculanizing effects).

Leukemic Infiltration

Ovaries are a common site for acute leukemia.
Ovarian involvement can occur in up to 50% of cases.
Large hypoechoic pelvic masses with smooth, lobulated margins are common findings.
THe tumor can infiltrate pelvic organs, thus making uterus and ovaries difficult/impossible to diagnose.

Pediatric Cancer Spread to Ovaries

Ovarian involvement occurs due to spread from other cancers (e.g., neuroblastoma, lymphoma and colon carcinoma).
Malignant tumors usually have central, low-resistance Doppler flow characteristics. Benign tumors, however, usually have peripheral, high-resistance Doppler flow characteristics.
Non-neoplastic conditions like tubo-ovarian abscess, corpus luteum, and ectopic pregnancies can also result in abnormal Doppler flow images.

Uterine & Vaginal Abnormalities

Congenital abnormalities such as a bicornuate uterus, hydrocolpos/hydrometrocolpos, imperforate hymen, transverse vaginal septum, or a stenotic/atretic vagina can be diagnosed.
Congenital abnormalities found in adults can also be found in children.

Mayer-Rokitansky-Kuster-Hauser Syndrome (MRKH)

Second most common cause of primary amenorrhea.
Characterized by vaginal atresia, a rudimentary bicornuate uterus, and normal fallopian tubes and ovaries.
Frequently associated with renal and skeletal anomalies. Usually unilateral renal agenesis/ectopia.

Rhabdomyosarcoma

Most common primary malignant tumor of the uterus and vagina, but vagina is often the primary site (arising close to the cervix).
Most frequently diagnosis occurs in children 6-18 months old.
Presents with vaginal bleeding; tumors arise from the vaginal anterior wall and may extend into the bladder.
Solid, homogeneous mass that fills the vaginal cavity - seen on sonograph.

Other Considerations

Pregnancy

Pregnancy needs to be considered in children over age 9.
Increased risk for pregnancy-related complications like toxemia, pre-eclampsia, placental abruption, lacerations, and C-sections.
Premature labor and delivery, and perinatal mortality are higher in this group.

Foreign Bodies

Foreign bodies, such as a wad of toilet paper, can cause vaginal bleeding/discharge, and vaginitis (4% of cases).
Appears as an echogenic structure with distal acoustic shadowing on a sonogram, possibly indenting the posterior bladder wall.

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Description

This quiz focuses on pediatric conditions and considerations related to the pelvis, emphasizing imaging techniques used for evaluation. Participants will explore sonographic methods, normal anatomy, and various abnormalities, enhancing their understanding of pediatric pelvic health.