Ultrasound of the pediatric abdomen

  • Patient preparation: NPO for 4 hours
  • Contrast used: none
  • Technique: scan the entire abdomen, documenting normality and abnormality of the solid organs
  • Images to obtain:
    — Hepatic veins going into the inferior vena cava
    — Left lobe of the liver and left portal vein
    — Right lobe of the liver and right portal vein
    — Right lobe of the liver and gall bladder
    — Pancreas – document position of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). The SMV should be anterior and to the right of the SMA. If it is not in the correct position the possibility of malrotation is greatly increased and you should do an upper GI to rule out malrotation
    — Left lobe of liver
    — Aorta/celiac axis/SMA – image may be obtained by scanning coronal from left side and angling slightly anterior. Measure the distance between the anterior wall of the aorta and the posterior wall of the liver. If the distance is greater than 1.7 times the diameter of the aorta the distance is abnormally increased and this can be due to lymphadenopathy, varices, or fat if the patient is on steroids
    — Inferior vena cava
    — Right lobe of liver and measure it and right kidney. As a rule of thumb, the liver edge should not extend below the edge of the kidney
    — Spleen and measure it. As a rule of thumb, the spleen edge should not extend below the edge of the kidney
    — Kidneys transverse and sagittal – measure them
    — Adrenals
  • Looking for: organomegaly, focal solid organ lesions, hepatobiliary pathology, in a patient with abdominal mass you must attempt to demonstrate the organ of origin of the abdominal mass and must see if there is vascular invasion by the mass
  • Post procedure tasks: none