A Pediatric Radiology textbook and Pediatric Radiology digital library
Ultrasound of the head
Patient preparation: none
Contrast used: none
Technique: — Review previous exams if available — Check transducer left / right orientation — Scan through the anterior fontanelle — Fill screen with image by varying the depth – use the 4th ventricle image for this
Images to obtain: — Coronal: — 1st – Through the orbits — 2nd – Star image (pentagon sign) through the Circle of Willis — 3rd – 3rd ventricle — 4th – 4th ventricle (check this image first to set depth) — 5th – Choroid plexus — 6th – Over the top of (posterior to) the lateral ventricles — Sagittal: — 1st – Midline — 2nd – Left of midline through lateral ventricle — 3rd – Even more left of midline through the Sylvian fissure — 4th – Midline — 5th – Right of midline through lateral ventricle — 6th – Even more right of midline through the Sylvian fissure — Take additional images of any pathology you see
Looking for: — In premature infant – germinal matrix hemorrhage, intraventricular hemorrhage, intraparenchymal hemorrhage, periventricular leukomalacia, edema, ventricular dilation — In term infant – hydrocephaleus or enlarged subarachnoid space — In pre-ECMO patient – intracranial developmental abnormality, pre-existing intracranial bleed — In ECMO patient – intraparenchymal hemorrhage, subdural hematoma, cerebral atrophy