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Focal nodular hyperplasia (FNH) in children is a rare but benign tumour, which must be differentiated from malignant entities to avoid unnecessary treatment, leading to potential morbidity.To provide data on imaging findings of these lesions with a suggested algorithm for diagnosis, sampling and follow-up.This retrospective review evaluated imaging of all patients diagnosed with FNH in two tertiary referral centres in Europe between 1975 and 2018.One hundred and four patients with 137 tumours were reviewed. The mean age at presentation was 8.2 years. The median tumour size was 5 cm (range: 0.3-29 cm). Multiple lesions were seen in 16.3% of patients. The male-to-female ratio was 1:2.FNH with typical features on imaging can be safely followed up once the diagnosis has been established. The use of contrast-enhanced ultrasound and magnetic resonance imaging allows accurate characterisation in most cases. Histological sampling is only advised when there is diagnostic doubt. Atypical arterial enhancement of FNH should prompt the search for a congenital portosystemic shunt.

Umbilical catheters are commonly used in the neonatal period for blood sampling or for administering medication or parenteral nutrition. The position of the catheter is usually confirmed with radiography. However, many complications associated with the use of umbilical catheters, such as liver collections from extravasation or vascular thrombosis, are not apparent on radiographs but can be easily diagnosed with ultrasound. This pictorial review illustrates the sonographic findings of complications that should be excluded in the sick neonate with an indwelling catheter.

Hepatic blood flow is critical for successful liver transplantation. To reliably calculate flow, vessel cross-sectional area and mean flow velocities must be reproducibly measurable. To assess the reproducibility of sonographic measurements of portal vein (PV) and hepatic artery (HA) diameters and mean flow velocities in children after transplantation. Ten children were scanned by two operators 5 or 7 days after transplantation. Each scanned the same patient twice measuring the diameter and the time-averaged velocity (TAV) in the PV and HA. Operators were blinded to all measurements. Agreement and repeatability were analysed statistically. The interobserver variation in PV and HA diameters and TAVs were expressed as mean differences between operators and plotted against the mean value for each. This showed relatively poor agreement for PV diameter (mean difference 1.23 ± 0.96 mm), but better agreement for HA diameter (mean difference 0.18 ± 0.6 mm). Intraobserver differences were of similar magnitude. TAVs showed better agreement and repeatability. This study demonstrates substantial inter- and intraobserver variation in sonographic measurements of vessel diameters and TAV after paediatric liver transplantation. Estimates of volume of blood flow to the transplant derived from these measurements are poorly reproducible.