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The omphalocele is an abdominal wall defect at the base of the umbilical cord, with the worldwide prevalence of 2.6 per 10,000 births. Omphalocele contains herniated abdominal organs and is classified in small and giant based on the size of the defect. Omphalocele is associated with several syndromes or structural anomalies. We reported a case of giant omphalocele of 6 cm with right lung agenesis with tracheal and right bronchial hypoplasia. Laryngeal mask stabilized the newborn allowing endotracheal intubation. Due to serious malformations, the newborn died after few hours of life for cardio-respiratory arrest. Early and accurate prenatal diagnosis allows a better intervention strategies in delivery room, improving the chances of survival and reducing complications for infants with omphalocele., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Background: Omental infarction is a rare pediatric disease. Ultrasound is a useful modality for a non-invasive pre-operative differential diagnosis between inflammatory conditions (as appendicitis) and omental infarction, especially by detecting immobility of the omentum adhered to the abdominal wall ("tetherd fat sign"). However, this is a dynamic sign that cannot be documented in a static image with B-mode technique. The goal of this work is to incorporate the versatile function of motion mode (M-mode) into omental infarction diagnosis to describe how the M-mode is useful in the evaluation of fat motion in children suspected of having omental infarction. In 2019 we suggested a new Ultrasound sign named "tethered fat sign" for an accurate non-invasive diagnosis of omental infarction in children. This finding was observed in 6 of the 234 seen children of our previous study with 4 laparoscopic confirmed diagnosis., Methods: From January 2019 to July 2021, we evaluated 195 children (91 boys and 104 girls, from 3 to 15 years) admitted to our Santobono-Pausilipon Children Hospital with acute right-sided abdominal pain. Abdominal ultrasound was performed to all the patients and the investigation of "tethered fat sign" was always included., Results: In 7 patients ultrasound showed the presence of a hyperechoic oval mass localized in the right upper abdominal quadrant and in 2 of these M-mode documented a normal subhepatic fat moving during respiratory movements in relation with the abdominal wall. The remaining 5 patients had an omental infarction showed as a subhepatic motionless mass tethered to the abdominal wall on M-mode. In these patients, a sonographic follow-up was performed every 15 d for 2 months showing a progressive reduction in size of the right-sided hyperechoic mass., Conclusions: In the evaluation of all children who showed the presence of the "tethered fat sign" the use of M-mode provide a certified image in diagnostic ultrasound., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1691/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Hiatal hernia is the passage of digestive tract portions into the posterior mediastinum through a defect in the esophageal diaphragmatic hiatus. By guidelines, the diagnosis uses first-level radiographic investigations such as chest X-ray and contrastographic methods. As of today, use of ultrasonography in the suspicion/diagnosis of hiatal hernia is not standardized although it shows advantages such as not using ionizing radiation, which is essential in the small pediatric patient. We report the case of a little 4-month-old patient who came to our attention for dysphagia, vomiting and borborygmus to whom Type II hiatal hernia was suspected by ultrasound investigation, later confirmed by guidelines approved methods., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Bladder duplication is an extremely rare congenital anomaly of the urinary system that is more frequent in boys; the literature is limited to case reports and case series. We describe two cases of bladder duplication in two infant girls with an uncommon variant of complete sagittal septum not included in the Abrahamson classification. The diagnosis was made using magnetic resonance urography, combining excellent anatomical information and static and dynamic evaluation of the urinary tract. The diagnostic information provided by MR-urography was confirmed on surgical exploration. These cases provide an opportunity for paediatric radiologists and urologists to learn more about bladder duplication and improve their diagnosis of this rare condition., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Hepatic hemangiomas (HHs) are the most common benign liver tumors in infancy, but despite their frequent occurrence, their radiologic appearance may be particularly challenging to assess, owing to unique anatomical and development features that distinguish their subtypes in the pediatric population. There are 3 main patterns of the lesions recognized in HHs: focal, multifocal and diffuse. Medical care strategies range from simple observation to surgery, and a timely diagnosis is crucial to establish the most appropriated clinical management and therapy. Ultrasound (US) is typically the first level examination of pediatric vascular anomalies, able to meet a satisfactory diagnosis and has proved very helpful to assess for involution through serial imaging. CT and MRI are second-level methods seldom performed, offering an anatomical panoramic view and clarification when US is non-conclusive. Histologic confirmation is rarely required. HHs show a variable sonographic appearance, with hypoechoic (mostly) or hyperechoic solitary\multifocal mass and wide features. Hepatic vessels assessment reveals an abnormal flow, enlarged vasa, decreased resistive index (RI) values, scarce blood supply distally to lesions and hyper vascular regions inside them. In this pictorial essay, we review HHs subtypes in further details, illustrate US, CT and MRI findings and clarify a recurrent dispute over the existing terminology., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

A 5-month-old boy was evaluated for an unusually large presternal bump present since birth. The ultrasound examination revealed a well-defined soft tissue mass with an oval shape. The lesion demonstrated a regular and well-demarcated outline, with an upper margin that was thinned and inserted into the upper skin plane; the content was anechoic with a small echogenic formation, mobile with changes in the patient's decubitus. The histologic diagnosis was dermoid cyst. Although dermoid cysts are commonly seen in the midline, the midsternal location, found in our patient, is rare. Dermoid cysts can have ultrasonographic features similar to those of other subcutaneous cystic masses. However, if an anechoic cyst with an internal well-circumscribed echogenic ball-like formation is seen within the presternal subcutaneous fat layer, as in our patient, dermoid cyst should be considered in the differential diagnosis of subcutaneous cystic masses., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Meigs syndrome is a rare disease defined by the coexistence of benign ovarian neoplasm, ascites and hydrothorax, which mainly affects women over the age of 30. This clinical condition refers only to cases in which the ovarian neoformation is a fibroid, a thecoma, a granulosa cell tumor or a Brenner tumor with disappearance of symptoms and effusions after removal of the neoplasm. Meigs syndrome is most frequently characterized by the presence of an ovarian fibroid, which in childhood is very rare and not commonly associated with the disease. In this article we report the case of an 11- year-old girl who came to our observation for a high fever for five days accompanied by cough and abdominal pain; imaging methods revealed bilateral hydrothorax, ascites, and a voluminous expansive right ovarian formation. On histological examination, the mass showed a cellular fibroid and the diagnosis of Meigs syndrome was made. Furthermore, we present a review of the literature aimed at detecting the state of knowledge on this disease in pediatric age, giving particular emphasis to the condition for which, in the presence of pleural effusion and ascites, an ovarian neoformation is not necessarily malignant. KEY WORDS: CT, Meigs syndrome, Pediatric, Pelvic mass, Ultrasounds.

In pediatric age, duodenal hematoma is rare and generally occurs following a closed abdominal trauma due to the crushing of the duodenum against the rigid plane of the spine; it rarely follows anticoagulant therapy, pancreatitis, bleeding disorders, vasculitis, tumors or upper digestive endoscopy. Duodenal hematoma is a rare cause of obstruction of the upper gastrointestinal tract and acute pancreatitis, and the diagnosis is sometimes difficult and late. On the other hand, the identification of the pathology in its initial stages allows the young patients to be subjected to a conservative treatment that resolves the issue most of the time, thus avoiding surgery. In this article we describe an unusual case of duodenal hematoma, following esophagus-gastro-duodenoscopy, in a 12-year-old boy with Di George syndrome., (© 2020. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Pseudopapillary solid tumour of the pancreas is a rare neoplasm that mainly affects young women in the second and third decade of life and less frequently children; originates from the exocrine component of the pancreas; and is characterized by slow growth, low potential for malignancy, and excellent prognosis following complete surgical resection. The tumour often presents as an asymptomatic abdominal mass that is accidentally detected during radiological investigations performed for other reasons. In this article, we report the clinical case of a 10-year-old girl who came to our observation for pain in the left hypochondrium, which had arisen for a week following a trauma; the imaging methods revealed a voluminous expansive pancreatic formation in the abdomen; on histological examination, the mass was a solid pseudopapillary tumour. Furthermore, we present a review of the literature aimed at highlighting the salient features of this neoplasm in paediatric age., (© 2021. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Acute lymphoblastic leukemia is the most frequent cancer in children: it represents 80% of leukemias and about 24% of all neoplasms diagnosed between 0 and 14 years. Acute lymphoblastic leukemia mainly affects children between 2 and 5 years old and in this age group the incidence is about 80-90 cases per million per year. In acute lymphoblastic leukemia, cancer cells multiply rapidly and accumulate in the bone marrow and subsequently invade the blood. However, at the time of diagnosis, leukemia rarely occurs outside the bone marrow or blood vessels and the extramedullary involvement happens mostly in patients with refractory or relapsing disease. In this article, we report an unusual clinical presentation of acute B cell lymphoblastic leukemia with intestinal and ovarian localizations in a 5-year-old girl., (© 2020. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Nowadays, cranial ultrasonography (US) of the newborn represents the first imaging method in brain damage study and its possible outcomes. This exam is performed using the natural fontanelles, especially the anterior one. It is fast, non-invasive and does not produce any side effect. Ultrasonographic examination is usually performed in cases of prematurity, especially in children with birth weight less than 1500 g, because important informations about the possible presence of pathologies such as cerebral hemorrhage and hypoxic-ischemic encephalopathy are given. This approach can be useful also in the study of pre- and post-natal infections, for example, type II Herpes Simplex virus or Cytomegalovirus infections, or pointing out vascular malformations such as vein of Galen aneurysm. Although less important than methods such as computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of trauma and tumors, ultrasound can provide useful informations or be used in first instance in the suspicion of a brain mass.

The study of the gastrointestinal tract by imaging, particularly using ultrasound, is a required instrument for diagnosis of acute and chronic gastrointestinal pathologies in pediatric age. Actually, ultrasound plays an increasing role in the evaluation of gastrointestinal tract in neonatal and pediatric patients because of their small body habitus and the presence of less fat tissue in the abdominal wall and peritoneal cavity. Ultrasound has certain advantages, thanks to the new wide-spectrum frequency probes able to assess a detailed study of the morphological aspects and functional characteristics of bowel loops, adding a new dimension to the imaging of this body system. In this paper, we review anatomy, ultrasound technique and sonographic findings of bowel pathology frequently encountered in neonatal and pediatric emergency setting.

The purpose of this article is to provide an up-to-date overview on imaging of paediatric vascular soft tissue masses, including both neoplastic and non-neoplastic lesions. We describe the-often challenging-imaging diagnosis-mainly performed by ultrasound (and secondarily by MRI) and differential diagnosis of vascular soft tissue lesions in children. We underline how important it is to determine whether a vascular anomaly has a regional vascular origin, or if there are other entities, ranging from benign to malignant lesions, which have flow-signal or blood degradation products. Even though clinical examination and patient's history are the first and indispensable steps in the initial diagnosis, the role of imaging is crucial, not only to determine whether a mass represents a true tumour/pseudo-tumour, but also to achieve a more correct diagnosis and determine the extension of the tumour/pseudo-tumour and its relation with the nearby anatomic structures.

Pediatric renal cystic diseases include a variety of hereditary or non-hereditary conditions. Numerous classifications exist and new data are continuously published. Ultrasound is the primary technique for evaluating kidneys in children: conventional and high-resolution US allows a detailed visualization of renal parenchyma and of number, size and location of the cysts, hence representing the most important diagnostic imaging technique for the first diagnosis and follow-up of these young patients. The purpose of this pictorial essay is to review the spectrum of renal cystic lesions in children from simple, complex or malignant single cysts to the several poly/multicystic kidney diseases.

The neck structures are located very superficially and are therefore easy to explore by ultrasound examination. Ultrasonography is crucial for the detection of neck pathologies in children. High-frequency probes (10-15 MHz) are used for the ultrasound examination on the patient lying in supine decubitus and with their neck stretched out. The outcome of the exam depends mainly on the child's cooperation-hence the need for warm sonographic gel and a comfortable cushion to place under the patient's shoulders. The complete scan of the neck includes the evaluation of the thyroid and salivary glands and the vascular structures as well as the lymph node analysis. In children and adolescents, the thymus is often visualised in the supraclavicular and jugular scans. It appears as a structure, usually hypoechoic, with thin hyperechoic straps, though echogenicity increases with age. In this pictorial essay, the main pathological conditions of the neck in paediatric age will be examined, such as thyroid dysgenesis, thyroiditis, thyroid nodules, lymphadenopathies, cystic lesions, haemangiomas and vascular malformation, cervical thymus, fibromatosis colli and pilomatrixoma.

Proper nomenclature is a major obstacle in understanding and managing vascular anomalies. Often the same term is used for totally different types of lesions or, conversely, the same lesion may be labeled with different terms. Although in recent times there has been a greater understanding of the problems concerning vascular anomalies, episodes of improper use of terminology still remain. The aim of this article, starting from the most recent classification of vascular anomalies, is to provide a clinical and instrumental approach to identifying these lesions and to converge towards a clear and unambiguous terminology that must become univocal among the various operators to avoid diagnostic misunderstandings and therapeutic errors.

Percutaneous renal biopsy (PRB) is an important procedure in the diagnostic and prognostic evaluation of renal disorders. Despite the relative simplicity, it can be a possible cause of iatrogenic renovascular injury. We describe two cases of iatrogenic pseudoaneurysm, a major post-biopsy complication, in two pediatric patients with persistent micro- and macro-hematuria, promptly diagnosed using color Doppler ultrasound, confirmed with renal arteriography and treated with embolization.

Urinary schistosomiasis is a tropical infection with a high endemicity in the developing countries and is included in the list of "Neglected Tropical Diseases". It is caused by a parasitic worm, Schistosoma haematobium, and it has come into the spotlight as a major cause of urogenital disease. Furthermore, it is linked to bladder cancer and it is a predisposing factor for HIV/AIDS. In this case, we describe a bladder schistosomal disease in a young African boy with persistent macroscopic hematuria and its ultrasound diagnostic bladder imaging.

Thoracic trauma accounts for approximately 14% of blunt force traumatic deaths, second only to head injuries. Chest trauma can be blunt (90% of cases) or penetrating. In young patients, between 60 and 80% of chest injuries result from blunt trauma, with over half as a consequence of impact with motor vehicles, whereas in adolescents and adults, penetrating trauma has a statistically more prominent role. Pulmonary contusions and rib fractures are the most frequent injuries occurring. Chest X-ray is the first imaging modality of choice to identify patients presenting with life-threatening conditions (i.e., tension pneumothorax, huge hemothorax, and mediastinal hematoma) and those who require a CT examination. Multi-Slice Computed Tomography is the gold standard to evaluate chest injuries. In fact, the high spatial resolution, along with multiplanar reformation and three-dimensional (3D) reconstructions, makes MDCT the ideal imaging method to recognize several chest injuries such as rib fractures, pneumothorax, hemothorax, lung contusions and lacerations, diaphragmatic rupture, and aortic injuries. Nevertheless, when imaging a young patient, one should always keep into account the ALARA concept, to balance an appropriate and low-dose technique with imaging quality and to reduce the amount of ionizing radiation exposure. According to this concept, in the recent years, the current trends in pediatric imaging support the rising use of alternative imaging modalities, such as US and MRI, to decrease radiation exposure and to answer specific clinical questions and during the observation period also. As an example, ultrasound is the first technique of choice for the diagnosis and treatment of pleural and pericardial effusion; its emerging indications include the evaluation of pneumothoraces, costocondral and rib fractures, and even pulmonary contusions.

Background: Coughing is the most efficient mechanism for clearing mucus and fluid secretions from the airways and its reflex can be suppressed by sleep. Spontaneous tracheal ruptures are believed to result from raised intratracheal pressure against a closed glottis, such as for severe coughing. This is the first reported case of tracheal rupture presented on morning awakening after bronchial mucous plug formation during the nighttime sleep because of an ineffective cough reflex., Case Presentation: An otherwise healthy white 4-year-old child presented morning onset of dyspnea, chest pain and diffuse swelling of the neck. His history was significant only for nonsevere coughing episodes before his nighttime rest; the child's parents denied any recent fever, weight loss, pains, trauma, bronchial asthma, and sick contacts. A chest X-ray and computed tomography scan revealed pneumomediastinum, obstructive atelectasis of the lower lobe of his left lung, and a small tracheal laceration confirmed by an emergency bronchoscopy. After endoscopic removal of a mucous plug and secretions, the child's pulmonary gas exchange and respiratory rate improved, so our patient was managed conservatively., Conclusions: This report illustrates an unusual presentation of lung obstructive atelectasis due to a mucous plug manifested by tracheal rupture. This report also highlights the importance of the coughing reflex as one of several defensive mechanisms protecting the airways from the potentially damaging effects of aspirate and accumulated secretions.

Purpose: To describe the characteristics of lymphangioma reporting a pediatric case of small bowel mesentery location, showing ultrasound-elastosonographic and computed tomography findings., Methods: A 7-year-old girl suffering from vomiting and abdominal pain underwent chest-abdomen radiography and abdomen ultrasound examination at our institution. These exams were repeated for 5 days after medical therapy and a computed tomography investigation was also performed., Results: Abdominal ultrasound and computed tomography examinations revealed the presence of a heterogeneous mesenteric mass occupying the right hemiabdomen displacing small bowel loops. Moreover, the mass had an irregular vascularisation pattern on color-Doppler study and appeared mostly green colored, like soft tissues, on elastosonographic colorimetric map. The little patient underwent surgery with removal of both the mass and the close adherent ileal loop. Finally, anatomopathologic diagnosis of mesenteric lymphangioma was made., Conclusions: Although mesenteric lymphangioma is a rare disease that presents neither clinical nor imaging typical features requiring invasive procedure to be diagnosed, ultrasound-elastosonographic findings can suggest a benign condition and computed tomography scan is useful in order to plan surgery.