2 is there a defect in the cortex of the long bone or

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2. Is there a defect in the cortex of the long bone or the skull? 3. Is there a hip effusion > 5 mm, or a difference of > 2 mm between the symptomatic and the asymptomatic (contralateral) hip? The questions for pediatric inferior vena cava ultrasound evaluation are as follows: 1. Does the longitudinal IVC collapse more than 50% with inspiration? 2. Is the transverse IVC/aorta ratio less than 1 : 1? Anatomy The gastrointestinal anatomy of the pediatric patient is essentially the same as the adult and is well described in Chapter 12 . The only structure not men- tioned previously is the pylorus, which is a thickened area of muscle between the gastric antrum and the duodenal cap. The pyloric muscle is hypoechoic and surrounds echogenic mucosa. A normal exam of the pylorus will docu- ment relaxation of the pyloric canal as fluid travels from the stomach to the duodenum. Musculoskeletal anatomy of the pediatric patient is also essentially the same as the adult and is well described in Chapter 11 . The only structure not mentioned in Chapter 11 is the hip. When the linear probe is held along the axis of the femoral neck, the bright shadow of the femoral head and neck are seen, with the intervening echolucent joint fluid. Just anterior to the fluid is the outer margin of the capsule, which is usually seen as an echogenic line mirroring the femoral neck and extending over the femoral head ( Figure 13.6 ). Figure 13.6 Normal hip. Note the echogenic line of the joint capsule. Diagnostic ultrasound 247 Pediatric ultrasound
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Aorta and IVC anatomy is also essentially the same as in the adult and is described in Chapters 4 and 14 . Again, the most important landmark when evaluating these two vessels is to ensure that the vertebral shadow is well visualized and that the vessels are located just anterior to this shadow ( Figure 13.7 ). Care must be taken when imaging the vena cava longitudinally that the probe does not slide over the aorta instead of the vena cava. Fanning side to side in the longitudinal plane can help to ensure that the probe is being held over the widest diameter and over the correct vessel. Technique Probe selection Most pediatric applications use the high-frequency linear probe because most of the salient structures are at a relatively shallow depth. In pediatric gastro- intestinal applications, unless there is a significant amount of soft tissue or abdominal fat, the linear probe will give images with the most detail. This is certainly also true for pediatric musculoskeletal applications, where the linear probe is used almost exclusively. When imaging the IVC, it depends on the size of the child. This is the one application where even small children may need to be imaged using the lower-frequency probe, since the structures of interest are often more than 5–6 cm deep.
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