Ingmar Gassner

Background Early diagnosis of ovarian torsion is mandatory to avoid common complications. Sonography is the imaging modality of choice, but diagnosis is still a challenge. Objective To report an additional sonographic feature of ovarian torsion in order to improve diagnostic accuracy. Materials and methods Grey-scale and colour Doppler pelvic sonography was performed in 12 patients with acute onset of intermittent lower abdominal pain and in 1 asymptomatic patient with a palpable mass in the labium majus. Patient ages ranged from 4 months to 17 years. Results In all patients an enlarged ovary with peripheral cysts was demonstrated. High-resolution sonography detected fluid-debris levels within these cystic structures in 11 of the 13 patients (sensitivity 85%) and provided an additional diagnostic sign. Six patients had cystic teratoma. Conclusions We confirm the fluid-debris level as a pathognomonic sonographic sign of ovarian torsion with or without associated teratoma.

Die pränatale Ultraschalluntersuchung, v. a. im 3. Trimenon, erfasst viele Harntraktanomalien, die einer Behandlung zugänglich sind, bevor sie klinisch durch eine Harnweginfektion oder Niereninsuffizienz symptomatisch werden. Sie lenkt die gezielte postnatale Bildgebung, mit der beim Neugeborenen die pränatal entdeckte Pathologie abgeklärt wird. Die Ultraschalluntersuchung durch einen mit dem Spektrum möglicher Fehlbildungen vertrauten Untersucher ermöglicht eine genaue morphologische Diagnose. Bei Harntraktdilatation, einseitiger Nierenagenesie und multizystisch dysplastischer Niere ist immer ein Miktionszystourethrogramm (MCUG) zum Refluxnachweis bzw. -ausschluss indiziert! Über das genaue Ausmaß einer abklärungswürdigen Nierenhohlsystemerweiterung besteht noch keine Einigkeit. Die meisten Autoren akzeptieren einen maximalen a.p. Durchmesser des Nierenbeckens von 7 mm als oberes Limit. Der Schweregrad einer Harnwegobstruktion wird mittels Nierenfunktionsszintigraphie erfasst. Die Ultraschalluntersuchung sollte erst nach der Phase der physiologischen postpartalen Dehydratation, d. h. 3–5 Tage nach der Geburt, durchgeführt werden, bei dringlichen Fällen am 1. Lebenstag. Der Einsatz der MR-Urographie bei der Abklärung der Harntraktanomalien, insbesondere der Harnwegobstruktionen, wird gegenwärtig evaluiert. Aufgrund der gemeinsamen embryologischen Entwicklung von Harn- und Genitaltrakt treten Malformationen oft in beiden Systemen auf, sodass bei bestimmten Anomalien des Harntrakts (einseitige Nierenagenesie, multizystisch dysplastische Niere) v. a. bei Mädchen nach Anomalien des inneren Genitale gesucht werden sollte. Improvements in ultrasound technology and the appropriate timing of antenatal ultrasound has led to refined prenatal diagnosis and enhanced accuracy of diagnosis of fetal renal anomalies and makes it possible to treat obstructive and/or refluxing uropathies before the onset of clinical symptoms. The third trimester renal sonography is the most important to detect hydronephrosis amenable to treatment. Classically, the prenatal diagnosis of hydronephrosis, unilateral renal agenesis, or MDKD initiates postnatal investigations, including sonography, voiding cystourethrography (VCUG), and isotopic renography. The exact degree of renal pelvic dilatation that requires full postnatal investigation is still not entirely resolved. Most authors accept the upper limit of 7 mm for the AP diameter of the renal pelvis. The US examination should be performed after the physiological dehydration period, namely 3–5 days after birth, in an urgent case on the 1st day. A meticulous ultrasound examination performed by a physician who is familiar with the renal abnormalities shows the whole extent of underlying pathology. The role of MR urography in the work-up of renal anomalies, particularly of hydronephrosis, is currently being investigated. Due to the close developmental relationship of the urinary and genital tracts, malformations frequently occur in both of these systems. Therefore in all patients, especially in girls with renal anomalies (unilateral renal agenesis, multicystic dysplastic kidney disease), the internal genitalia need to be evaluated.

Background: Oesophageal atresia and tracheo-oesophageal fistula (TOF) in neonates and young infants is routinely diagnosed using frontal and lateral chest radiographs in the former and fluoroscopic studies in the latter. Objective: The aim of the study was to assess whether a combination of mediastinal and abdominal sonography can be used for the diagnosis of these anomalies in paediatric patients. Material and methods: Sonography was performed in 16 neonates (age range 1–20 days; mean 4 days) with radiologically confirmed oesophageal atresia or isolated TOF. A small volume of saline solution was instilled into the blind upper oesophageal pouch to document its extension. Results: Sonography identified 11 neonates with the most common type of oesophageal atresia (type IIIb), one patient with type II and one with type IIIa anomaly. The length of the upper pouch and the features of its wall were clearly documented in all cases. In one case, two upper TOF were first diagnosed by mediastinal sonography and later confirmed by fluoroscopy. In two of three cases with isolated TOF, the fistula could be located sonographically by detecting moving air bubbles. In all cases the position of the aortic arch, as well as associated malformations, could be documented during a single US examination. Conclusions: These results indicate that mediastinal sonography is a useful tool for the diagnosis of oesophageal atresia and, if air bubbles can be detected, isolated TOF.

Congenital anomalies of the female genital tract result from müllerian duct anomalies and/or abnormalities of the urogenital sinus or cloaca. Due to the close developmental relationship between the genital and the urinary tracts, association of anomalies in both systems are common. This article reviews the appearance of developmental anomalies of the female urinary and genital tracts and points out common associated malformations to allow an early and complete sonographic assessment of affected infant.