Abdominal ultrasound is normal. Part 2, Kolesnichenko Yu.Yu., ultrasound doctor :: Ultrasound doctors website :: Ultrasound standards

Normal dimensions of the gallbladder:

- length up to 8-12cm[1,5,7];

— transverse size up to 3.5-5 cm [1,5,7];

— wall up to 3-4mm*[1,5,7].

*All measurements are given on an empty stomach, i.e. when the gallbladder is full. The wall of the gallbladder in a contracted state can be thicker!

When conducting a food test to determine the function of the gallbladder using ultrasound, it should shrink by 2/3 of its original volume by about 30 minutes after eating.

Percussion of the spleen

Percussion of the spleen is used to determine its size. Quiet percussion is used. The patient can be in a vertical position with arms extended forward or in a horizontal position, lying on the right side, his left arm should be bent at the elbow joint and lie freely on the front surface of the chest, the right arm should be under the head, the right leg should be extended, the left leg should be bent at the knee and hip joints.

To determine the upper border of the spleen, a finger-pessimeter (Fig. 64, a) is placed along the midaxillary line in the VI-VII intercostal space and percussed down the intercostal spaces until a clear pulmonary sound is replaced by a dull one. The boundary is marked from the direction of clear sound.

Rice. 64. Percussion of the spleen: a — position of the pessimeter finger when determining the upper and lower boundaries of the spleen; b - anterior and posterior borders.

To establish the lower border of the spleen, a finger-pessimeter (see Fig. 64, a) is also installed along the mid-axillary line, parallel to the expected border, below the costal arch and percussed from bottom to top from the tympanic sound to dullness. The border is marked from the side of the tympanic sound.

To determine the anterior border of the spleen (Fig. 64, b), a finger-pessimeter is placed on the anterior abdominal wall, to the left of the navel, parallel to the desired border (approximately at the level of the X intercostal space) and percussed towards the diameter of the splenic dullness until dullness appears. The mark is placed on the side of clear sound. Normally, the anterior border is 1-2 cm to the left of the anterior axillary line.

Rice. 65. Dimensions of a normal spleen.

To find the posterior border of the spleen, a finger-pessimeter (see Fig. 64, b) is placed on the X rib, perpendicular to it, i.e., parallel to the desired border, between the posterior axillary and scapular lines, and percussed from back to front until a dull sound appears.

Next, measure the distance between the upper and lower borders of the spleen, i.e. its diameter, which is located between the IX and XI ribs and is normally 4-6 cm. Then measure the distance between the anterior and posterior borders of the spleen, i.e. the length of the spleen, which is normally 6-8 cm (Fig. 65).

An increase in the diameter and length of splenic dullness indicates an enlargement of the spleen. This can be observed in infectious diseases (abdominal, typhus, relapsing fever, malaria, brucellosis, sepsis, etc.), diseases of the hematopoietic system (leukemia, hemolytic anemia, lymphogranulomatosis, thrombocytopenic purpura, etc.), liver diseases (hepatitis, cirrhosis), metabolic disorders (diabetes mellitus, amyloidosis, etc.), circulatory disorders (thrombosis of the splenic or portal veins), and damage to the spleen (inflammatory process, traumatic injury, tumor, echinococcosis).

In the case of acute infectious diseases, the spleen has a rather soft consistency (especially in sepsis). In chronic infectious diseases, blood diseases, portal hypertension, it thickens, especially with amyloidosis and cancer. With echinococcosis, cysts, syphilitic gummas, and infarctions of the spleen, its surface becomes uneven.

Soreness of the spleen is observed with its inflammation, infarction, and also with thrombosis of the splenic vein.

Palpation of the spleen

Normal stomach wall thickness:

- up to 3.5+-1.1mm[6].

Normally, on an empty stomach there should be no liquid contents in the stomach.

Ultrasound for children: norms

Ultrasound for children: norms. What are they? What can an ultrasound detect? First of all, it should be noted that these figures may differ depending on the age of the child and some related factors. However, it is worth familiarizing yourself with the norms of ultrasound diagnostics of children for a deeper understanding and interpretation of the results of the ultrasound diagnostics obtained.

Norms of cardiac ultrasound in children

Heart ultrasound in children is designed to determine the size of the heart chambers, their condition and integrity. The thickness of the atria, ventricles and the condition of their walls are also studied. The study can also detect a large number of heart diseases.

Ultrasound (sizes) in children are normally as follows (for newborns):

The diameter of the aorta is rarely determined;
The left ventricle (side) is 4.5 mm thick;
The thickness of the pancreas side is 3.3 mm;
The septum (length) between the ventricles is from 3 to 9 mm;
LV ejection fraction – from 66 to 76 percent;
Heart rate – 120-140 beats per minute.

For a one-year-old child, the norms will be as follows: diameter (at relaxation) of the left ventricle – 20-32 mm;
diameter (with contraction) of the LV – 12-22 mm; the posterior side of the LV in thickness is 3-6 mm; aorta diameter – 10-17 mm; left atrium diameter – 14-24 mm; the middle wall of the pancreas in thickness is 1-4 mm; The diameter of the pancreas is 3-14 mm. The same data for a child from six to ten years old will be as follows: the diameter of the left ventricle at relaxation is 29-44 mm; LV diameter during contraction – 15-29 mm; The posterior side of the LV is 4-8 mm thick; aorta diameter – 13-26 mm; left atrium diameter – 16-31 mm; the thickness of the median wall of the pancreas is the same as in the previous case; The diameter of the pancreas is 5-16 mm.

RV – right ventricle of the heart, LV – left ventricle.

Norms of kidney size according to ultrasound in children

In what cases can a doctor prescribe an ultrasound scan of the kidneys for a child? These are swelling, pain in the abdomen and lower back, problems with urination, colic, test results that deviate from the norm. Diagnostics is also indicated for injuries. Preventive examination should be carried out in children aged one and a half months.

If the contours of the kidneys are smooth and the fibrous capsule is clearly visible, we can speak of normality.

The size of the kidneys is directly dependent on the age and height of the child being diagnosed. If the height is no more than fifty to eighty centimeters, the length and width must be measured.

An ultrasound of the kidneys in children (normal) shows that the kidneys on the left and right differ in size. The length of the kidney on the left should be between 4.8 and 6.2 cm, on the right - from 4.5 to 5.9 cm. The left kidney (wide part) should be between 2.2 and 2.5 cm, the right - from 2.2 to 2.4 cm.

The full parenchymal renal thickness on the left is 0.9 - 1.8 cm, and for the kidney on the right - 1 - 1.7 cm.

If the diagnosis mentions intestinal pneumatosis, this indicates that the child has increased gas formation and special preparation for the study was not carried out.

Norms of liver size according to ultrasound in children

Diagnosis of the liver by ultrasound in childhood is indicated in the following cases: hepatitis, yellowing of the skin and whites of the eyes, pain on palpation, as well as pain in the right hypochondrium.

“Ultrasound of the liver (normal in children): table” - this method helps to quickly find the necessary parameters and compare them with the available results. Below are normal indicators for the main age groups of children.

For a one-year-old child: the norm for the right hepatic lobe is 60 mm, for the left - 33 mm; normal portal vein - from 2.91 to 5.7 mm.
For a five-year-old child: the right lobe of the liver is 84 mm, the left is 41 mm; portal vein – from 4.3 to 7.6 mm.
For a nine-year-old child: the norm for the right lobe will be 100 mm, the size on the left will be 47 mm; Norms for a fifteen year old teenager: right hepatic lobe – 100 mm, left – 50 mm.

Thyroid gland (children): normal ultrasound

The thyroid gland can influence many processes in the body, and for a child its normal functioning is especially important, since thyroid hormones are responsible for normal physical development, growth, metabolism and the functioning of the nervous system.

From birth until the age of two years, the volume of the organ should not be more than 0.84 ml. Before reaching six years of age, growth up to 2.9 ml is considered normal. During puberty, the thyroid gland begins to grow very actively. In boys, by the age of fifteen, the volume of the organ reaches 8.1 - 11.1 ml. As for girls at this age, the volume will be 9 - 12.4 ml.

Ultrasound of the thyroid gland is extremely necessary, since if pathology is detected in childhood, there is a favorable prognosis for treatment.

Norms of the spleen according to ultrasound in children

Ultrasound diagnosis of the spleen in childhood is most often prescribed if there is a suspicion of enlargement of this organ.

As for the standards for ultrasound diagnostics, it should be noted that a lot depends on how the ultrasound is performed and you should not forget that in a newborn the size of the spleen is extremely small: 4.5 cm in length and 2 cm in thickness. If the spleen of a one-year-old child is examined, its length is slightly more than 5 cm and its thickness is 2.5 cm. As for a five-year-old child. The length of his spleen within the normal range should be 7.5 cm, and its thickness – 3.5 cm. For a ten-year-old child, the length will increase to 10.5 cm, and the thickness to 5 cm.

Ultrasound of the abdominal cavity in children (normal)

The main indications for performing an ultrasound of the peritoneum in children are:

Painful sensations in any part of the peritoneum;
Constipation and gas;
Repulsive odor from the mouth and belching;
Jaundice;
Internal organ injuries.

This ultrasound includes diagnostics of the liver, kidneys, children's spleen, pancreas and gall bladder. The parameters of the first three organs were discussed above. As for the norms of the pancreas, they will be as follows for a newborn: 10 by 14 mm (head of the gland), 1 by 1.4 cm (tail of the gland). 0.6 by 0.8 cm (body). For a child from one to five years: 1.7 by 2 cm (head part), 1.8-2.2 cm (tail part), 1 by 1.3 cm (body). Interpretation of an adult prostate ultrasound will be completely different.

The normal dimensions of the gallbladder in children are as follows: from two to five years: the long part is about 5.1 cm, the wide part is 1.7 cm; for a child from 9 to 11 years old: long part 6.4 cm, wide part 2.3 cm. It is also convenient to use tables for independent interpretation of ultrasound results.

Normal kidney sizes:

- length 9-12 cm [1,5,7] (length less than 9 cm can be considered as hypoplasia), sometimes in tall people the kidneys can be longer than normal, also when lengthening the kidney, it is necessary to exclude doubling of the kidney, which is often asymptomatic (t i.e. often not dangerous to health) and is detected by chance (i.e. for another reason) on urography;

— transverse size 4-6cm[1,5,7];

— parenchyma thickness 1.3-25 mm[1].

The adrenal glands are normally visible only in infants, usually up to 1-2 months of life. On ultrasound they appear as hypoechoic curved linear structures.

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Sometimes you can find a description of the size of the adrenal glands in some literature sources[6] and in reports on adults; most often this is simply a measurement of a piece of fatty tissue in the area of the upper pole of the kidney, because according to classical ideas about anatomy, this is where the adrenal gland should be located (as the name suggests). In fact, in adults, the adrenal glands are not visible on ultrasound (i.e., they are indistinguishable on ultrasound from the fatty tissue around the kidney), and they can be located not only in the area of the upper pole of the kidney. And the main task of ultrasound is to search for formations of the adrenal gland, which are often visible on ultrasound!

Normally, the ureters are also not visible on ultrasound; they become visible when they expand due to diseases. The exception is when the bladder is full. In such cases, the patient should be asked to go to the toilet and look again.

The bladder normally has an oval shape and an anechoic lumen, the thickness of the wall when filled is up to 4 mm [1,7], if the bladder is empty or poorly filled, the wall may be thicker.

Treatment

Medicines for each little patient are selected individually

When an enlarged spleen is detected in a newborn baby, doctors take a wait-and-see approach. This is explained by the fact that the size of the organ in infants is directly related to the intensity of blood circulation - the stronger the filling with blood, the larger its size. In all other cases, splenomegaly requires medical attention.

Therapy in this case is prescribed after a complete examination of the children and is aimed at eliminating the underlying disease.

If the cause of splenomegaly is infectious processes of bacterial origin, treatment with antibacterial drugs is prescribed.

Pathologies that develop against the background of neoplasms are treated with antitumor drugs or surgery.

For autoimmune causes of the disease, immunosuppressants are recommended - drugs that suppress the immune system.

Regardless of the reasons that led to an enlarged spleen in children, treatment is always supplemented by taking vitamin and mineral complexes.

Surgical treatment

Surgical treatment is recommended when conservative therapy for the underlying disease has not given the required results, as a result of which the organ has greatly increased in size. In this case, we are usually talking about deletion.

The exception is cases of lymphogranulomatosis - malignant degeneration of lymphoid tissue or a strong increase in the size of the organ, leading to thinning of its tissues - in such situations the spleen is removed immediately, without prior treatment.

The operation to remove the spleen is called splenectomy. When treating children, it is performed laparoscopically, which is the most gentle, practically bloodless and favorable from the point of view of subsequent rehabilitation. Other removal methods require direct access to the organ through an incision in the peritoneum.

After surgery, the child’s immunity is greatly reduced, and he becomes susceptible to various infections, both viral and bacterial in origin. Bacteria pose a particular danger in this case, and therefore operated children are vaccinated against pneumococcus, meningococcus and Haemophilus influenzae.

A decrease in immunity is, as a rule, temporary - in the vast majority of cases, the body compensates for the absence of an organ within one and a half to two years from the date of surgery. The child begins to get sick much less, his life becomes full, not requiring any restrictions.

Ultrasound of the obstructive system for children (liver, spleen, gallbladder, pancreas)

The abdominal cavity is a rather broad concept.
It includes the most important organs and systems for human life. All of them can be examined and assessed by an ultrasound specialist. An abdominal ultrasound of a child includes examination of the liver, spleen, pancreas and gallbladder. All of these organs are involved in the digestion process, so it is necessary to identify possible problems associated with digestion as early as possible and help the child cope with them as quickly as possible. Ultrasound waves reflecting from organs make it possible to provide accurate information about the size and density of organs, structure, and wall thickness. Ultrasound diagnostics has been used in pediatric practice for more than 20 years and is a safe examination even for children.

Preparing for an abdominal ultrasound for a child

An ultrasound scan of the abdominal cavity requires preparation in order to reduce gas formation, which can distort the picture of the examination. Before an abdominal ultrasound, children should exclude from their diet: legumes, brown bread, milk, apples, grapes, bananas, fatty foods, raw vegetables and fruits, carbonated drinks and dairy products, sweets (cakes, pastries). If necessary, you can take enzymes (Festal, Mezim-Forte, Microzim, Creon) 2-3 days before the ultrasound. The examination is performed on an empty stomach 8-10 hours after eating. On the day of the examination (at least 6 hours in advance), the child is not given anything to eat and is not given water for 2 hours beforehand.

Diseases of the spleen in children: enlargement, cyst and rupture

In children, the size of the spleen depends entirely on their age. In the first days of life, if a child’s spleen is enlarged, this is considered a normal indicator. Subsequently, the organ gradually grows. When conducting a size study, specialists always compare the age, height and weight of the child and determine the spleen norms using ultrasound.

The normal size chart for the spleen in children looks like this:

Age of the childLength of the spleen in millimeters Width of the spleen in millimeters

1 year	50 – 65	17 – 25
2 years	56 – 72	24 – 34
3 years	61 – 79	27 – 37
4 years	64 – 84	27 – 39
5 years	68 – 88	27 – 39
6 years	71 – 91	27 – 41
7 years	74 – 96	27 – 41
8 years	76 – 100	29 – 43
9 years	78 – 102	29 – 43
10 years	79 – 103	30 – 44
11 years	80 – 108	30 – 44
12 years	85 – 113	31 – 45
13 years	88 – 118	32 – 46
14 years	90 – 120	33 – 48
15 years	90 – 120	34 – 49
16 years	91 – 121	35 – 51

Ultrasound examination allows you to determine the size of the organ, its structure and shape.
This part of the body cannot be detected by palpation. It is possible to detect an organ by palpation when it is significantly enlarged. The spleen has the ability to perform several functions:

to fight various infections - produces antibodies;
cleanses and filters blood;
regulates hematopoietic processes;
actively participates in protein synthesis.

Causes of organ enlargement

Experts call enlargement of an internal organ in a child splenomegaly. Pathological enlargement of an organ is not an independent disease; it is often a sign of other more aggressive diseases. The reasons for an enlarged spleen in a child are as follows:

Acute bacterial infections: sepsis, typhoid fever.
Blood diseases: leukemia, anemia, lymphogranulomatosis.
Liver diseases: cirrhosis, cystic fibrosis.
Bacterial infections of chronic etiology: brucellosis, tuberculosis, syphilis.
Diseases associated with metabolic disorders in the body: Gaucher disease.
Heart defects.
Sarcoma.
Hemangioma, cyst.

Specialists prescribe all possible examinations, during which the true causes of an enlarged spleen in children are found.

Signs indicating organ enlargement

Characteristic signs of enlargement are:

pain under the rib on the left;
pale skin;
feeling of heaviness and fullness in the stomach;
lethargy and increased fatigue;
increased sweating;
temperature increase.

Enlarged "couple"

In most cases, enlargement of the liver, spleen and lymph nodes occurs simultaneously, since these organs are in direct relationship. An enlarged liver and spleen is the first sign of diseases of the hematopoietic organs and blood. In some cases, this symptom indicates the presence of infectious mononucleosis. Hepatolienal syndrome is a sign of chronic lymphocytic leukemia at the last stage.

Experts determine the cause of the simultaneous increase using a medical examination: blood biochemistry, X-ray studies, CT scans, scanning, ultrasound, MRI. These studies allow us to thoroughly examine the area of the spleen in children. There is no specific treatment for enlarged organs. Causes and treatment are closely related. After all, in order to successfully carry out treatment, it is necessary to correctly diagnose the causes of this condition.

Cyst on an organ: what to do, how to help with rupture

A splenic cyst in a child is usually detected completely by accident during an ultrasound scan. The treatment method for this pathology depends on the size of the formation. If a small cyst is detected, the child is monitored by specialists, and control examinations are done 2–3 times a year.

If a large or medium-sized cyst is detected, inflamed or ruptured, surgical intervention is performed. In this case, the cyst is removed, and in some cases the entire organ is removed.

An enlarged spleen in a child entails the destruction of blood cells. In turn, this condition can provoke rupture of the enlarged organ. How to determine pathology and what could be the cause? A fairly serious illness requires urgent medical attention.

Most often, a break does not occur suddenly. First, a hematoma forms, then under certain conditions it ruptures. In children, the organ is not sufficiently covered by the ribs, and therefore is poorly protected from external influences. In newborns, rupture occurs due to infectious diseases.