A practical guide to urinary tract ultrasound in a child: Pearls and pitfalls

Abstract

The aim of this review article is to equip the sonographer with the necessary knowledge to perform a detailed and clinically relevant assessment of the urinary tract in a child. Many of the techniques and principles used in the imaging of the urinary tract in adults can be applied to children. There are, however, notable differences with which the sonographer should be familiar. There is often a certain amount of trepidation when asked to image a child, but there are a number of simple steps that can make the process easier and more fulfilling. This article begins with advice on how to maintain cooperation in a child and the differences in the technical aspects of imaging of children. This is followed by a detailed review of the different pathologies that may be encountered, as well as highlighting information that is particularly relevant to the clinician looking after the child.

Keywords: Urinary tract imaging; child; paediatric; renal tract imaging; ultrasound.

Figure 1

‘Bear hug’ embrace

Figure 2

Ultrasound appearance of a ureterocoele

Figure 3

Longitudinal view of mass behind the bladder

Figure 4

Normal appearance of a neonatal kidney

Figure 5

Duplex kidney with dilated lower moiety

Figure 6

Thickened bladder wall (catheter in situ) in a child with chronic obstruction secondary to posterior urethral valves

Figure 7

Multi-cystic dysplastic kidney

Figure 8

Autosomal recessive polycystic kidney disease

Figure 9

Tumour thrombus in IVC

Figure 10

Appearance of a hydronephrotic kidney immediately following birth (a) and after adequate hydration (b)

Figure 11

Obstructing stone in lower ureter

Figure 12

Early (a) and late (b) appearances of nephrocalcinosis

Figure 13

Pyonephrosis