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SummaryBackgroundHepatic portal venous gas (HPVG) is a rare imaging finding in children. It can be an important manifestation of severe diseases such as necrotizing enterocolitis (NEC) in neonates or bowel wall rupture in older children. However, there are many other diseases presenting with HPVG that do not necessarily require a surgical intervention.Case ReportIn the period between 2011–2015, there were 12 cases of HPVG in children aged up to 24 months in our hospital. We did not include children with NEC. We retrospectively analyzed clinical data and US examinations as regards the suspected causes and final diagnoses.Only 1 patient with HPVG required an immediate surgical intervention. This was – a 4-month-old girl 32 days after a repair of a congenital diaphragmatic hernia, with ultrasound signs of acute bowel wall necrosis. During surgery a bowel strangulation was revealed.Other causes included: – 4 patients with bowel inflammation (including complications of neoplastic diseases such as leukemia and Hodgkins’disease); – 3 patients with food allergy; – 1 patient with acute gastroenteritis; – 1 patient with hepatic injury because of a suspected metabolic disease; – 1 incidental finding revealed before closing a ventricular septum defect; – 1 patient during follow-up performed 2 weeks after a reconstruction of bowel continuity.ConclusionsHPVG is not always a sign of a life-threatening condition and it should not be by itself an indication for surgical treatment.HPVG requires a close monitoring of the clinical status, which is crucial for further management. In patients in non-severe clinical condition, we propose to perform a follow-up ultrasound imaging within 1–2 days, and not to extend diagnostic procedures, especially in case of ultrasound picture normalization.An abdominal ultrasound examination appears to be the method of choice for the identification of gas in the hepatic portal system in children.

The double aorta artifact was described and studied thoroughly twenty-five years ago. Despite this, it is still not commonly known today and can cause diagnostic difficulty. Total aortic duplication can be considered an anatomic defect whilst partial duplication mimics aortic dissection. In the literature, this artifact has been compared with a very rare anomaly, i.e. the occurrence of two aortas in one patient. Currently, however, the differentiation of this artifact from abdominal aortic dissection seems to be of greater significance. The double aorta image occurs when ultrasound waves encounter prismatic fat tissue of the anterior abdominal wall. This artifact is more frequently observed in children and athletic young adults since the structure of this anatomic region in these individuals is conductive to the occurrence of this phenomenon. Moreover, it can be observed more often when curved transducers are used. Due to all these factors, an ultrasound beam undergoes greater refraction and make the artifact clearer. This phenomenon is usually easily recognizable and avoidable, but it sometimes might cause diagnostic difficulty. Obtaining an image of double abdominal vessels on ultrasound examination in transverse sections requires further inspection of the aorta in a different (sagittal) plane. This is not always possible due to poor patient preparation for scanning. Symmetrical flow on Doppler sonography is a typical feature of this artifact. Finally, magnetic resonance imaging or computed tomography can be considered to rule out a pathology.

SummaryBackgroundExtravaginal testicular torsion (ETT), also called prenatal or perinatal, occurs prenatally and is present at birth or appears within the first month of life. It has different etiology than intravaginal torsion, which appears later in life. Testicular torsion must be taken into consideration in differential diagnosis of acute scrotum and should be confirmed or ruled out at first diagnostic step. Ultrasonography is a basic imaging modality, however diagnostic pitfalls are still possible. There is still wide discussion concerning management of ETT, which varies from immediate orchiectomy to conservative treatment resulting in testicle atrophy.Material/MethodsIn this article we present ultrasonographic spectrum of ETT in neonates, which were diagnosed and treated in our hospital during the last 8 years (2008–2015), in correlation with clinical and intraoperative findings.ResultsThirteen neonates with ETT were enrolled in the study – 11 patients with a single testicle affected and 2 patients with bilateral testicular torsion. Most common signs on clinical examination were: hardened and enlarged testicle and discoloration of the scrotum. Most common ultrasonographic signs were: abnormal size or echostructure of the affected testicle and absence of the blood flow in Doppler ultrasonography. In 3 patients ultrasound elastography was performed, which appeared very useful in testicle structure assessment.ConclusionsTesticular torsion may concern boys even in the perinatal period. Ultrasonographic picture of acute scrotum in young boys may be confused. Coexistence of the abnormal size or echostructure of the torsed testicle with absence of the blood flow in Doppler ultrasonography appear as very specific but late ultrasonographic sings. Ultrasound elastography may be a very useful tool for visualisation of a very common clinical sign – hardening of the necrotic testicle.

PurposeTo assess the extent to which a radiation dose can be lowered without compromising image quality and diagnostic confidence in congenital urinary tract abnormalities in children by using a CT scanner with an iterative reconstruction algorithm.Material and methods120 CT urography image series were analysed retrospectively. Image series were divided into four study groups depending on effective radiation dose (group 1: 0.8-2 mSv; group 2: 2-4 mSv; group 3: 4-6 mSv; group 4: 6-11 mSv). Objective and subjective image quality were investigated. In objective analysis, measurements of attenuation and standard deviation (SD) in five regions of interest (ROIs) were performed in 109 excretory image series, and image noise was evaluated. In subjective analysis, two independent radiologists evaluated 138 kidney units for subjective image quality and diagnostic confidence.ResultsThere were no significant differences in image noise in objective evaluation between the following study groups: 2 vs. 3 and 3 vs. 4 in all ROIs (with the only exception in spleen SD measurement between study groups 2 vs. 3), while there was significantly more image noise in group 2 in comparison to group 4. For all other ROIs in all study groups, there was more image noise on lower dose images. There were no significant differences in pairwise comparisons between study groups in subjective image quality. Diagnostic confidence was not significantly different between all study groups.ConclusionsLow-dose CT urography can be a valuable method in congenital urinary tract abnormalities in children. Despite poorer image quality, diagnostic confidence is not significantly compromised in examinations performed with lower radiation doses.