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.

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.

SummaryBackgroundAn abdominoscrotal hydrocele (ASH) is a rare lesion and should be considered in the differential diagnosis of abdominal cystic lesions in boys.Case ReportWe report a case of a 4-month-old boy with a thin-walled, anechoic cystic abdominal mass in ultrasound (US) examination. As the size of the lesion increased in follow-up US after one month, computed tomography (CT) was performed. CT demonstrated a communication between a cystic mass in the abdomen and a right scrotal hydrocele – an abdominoscrotal hydrocele (ASH).The patient had no symptoms and was observed by means of US examination. After the next 4 months, the size of the ASH decreased remarkably.ConclusionsThis rare entity should be considered in differential diagnosis of cystic abdominal masses in boys.Spontaneous resolution of ASH is rare, but asymptomatic patients can be followed up before surgery.