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Musculoskeletal ultrasonography of the lower extremities in infants and children

  • Pediatric Musculoskeletal Imaging: Beyond the Basics
  • Published:
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Abstract

Ultrasonography is a powerful diagnostic imaging tool for evaluating lower extremity anatomy and pathology in children. Indications for pediatric musculoskeletal lower extremity sonography include developmental dysplasia of the hip, hip joint sonography for the child with a painful hip, evaluation and characterization of superficial soft-tissue masses, evaluation for deep venous thrombosis, and foreign body localization, characterization and removal. This review highlights these established indications, but primarily focuses on additional US applications for evaluation of the lower extremities, including diagnosis and characterization of arthritis and monitoring of therapy, evaluation of tendon tears and muscle strain injuries, characterization of soft-tissue masses and evaluation of certain congenital abnormalities of the lower extremities. Techniques for optimal utilization of musculoskeletal US in children are also discussed.

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References

  1. Harcke HT (1995) The role of ultrasound in diagnosis and management of developmental dysplasia of the hip. Pediatr Radiol 25:225–227

    Article  PubMed  CAS  Google Scholar 

  2. Rosendahl K, Toma P (2007) Ultrasound in the diagnosis of developmental dysplasia of the hip in newborns. The European approach. A review of methods, accuracy and clinical validity. Eur Radiol 17:1960–1967

    Article  PubMed  Google Scholar 

  3. Marchal GJ, Van Holsbeeck MT, Raes M et al (1987) Transient synovitis of the hip in children: role of US. Radiology 162:825–828

    PubMed  CAS  Google Scholar 

  4. Glasier CM, Seibert JJ, Williamson SL et al (1987) High resolution ultrasound characterization of soft tissue masses in children. Pediatr Radiol 17:233–237

    Article  PubMed  CAS  Google Scholar 

  5. Dubois J, Garel L, David M et al (2002) Vascular soft-tissue tumors in infancy: distinguishing features on Doppler sonography. AJR Am J Roentgenol 178:1541–1545

    Article  PubMed  Google Scholar 

  6. DeAngelis GA, McIlhenny J, Willson DF et al (1996) Prevalence of deep venous thrombosis in the lower extremities of children in the intensive care unit. Pediatr Radiol 26:821–824

    Article  PubMed  CAS  Google Scholar 

  7. Shiels WE 2nd, Babcock DS, Wilson JL et al (1990) Localization and guided removal of soft-tissue foreign bodies with sonography. AJR Am J Roentgenol 155:1277–1281

    Article  PubMed  Google Scholar 

  8. Martinoli C, Valle M, Malattia C et al (2011) Paediatric musculoskeletal US beyond the hip joint. Pediatr Radiol 41(Suppl 1):S113–S124

    Article  PubMed  Google Scholar 

  9. Blaivas M, Lyon M, Brannam L et al (2004) Water bath evaluation technique for emergency ultrasound of painful superficial structures. Am J Emerg Med 22:589–593

    Article  PubMed  Google Scholar 

  10. van Holsbeek MT, Introcaso JH (2001) Sonography of the hip. Musculoskeletal ultrasound. Mosby, St. Louis, pp 573–581

    Google Scholar 

  11. Robben SG, Lequin MH, Diepstraten AF et al (1999) Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology 210:499–507

    PubMed  CAS  Google Scholar 

  12. Rohrschneider WK, Fuchs G, Troger J (1996) Ultrasonographic evaluation of the anterior recess in the normal hip: a prospective study on 166 asymptomatic children. Pediatr Radiol 26:629–634

    Article  PubMed  CAS  Google Scholar 

  13. Bianchi S, Martinoli C (2007) Anterior knee. In: Baert AL, Brady LW, Heilmann HP et al (eds) Ultrasound of the musculoskeletal system. Springer, Berlin, pp 650–662

    Google Scholar 

  14. Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  15. Nazarian LN (2008) The top 10 reasons musculoskeletal sonography is an important complementary or alternative technique to MRI. AJR Am J Roentgenol 190:1621–1626

    Article  PubMed  Google Scholar 

  16. Patel H (2001) Preventive health care, 2001 update: screening and management of developmental dysplasia of the hip in newborns. CMAJ 164:1669–1677

    PubMed  CAS  Google Scholar 

  17. Graf R (1984) Classification of hip joint dysplasia by means of sonography. Arch Orthop Trauma Surg 102:248–255

    Article  PubMed  CAS  Google Scholar 

  18. Harcke HT (1994) Screening newborns for developmental dysplasia of the hip: the role of sonography. AJR Am J Roentgenol 162:395–397

    Article  PubMed  CAS  Google Scholar 

  19. Karmazyn BK, Gunderman R, Coley BD et al (2010) ACR appropriateness criteria: Developmental dysplasia of the hip—child. [Online publication]. American College of Radiology, Reston

  20. Mahan ST, Katz JN, Kim YJ (2009) To screen or not to screen? A decision analysis of the utility of screening for developmental dysplasia of the hip. J Bone Joint Surg Am 91:1705–1719

    Article  PubMed  Google Scholar 

  21. Aronsson DD, Goldberg MJ, Kling TF Jr et al (1994) Developmental dysplasia of the hip. Pediatrics 94:201–208

    PubMed  CAS  Google Scholar 

  22. Keller MS (2005) Musculoskeletal sonography in the neonate and infant. Pediatr Radiol 35:1167–1173, quiz 1293

    Article  PubMed  Google Scholar 

  23. Bellah R (2001) Ultrasound in pediatric musculoskeletal disease: techniques and applications. Radiol Clin North Am 39:597–618

    Article  PubMed  CAS  Google Scholar 

  24. Karmazyn B (2011) Ultrasound of pediatric musculoskeletal disease: from head to toe. Semin Ultrasound CT MR 32:142–150

    Article  PubMed  Google Scholar 

  25. Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the normal neonatal and infant foot: an anatomic introduction to ultrasound assessment of foot deformities. Eur Radiol 12:2306–2312

    PubMed  CAS  Google Scholar 

  26. Aurell Y, Johansson A, Hansson G et al (2002) Ultrasound anatomy in the neonatal clubfoot. Eur Radiol 12:2509–2517

    PubMed  CAS  Google Scholar 

  27. Shiels WE 2nd, Coley BD, Kean J et al (2007) Focused dynamic sonographic examination of the congenital clubfoot. Pediatr Radiol 37:1118–1124

    Article  PubMed  Google Scholar 

  28. Coley BD, Shiels WE 2nd, Kean J et al (2007) Age-dependent dynamic sonographic measurement of pediatric clubfoot. Pediatr Radiol 37:1125–1129

    Article  PubMed  Google Scholar 

  29. Roye BD, Hyman J, Roye DP Jr (2004) Congenital idiopathic talipes equinovarus. Pediatr Rev 25:124–130

    Article  PubMed  Google Scholar 

  30. Reynolds DL Jr, Jacobson JA, Inampudi P et al (2004) Sonographic characteristics of peripheral nerve sheath tumors. AJR Am J Roentgenol 182:741–744

    Article  PubMed  Google Scholar 

  31. Lim R, Jaramillo D, Poussaint TY et al (2005) Superficial neurofibroma: a lesion with unique MRI characteristics in patients with neurofibromatosis type 1. AJR Am J Roentgenol 184:962–968

    Article  PubMed  Google Scholar 

  32. Hollingworth P (1995) Differential diagnosis and management of hip pain in childhood. Br J Rheumatol 34:78–82

    Article  PubMed  CAS  Google Scholar 

  33. Foster F (2004) The limping child. Imaging 16:153–160

    Article  Google Scholar 

  34. Kwack KS, Cho JH, Lee JH et al (2007) Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol 189:437–445

    Article  PubMed  Google Scholar 

  35. Zamzam MM (2006) The role of ultrasound in differentiating septic arthritis from transient synovitis of the hip in children. J Pediatr Orthop B 15:418–422

    Article  PubMed  Google Scholar 

  36. Strouse PJ, DiPietro MA, Adler RS (1998) Pediatric hip effusions: evaluation with power Doppler sonography. Radiology 206:731–735

    PubMed  CAS  Google Scholar 

  37. Kocher MS, Mandiga R, Murphy JM et al (2003) A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip. J Bone Joint Surg Am 85:994–999

    Article  PubMed  Google Scholar 

  38. Neubauer P, Weber AK, Miller NH et al (2007) Pigmented villonodular synovitis in children: a report of six cases and review of the literature. Iowa Orthop J 27:90–94

    PubMed  Google Scholar 

  39. Rosenberg D, Kohler R, Chau E et al (2001) Pigmented villonodular synovitis. Diffuse and localized forms in children. Arch Pediatr 8:381–384

    Article  PubMed  CAS  Google Scholar 

  40. Lin J, Jacobson JA, Jamadar DA et al (1999) Pigmented villonodular synovitis and related lesions: the spectrum of imaging findings. AJR Am J Roentgenol 172:191–197

    Article  PubMed  CAS  Google Scholar 

  41. Clarke E, Swischuk LE, Hayden CK Jr (1984) Tumoral calcinosis, diaphysitis, and hyperphosphatemia. Radiology 151:643–646

    PubMed  CAS  Google Scholar 

  42. Chakarun CJ, Talkin B, White EA et al (2011) Tumoral calcinosis: sonographic sedimentation sign. J Clin Ultrasound 39:367–370

    Article  PubMed  Google Scholar 

  43. Eich GF, Hoeffel JC, Tschappeler H et al (1998) Fibrous tumours in children: imaging features of a heterogeneous group of disorders. Pediatr Radiol 28:500–509

    Article  PubMed  CAS  Google Scholar 

  44. Blitman NM, Pandya D, Thornhill BA et al (2009) Pain in the butt: spectrum of gluteal region abnormalities in children. AJR Am J Roentgenol 192:1286–1291

    Article  PubMed  Google Scholar 

  45. Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754

    PubMed  CAS  Google Scholar 

  46. Mulliken JB, Glowacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 69:412–422

    Article  PubMed  CAS  Google Scholar 

  47. Enjolras O, Mulliken JB (1993) The current management of vascular birthmarks. Pediatr Dermatol 10:311–313

    Article  PubMed  CAS  Google Scholar 

  48. Donnelly LF, Adams DM, Bisset GS 3rd (2000) Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 174:597–608

    Article  PubMed  CAS  Google Scholar 

  49. Fishman SJ, Mulliken JB (1993) Hemangiomas and vascular malformations of infancy and childhood. Pediatr Clin North Am 40:1177–1200

    PubMed  CAS  Google Scholar 

  50. Simanovsky N, Leibner E, Hiller N et al (2005) Detection of radiographically occult fractures in pediatric ankle trauma. J Bone Joint Surg Br 88:333

    Google Scholar 

  51. Hoksrud A, Ohberg L, Alfredson H et al (2008) Color Doppler ultrasound findings in patellar tendinopathy (jumper’s knee). Am J Sports Med 36:1813–1820

    Article  PubMed  Google Scholar 

  52. Peetrons P, Creteur V, Bacq C (2004) Sonography of ankle ligaments. J Clin Ultrasound 32:491–499

    Article  PubMed  Google Scholar 

  53. Espinosa N, Rothenfluh DA, Beck M et al (2006) Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am 88:925–935

    Article  PubMed  Google Scholar 

  54. Pfirrmann CW, Mengiardi B, Dora C et al (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240:778–785

    Article  PubMed  Google Scholar 

  55. Troelsen A, Jacobsen S, Bolvig L et al (2007) Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips. Acta Radiol 48:1004–1010

    Article  PubMed  CAS  Google Scholar 

  56. Buck FM, Hodler J, Zanetti M et al (2011) Ultrasound for the evaluation of femoroacetabular impingement of the cam type. Diagnostic performance of qualitative criteria and alpha angle measurements. Eur Radiol 21:167–175

    Article  PubMed  Google Scholar 

  57. Lee JC, Healy J (2004) Sonography of lower limb muscle injury. AJR Am J Roentgenol 182:341–351

    Article  PubMed  Google Scholar 

  58. Van Holsbeek MT, Introcaso JH (2001) Traumatic bursitis. Musculoskeletal ultrasound. Mosby, St. Louis, p 167

    Google Scholar 

  59. De Maeseneer M, Debaere C, Desprechins B et al (1999) Popliteal cysts in children: prevalence, appearance and associated findings at MR imaging. Pediatr Radiol 29:605–609

    Article  PubMed  Google Scholar 

  60. Van Holsbeek MT, Introcaso JH (2001) Sonography of large synovial joints. Musculoskeletal ultrasound. Mosby, St. Louis, pp 235–275

    Google Scholar 

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Acknowledgments

The author would like to thank Drs. Sarah Bixby, Harriet Paltiel and Susan Connolly for providing images for this manuscript and Rhonda Johnson for her help in preparing this document.

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The author has no financial interests, investigational or off-label uses to disclose.

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Correspondence to Michael J. Callahan.

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Callahan, M.J. Musculoskeletal ultrasonography of the lower extremities in infants and children. Pediatr Radiol 43 (Suppl 1), 8–22 (2013). https://doi.org/10.1007/s00247-012-2589-6

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  • DOI: https://doi.org/10.1007/s00247-012-2589-6

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