The beauty of pediatric musculoskeletal ultrasound

Abstract

Purpose

Ultrasound is a powerful technique in pediatric imaging and musculoskeletal (MSK) imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in pediatric musculoskeletal ultrasound.

Materials and methods

Cases were collected by members of the Educational Committee of the ESSR (European Society of musculoSkeletal Radiology) and the Pediatric Subcommittee of the ESSR with expertise in musculoskeletal ultrasound.

Results

Fifteen clinical entities are discussed based on the features that allow diagnosis by ultrasound.

Conclusion

Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing pediatric musculoskeletal ultrasound.

Key Points

• Ultrasound in pediatric musculoskeletal imaging can achieve a diagnosis in specific clinical settings.

• Clinical history, location, and ultrasound appearance are keys to spot diagnoses.

• Knowledge of spot diagnoses in pediatric musculoskeletal ultrasound facilitates daily clinical practice.

Citation Format

• Drakonaki EE, Adriaensen M, Simoni P et al. The beauty of pediatric musculoskeletal ultrasound. Rofo 2025; 197: 172–185

Zusammenfassung

Ziel

Ultraschall ist in vielen spezifischen klinischen Szenarien eine leistungsstarke Technik in der pädiatrischen Bildgebung sowie in der muskuloskelettalen (MSK) Bildgebung. In diesem Artikel werden einige häufige und seltenere „Spot“-Diagnosen im pädiatrischen muskuloskelettalen Ultraschall vorgestellt.

Material und Methoden

Die Fälle wurden von Mitgliedern des Bildungsausschusses der ESSR (European Society of musculoSkeletal Radiology) und des pädiatrischen Unterausschusses der ESSR mit Expertise im muskuloskelettalen Ultraschall zusammengestellt.

Ergebnisse

Fünfzehn klinische Entitäten werden anhand der Merkmale, die eine Ultraschalldiagnose ermöglichen, erörtert.

Schlussfolgerung

Klinische Anamnese, Lokalisation und Ultraschallbild sind die Schlüssel für „Spot“-Diagnosen beim pädiatrischen muskuloskelettalen Ultraschall.

Kernaussagen

• Der pädiatrische muskuloskelettale Ultraschall kann in bestimmten klinischen Situationen eine Diagnose stellen.

• Klinische Anamnese, Lokalisation und Ultraschallbild sind entscheidend für die Diagnosestellung.

• Die Kenntnis von „Spot“-Diagnosen im pädiatrischen muskuloskelettalen Ultraschall erleichtert die tägliche klinische Praxis.

Keywords

ultrasound - soft tissues - diagnostic radiology

Publication History

Received: 12 January 2024

Accepted after revision: 26 March 2024

Article published online:
13 May 2024

• References

• 1 Martinoli C. Musculoskeletal ultrasound: technical guidelines. Insights Imaging 2010; 1 (03) 99-141
• 2 Drakonaki EE, Martinoli C, Vanhoenacker FM. et al. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. Fortschr Röntgenstr 2023; 195 (05) 385-392
• 3 Davis DJ. Neonatal subgaleal hemorrhage: diagnosis and management. CMAJ 2001; 164 (10) 1452-1453
• 4 Chadwick LM, Pemberton PJ, Kurinczuk JJ. Neonatal subgaleal haematoma: associated risk factors, complications and outcome. J Paediatr Child Health 1996; 32 (03) 228-232
• 5 Sharman AM, Kirmi O, Anslow P. Imaging of the skin, subcutis, and galea aponeurotica. Semin Ultrasound CT MR 2009; 30 (06) 452-464
• 6 Jain P, Jain R, Morton RP. et al. Plunging ranulas: high-resolution ultrasound for diagnosis and surgical management. Eur Radiol 2010; 20 (06) 1442-1449
• 7 Chung YS, Cho Y, Kim BH. Comparison of outcomes of treatment for ranula: a proportion meta-analysis. Br J Oral Maxillofac Surg 2019; 57 (07) 620-626
• 8 Bansal AG, Oudsema R, Masseaux JA. et al. US of Pediatric Superficial Masses of the Head and Neck. Radiographics 2018; 38 (04) 1239-1263
• 9 Bedi DG, John SD, Swischuk LE. Fibromatosis colli of infancy: variability of sonographic appearance. J Clin Ultrasound 1998; 26 (07) 345-348
• 10 Lee YS, Sohn YD, Oh YT. New, specific ultrasonographic findings for the diagnosis of pulled elbow. Clin Exp Emerg Med 2014; 1 (02) 109-113
• 11 Sohn Y, Lee Y, Oh Y. et al. Sonographic Finding of a Pulled Elbow: The “Hook Sign. ” Pediatric Emergency Care 2014; 30 (12) 919-921
• 12 Varga M, Papp S, Kassai T. et al. Two- plane point of care ultrasonography helps in the differential diagnosis of pulled elbow. Injury 2021; 52: S21-24
• 13 Gallardo-Villamil A, Cano-Aguilar LE, Pérez-Muñoz E. et al. Pachydermodactyly: Soft Tissue Enlargement of the Fingers in a Teenager. Cureus [Internet]. 2023 Jul 15 [cited 2024 Jan 4]. https://www.cureus.com/articles/165476-pachydermodactyly-soft-tissue-enlargement-of-the-fingers-in-a-teenager
• 14 Bento da Silva A, Lourenço MH, Gonçalves MJ. et al. Arthritis or maybe not? Pachydermodactyly: the great mimicker of juvenile idiopathic arthritis. ARP Rheumatol 2023; 2 (01) 78-82
• 15 Li L, Xu J, Wang S. et al. Ultra-High-Frequency Ultrasound in the Evaluation of Paediatric Pilomatricoma Based on the Histopathologic Classification. Front Med 2021; 8: 673861
• 16 Bako D, Yapici Ö. Silent anatomic variations of the pediatric chest: They might not be congenital. European Journal of Radiology 2021; 142: 109888
• 17 Donnelly LF, Taylor CN, Emery KH. et al. Asymptomatic, palpable, anterior chest wall lesions in children: is cross-sectional imaging necessary?. Radiology 1997; 202 (03) 829-831
• 18 Dubois J, Patriquin HB, Garel L. et al. Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR Am J Roentgenol 1998; 171 (01) 247-252
• 19 Aparisi Gómez MP, Errani C, Lalam R. et al. The Role of Ultrasound in the Diagnosis of Soft Tissue Tumors. Semin Musculoskelet Radiol 2020; 24 (02) 135-155
• 20 Jin J. Folic Acid Supplementation for Prevention of Neural Tube Defects. JAMA 2017; 317 (02) 222
• 21 Aparisi Gómez MP, Watkin S, Perry D. et al. Anatomical Considerations of Embryology and Development of the Musculoskeletal System: Basic Notions for Musculoskeletal Radiologists. Semin Musculoskelet Radiol 2021; 25 (01) 003-21
• 22 Imbruglia L, Cacciatore A, Carrara S. et al. Abnormal skull findings in neural tube defects. J Prenat Med 2009; 3 (03) 44-47
• 23 Hornig GW, Greene C. NEUROSURGICAL CONDITIONS. In: Ashcraft’s Pediatric Surgery. Elsevier; 2010: 235-246 https://linkinghub.elsevier.com/retrieve/pii/B9781416061274000197
• 24 Bulsara KR, Zomorodi AR, Villavicencio AT. et al. Clinical outcome differences for lipomyelomeningoceles, intraspinal lipomas, and lipomas of the filum terminale. Neurosurg Rev 2001; 24 (04) 192-194
• 25 Perera D, Craven CL, Thompson D. Lumbosacral lipoma in childhood, how strong is the evidence base? A systematic review. Childs Nerv Syst 2023;
• 26 Moraux A, Balbi V, Cockenpot E. et al. Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins. J of Ultrasound Medicine 2018; 37 (06) 1543-1553
• 27 Bianchi S, Martinoli C. Ultrasound of the Musculoskeletal System. New York, Boulder: Springer NetLibrary, Inc. [distributor]; 2008
• 28 Weel H, Joosten AJP, van Bergen CJA. Apophyseal Avulsion of the Rectus Femoris Tendon Origin in Adolescent Soccer Players. Children (Basel) 2022; 9 (07) 1016
• 29 Kang YR, Koo J. Ultrasonography of the pediatric hip and spine. Ultrasonography 2017; 36 (03) 239-251
• 30 Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 1999; 81 (12) 1662-1670
• 31 Kocher MS, Mandiga R, Zurakowski D. et al. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am 2004; 86 (08) 1629-1635
• 32 Singhal R, Perry DC, Khan FN. et al. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. J Bone Joint Surg Br 2011; 93 (11) 1556-1561
• 33 Nguyen A, Kan JH, Bisset G. et al. Kocher Criteria Revisited in the Era of MRI: How Often Does the Kocher Criteria Identify Underlying Osteomyelitis?. J Pediatr Orthop 2017; 37 (02) e114-119
• 34 Habre C, Botti P, Laurent M. et al. Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections. Pediatr Radiol 2022; 52 (06) 1086-1094
• 35 Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369 (9563) 767-778
• 36 Pracoń G, Aparisi Gómez MP, Simoni P. et al. Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population. Semin Musculoskelet Radiol 2021; 25 (01) 68-81
• 37 Sudoł-Szopińska I, Jans L, Jurik AG. et al. Imaging Features of the Juvenile Inflammatory Arthropathies. Semin Musculoskelet Radiol 2018; 22 (02) 147-165
• 38 Brunner E, Ting T, Vega-Fernandez P. Musculoskeletal ultrasound in children: Current state and future directions. Eur J Rheumatol 2020; 7 (Suppl. 01) S28-37
• 39 Khalefa MA, Hussain S, Bache EC. Common Peroneal Nerve Compression Neuropathy Due to a Large Synovial Cyst From the Proximal Tibiofibular Joint in a Teenager. Cureus 2023; 15 (10) e46562
• 40 Bucher F, Maerz V, Obed D. et al. Intraneural Ganglion of the Peroneal Nerve-A Rare Cause of Pediatric Peroneal Nerve Palsy: A Case Report. European J Pediatr Surg Rep 2022; 10 (01) e33-36
• 41 Vial J, Chiavassa-Gandois H. Limb infections in children and adults. Diagn Interv Imaging 2012; 93 (06) 530-546
• 42 Bartoloni A, Aparisi Gómez MP, Cirillo M. et al. Imaging of the limping child. European Journal of Radiology 2018; 109: 155-170
• 43 Mellado Santos JM. Diagnostic imaging of pediatric hematogenous osteomyelitis: lessons learned from a multi-modality approach. Eur Radiol 2006; 16 (09) 2109-2119
• 44 Averill LW, Hernandez A, Gonzalez L. et al. Diagnosis of osteomyelitis in children: utility of fat-suppressed contrast-enhanced MRI. AJR Am J Roentgenol 2009; 192 (05) 1232-1238