Skip to main content
SpringerLink
Log in

Abdominal Vessels

  • Chapter
  • First Online:
Diagnostic and Interventional Ultrasound in Pediatrics and Pediatric Surgery

  • 1577 Accesses

Abstract

Ultrasonography of abdominal vessels aids in the workup of many abdominal conditions in children. Increasing use of this technology has simplified the diagnosis and monitoring of vascular occlusion, thrombosis, stenosis, and compression syndromes, often at the bedside. Abnormalities of the normal central vascular anatomy make diagnosis of malrotation and volvulus by sonography a feasible option. Simple to employ with no risks to the patient, ultrasound has become a tool in the armamentarium for diagnostic workup, assisting in management decisions. Every abdominal organ, its vascular supply, and the large central vessels are able to be imaged with ultrasound, making it a very versatile modality. Color Doppler can picture and quantify pathology within the vasculature itself. Because ultrasound is a noninvasive procedure, easy to repeat, and involves no contrast or radiation, it is a logical study to be included in the workup of many diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Epelman M. The whirlpool sign. Radiology. 2006;240(3):910–1.

    Article  PubMed  Google Scholar 

  2. Applegate KE. Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol. 2009;39:161–3.

    Article  Google Scholar 

  3. Stephens LR, Donoghue V, Gillick J. Radiological versus clinical evidence of malrotation, a tortuous tale–10-year review. Eur J Pediatr Surg. 2012;22(3):238–42.

    Article  PubMed  Google Scholar 

  4. Chao H-C, Kong M-S, Chen J-Y, Lin S-J, Lin J-N. Sonographic features related to volvulus in neonatal intestinal malrotation. J Ultrasound Med. 2000;19(6):371–6.

    CAS  PubMed  Google Scholar 

  5. Gaines P, Saunders A, Drake D. Midgut malrotation diagnosed by ultrasound. Clin Radiol. 1987;38(1):51–3.

    Article  CAS  PubMed  Google Scholar 

  6. Loyer E, Eggli KD. Sonographic evaluation of superior mesenteric vascular relationship in malrotation. Pediatr Radiol. 1989;19(3):173–5.

    Article  CAS  PubMed  Google Scholar 

  7. Weinberger E, Winters W, Liddell R, Rosenbaum D, Krauter D. Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. AJR Am J Roentgenol. 1992;159(4):825–8.

    Article  CAS  PubMed  Google Scholar 

  8. Zerin JM, DiPietro M. Superior mesenteric vascular anatomy at US in patients with surgically proved malrotation of the midgut. Radiology. 1992;183(3):693–4.

    Article  CAS  PubMed  Google Scholar 

  9. Dufour D, Delaet M, Dassonville M, Cadranel S, Perlmutter N. Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol. 1992;22(1):21–3.

    Article  CAS  PubMed  Google Scholar 

  10. Pracros J, Sann L, Genin G, Tran-Minh V, de Finfe CM, Foray P, et al. Ultrasound diagnosis of midgut volvulus: the “whirlpool” sign. Pediatr Radiol. 1992;22(1):18–20.

    Article  CAS  PubMed  Google Scholar 

  11. Shimanuki Y, Aihara T, Takano H, Moritani T, Oguma E, Kuroki H, et al. Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus. Radiology. 1996;199(1):261–4.

    Article  CAS  PubMed  Google Scholar 

  12. Patino MO, Munden MM. Utility of the sonographic whirlpool sign in diagnosing midgut volvulus in patients with atypical clinical presentations. J Ultrasound Med. 2004;23(3):397–401.

    PubMed  Google Scholar 

  13. Yeh WC, Wang HP, Chen C, Wang HH, Wu MS, Lin JT. Preoperative sonographic diagnosis of midgut malrotation with volvulus in adults: the “whirlpool” sign. J Clin Ultrasound. 1999;27(5):279–83.

    Article  CAS  PubMed  Google Scholar 

  14. Van Winckel M, Voet D, Robberecht E. “Whirlpool sign”: not always associated with volvulus in intestinal malrotation. J Clin Ultrasound. 1996;24(7):367–70.

    Article  PubMed  Google Scholar 

  15. Marine MB, Karmazyn B. Imaging of malrotation in the neonate. Semin Ultrasound CT MR. 2014;35(6):555–70.

    Article  PubMed  Google Scholar 

  16. Applegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 2006;26(5):1485–500.

    Article  PubMed  Google Scholar 

  17. Yousefzadeh DK. The position of the duodenojejunal junction: the wrong horse to bet on in diagnosing or excluding malrotation. Pediatr Radiol. 2009;39(2):172–7.

    Article  Google Scholar 

  18. Orzech N, Navarro OM, Langer JC. Is ultrasonography a good screening test for intestinal malrotation? J Pediatr Surg. 2006;41(5):1005–9.

    Article  PubMed  Google Scholar 

  19. Esposito F, Vitale V, Noviello D, Serafino MD, Vallone G, Salvatore M, et al. Ultrasonographic Diagnosis of midgut volvulus with malrotation in children. J Pediatr Gastroenterol Nutr. 2014;59(6):786–8.

    Article  PubMed  Google Scholar 

  20. Quail MA. Question 2 is Doppler ultrasound superior to upper gastrointestinal contrast study for the diagnosis of malrotation? Arch Dis Child. 2011;96(3):317–8.

    Article  PubMed  Google Scholar 

  21. Ashley LM, Allen S, Teele RL. A normal sonogram does not exclude malrotation. Pediatr Radiol. 2001;31(5):354–6.

    Article  CAS  PubMed  Google Scholar 

  22. Harjola PT. A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 1963;52:547–50.

    CAS  PubMed  Google Scholar 

  23. Aschenbach R, Basche S, Vogl TJ. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation. J Vasc Interv Radiol. 2011;22(4):556–61.

    Article  PubMed  Google Scholar 

  24. Moneta GL, Yeager RA, Dalman R, Antonovic R, Hall LD, Porter JM. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg. 1991;14(4):511–20.

    Article  CAS  PubMed  Google Scholar 

  25. Lynch K. Celiac artery compression syndrome a literature review. J Diagn Med Sonogr. 2014;30(3):143–8.

    Article  Google Scholar 

  26. Wolfman D, Bluth EI, Sossaman J. Median arcuate ligament syndrome. J Ultrasound Med. 2003;22(12):1377–80.

    PubMed  Google Scholar 

  27. Papacci P, Giannantonio C, Cota F, Latella C, Semeraro CM, Fioretti M, et al. Neonatal colour Doppler ultrasound study: normal values of abdominal blood flow velocities in the neonate during the first month of life. Pediatr Radiol. 2009;39(4):328–35.

    Article  PubMed  Google Scholar 

  28. Moneta GL, Lee RW, Yeager RA, Taylor LM, Porter JM. Mesenteric duplex scanning: a blinded prospective study. J Vasc Surg. 1993;17(1):79–86.

    Article  CAS  PubMed  Google Scholar 

  29. Roayaie S, Jossart G, Gitlitz D, Lamparello P, Hollier L, Gagner M. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg. 2000;32(4):814–7.

    Article  CAS  PubMed  Google Scholar 

  30. Kohn GP, Bitar RS, Farber MA, Marston WA, Overby DW, Farrell TM. Treatment options and outcomes for celiac artery compression syndrome. Surg Innov. 2001;18(4):338–43.

    Google Scholar 

  31. Wilkie D. Chronic duodenal ileus. Am J Med Sci. 1927;173(5):643–8.

    Article  Google Scholar 

  32. Neri S, Signorelli S, Mondati E, Pulvirenti D, Campanile E, Di Pino L, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J Intern Med. 2005;257(4):346–51.

    Article  CAS  PubMed  Google Scholar 

  33. Unal B, Aktas A, Kemal G, Bilgili Y, Guliter S, Daphan C, et al. Superior mesenteric artery syndrome: CT and ultrasonography findings. Diagn Interv Radiol. 2005;11(2):90–5. http://www.ultrasoundoftheweek.com/uotw-21-answer/.

    PubMed  Google Scholar 

  34. Arthurs O, Mehta U, Set P. Nutcracker and SMA syndromes: what is the normal SMA angle in children? Eur J Radiol. 2012;81(8):e854–e61.

    Article  CAS  PubMed  Google Scholar 

  35. Abu-Zidan F, Hefny A, Saadeldinn Y, El-Ashaal Y. Sonographic findings of superior mesenteric artery syndrome causing massive gastric dilatation in a young healthy girl. Singapore Med J. 2010;51(11):e184–6.

    CAS  PubMed  Google Scholar 

  36. Chin L-W, Chou M-C, Wang H-P. Ultrasonography diagnosis of superior mesenteric artery syndrome in the ED. Am J Emerg Med. 2005;25:864.e5–.e6.

    Google Scholar 

  37. Fagarasanu I. Recherches anatomiques sur la veine renale gauche et ses collaterales; leurs rapports avec la pathogenie du varicocele essential et des varices du ligament large. (Demonstrations experimentales). Ann Anat Pathol. 1938;15:9–52.

    Google Scholar 

  38. Grant J. Method of anatomy. Baltimore: Williams and Wilkins; 1938. p. 1.

    Google Scholar 

  39. De Schepper A. “ Nutcracker” phenomenon of the renal vein and venous pathology of the left kidney. J Belge Radiol. 1971;55(5):507–11.

    Google Scholar 

  40. Alaygut D, Bayram M, Soylu A, Cakmakcı H, Türkmen M, Kavukcu S. Clinical course of children with nutcracker syndrome. Urology. 2013;82(3):686–90.

    Article  PubMed  Google Scholar 

  41. Wolfish N, McLaine P, Martin D. Renal vein entrapment syndrome: frequency and diagnosis. A lesson in conservatism. Clin Nephrol. 1986;26(2):96–100.

    CAS  PubMed  Google Scholar 

  42. Arima M, Hosokawa S, Ogino T, Ihara H, Terakawa T, Ikoma F. Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiography. Int Urol Nephrol. 1990;22(1):3–6.

    Article  CAS  PubMed  Google Scholar 

  43. Okada M, Tsuzuki K, Ito S. Diagnosis of the nutcracker phenomenon using two-dimensional ultrasonography. Clin Nephrol. 1998;49(1):35–40.

    CAS  PubMed  Google Scholar 

  44. Takahashi Y, Sano A, Matsuo M. An ultrasonographic classification for diverse clinical symptoms of pediatric nutcracker phenomenon. Clin Nephrol. 2005;64(1):47–54.

    Article  CAS  PubMed  Google Scholar 

  45. Zerin J, Hernandez R, Sedman A, Kelsch R. “Dilatation” of the left renal vein on computed tomography in children: a normal variant. Pediatr Radiol. 1991;21(4):267–9.

    Article  CAS  PubMed  Google Scholar 

  46. Buschi AJ, Harrison RB, Norman A, Brenbridge A, Williamson B, Gentry R, et al. Distended left renal vein: CT/sonographic normal variant. Am J Roentgenol. 1980;135(2):339–42.

    Article  CAS  Google Scholar 

  47. Park SJ, Shin JI. Renal Doppler ultrasonography in the diagnosis of nutcracker syndrome. Eur J Pediatr. 2013;172(1):135–6.

    Article  PubMed  Google Scholar 

  48. Stavros AT, Sickler KJ, Menter RR. Color duplex sonography of the nutcracker syndrome (aortomesenteric left renal vein compression). J Ultrasound Med. 1994;13(7):569–74.

    CAS  PubMed  Google Scholar 

  49. Takebayashi S, Ueki T, Ikeda N, Fujikawa A. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. Am J Roentgenol. 1999;172(1):39–43.

    Article  CAS  Google Scholar 

  50. Kim SH, Cho SW, Kim HD, Chung JW, Park JH, Han MC. Nutcracker syndrome: diagnosis with Doppler US. Radiology. 1996;198(1):93–7.

    Article  CAS  PubMed  Google Scholar 

  51. Cho BS, Choi YM, Kang HH, Park SJ, Lim JW, Yoon TY. Diagnosis of nut-cracker phenomenon using renal Doppler ultrasound in orthostatic proteinuria. Nephrol Dial Transplant. 2001;16(8):1620–5.

    Article  CAS  PubMed  Google Scholar 

  52. Kavukcu S, Kasap B, Göktay Y, Seçil M. Doppler sonographic indices in diagnosing the nutcracker phenomenon in a hematuric adolescent. J Clin Ultrasound. 2004;32(1):37–41.

    Article  PubMed  Google Scholar 

  53. Cheon J-E, Kim WS, Kim I-O, Kim SH, Yeon KM, Ha IS, et al. Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein. Pediatr Radiol. 2006;36(7):682–6.

    Article  PubMed  Google Scholar 

  54. Shin JI, Park JM, Lee JS, Kim MJ. Effect of renal Doppler ultrasound on the detection of nutcracker syndrome in children with hematuria. Eur J Pediatr. 2007;166(5):399–404.

    Article  PubMed  Google Scholar 

  55. Shin JI, Park JM, Lee JS, Kim MJ. Doppler ultrasonographic indices in diagnosing nutcracker syndrome in children. Pediatr Nephrol. 2007;22(3):409–13.

    Article  PubMed  Google Scholar 

  56. Park SJ, Oh JY, Shin JI. Diagnostic value of renal Doppler ultrasonography for detecting nutcracker syndrome in children with recurrent gross hematuria. Clin Pediatr (Phila). 2012;51(10):1001-.

    Google Scholar 

  57. TA L, Gajjar P, McCulloch M, Scott C, Numanoglu A, Nourse P. Impact of revascularization on hypertension in children with Takayasu’s arteritis-induced renal artery stenosis: a 21-year review. Pediatr Nephrol. 2015. Feb 4.

    Google Scholar 

  58. Hoshino S, Tsuda E, Yamada O. Characteristics and fate of systemic artery aneurysm after Kawasaki disease. J Pediatr. 2015;167:108–12.e2.

    Article  PubMed  Google Scholar 

  59. Puri A, Acharya H, Tyagi S, Curian S, Chadha R, Anand R, Choudhary SR. Pseudoaneurysm of the radial branch of the splenic artery with pancreatic pseudocyst in a child with recurrent acute pancreatitis: treatment with endovascular stent graft and cystogastrostomy. J Pediatr Surg. 2012;47(5):1012–5.

    Article  PubMed  Google Scholar 

  60. Safavi A, Beaudry P, Jamieson D, Murphy JJ. Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J Pediatr Surg. 2011;46(5):938–41.

    Article  PubMed  Google Scholar 

  61. Pinter SZ, Rubin JM, Kripfgans OD, Novelli PM, Vargas-Vila M, Hall AL, Fowlkes JB. Volumetric blood flow in transjugular intrahepatic portosystemic shunt revision using 3-dimensional Doppler sonography. J Ultrasound Med. 2015;34(2):257–66.

    Article  PubMed  Google Scholar 

  62. Shah SH, West AN, Sepanski RJ, Hannah D, May WN, Anand KJ. Clinical risk factors for central line-associated venous thrombosis in children. Front Pediatr. 2015;3:35.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Karakitsos D, Labropoulos N, De Groot E, Patrianakos AP, Kouraklis G, Poularas J, et al. Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients. Crit Care. 2006;10(6):R162. http://www.radiologyteacher.com/index.cgi?&nav=view&DatID=95.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Cahn MD, Rohrer MJ, Martella MB, Cutler BS. Long-term follow-up of Greenfield inferior vena cava filter placement in children. J Vasc Surg. 2001;34(5):820–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Virginia, P.O. Box 800709, 1215 Lee Street, 22908, Charlottesville, VA, USA

    Justin Barr MD, PhD & Sara K. Rasmussen MD, PhD

Authors
  1. Justin Barr MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara K. Rasmussen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sara K. Rasmussen MD, PhD .

Editor information

Editors and Affiliations

  1. Division of Pediatric General & Thoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Stefan Scholz

  2. Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA

    Marcus D. Jarboe

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Barr, J., Rasmussen, S. (2016). Abdominal Vessels. In: Scholz, S., Jarboe, M. (eds) Diagnostic and Interventional Ultrasound in Pediatrics and Pediatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21699-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21699-7_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21698-0

  • Online ISBN: 978-3-319-21699-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation