Musculoskeletal ultrasound in children – Some of the challenges and pitfalls

Tobi Aderotimi, Kate Kingston, Radiology, York Hospital, York.

Use of ultrasound in both children and MSK imaging is well established. Our District General Hospital (DGH) performs about 1600 paediatric US per year, the majority being renal, abdominal and screening hip examinations by paediatric radiologists and sonographers. Over the past few years the exponential use of ultrasound for assessing superficial lumps and bumps and musculoskeletal problems in children has meant a steep learning curve for our MSK radiologists, predominantly trained in adult imaging. We would like to share some strategies we have learned.

There are many challenges associated with scanning a child; some of the more important are practical involving actually getting to scan the child and keeping them still for the duration. Our pictorial discussion will review the tricks and stratagems we use to persuade the child into the room and onto the bed. We show some of the parental holds and distraction techniques we employ in an effort to keep the child still. Young children may not accurately localise or communicate the site of symptoms, requiring flexibility of approach. Although scan technique is similar in adults and children, the anatomy may be unfamiliar and changes markedly over a relatively short period of time as cartilaginous parts of joints progressively ossify. We provide examples of joints at different ages and stages of maturation. One of the main pitfalls can be differentiating cartilage from joint effusion or synovitis, we will use cases to illustrate some of the techniques we have found useful in avoiding misinterpretation. Some conditions and injuries encountered are specific to children, the history may be unclear and in infants the possibility of infection, non-accidental injury or developmental anomalies with deeper communication must be considered.

Ultrasound is excellent for children in MSK but has associated challenges and pitfalls. We will discuss how some of these may be overcome.

View the Poster here