CEUS in the paediatric renal tract

Abstracts Comparing antenatal renal tract dilatation guidelines to the new UTD guidelines - What’s new? What’s different? Chintha Panditaratne, Jenny Bracken Royal Children’s Hospital, Melbourne, VIC, Australia KUB ultrasound is the bread and butter scan of the paediatric ultrasound department. Accurate and consistent measurements of hydronephrosis are important for treatment and interval surveillance of these patients. At present there is a mismatch between the measurements considered normal in the antenatal scan, and those taken post birth. A new consensus statement, The Multidisciplinary Urinary Tract Dilation Classification System (MUTDCS) has been created by representatives from eight societies related to the diagnosis and management of fetuses and children with urinary tract dilation. The MUTDCS updates and standardises the approach to the description, grading and monitoring of renal dilatation improving communication between all healthcare providers involved in treatment and management of this condition. The concensus also endeavours to streamline antenatal and postnatal findings providing uniformity and continuity of care with improved outcomes for patients.

CEUS in the paediatric renal tract Christoph F. Dietrich, Dagmar Schreiber-Dietrich Caritas Krankenhaus Bad Mergentheim, Uhlandstr. 7, 97980 Bad Mergentheim The renal indications for the use of intravenous CEUS in pediatric patients include diagnosis and follow-up of suspected complicated infections (carbuncle, abscess), complicated cysts, cystic masses, trauma, suspected infarction, evaluation of transplants, tumour vascularity and where there is a contraindication to CT or MR imaging contrast agents. Contrast-enhanced voiding urosonography (ceVUS) has also proven to be a safe and reliable imaging technique for detecting VUR and urethral abnormalities in children of both genders. CEVUS is a well-established application of pediatric CEUS to diagnose and to stage the severity vesico-ureteral reflux (VUR). The examination is performed following bladder catheterization. UCA is administered intravesically under real time US imaging. The presence of contrast agents (UCA) within the ureter, renal pelvis and calyces is indicative of VUR, graded in a similar manner to voiding cystourethrography (VCUG). There is currently no literature focusing on intra-cavitary use of CEUS in children but application in nephrostomy is possible. References: 1. Sidhu PS, Cantisani V, Deganello A, Dietrich CF, Duran C, Franke D, Harkanyi Z, et al. Role of Contrast-Enhanced Ultrasound (CEUS) in Paediatric Practice: An EFSUMB Position Statement. Ultraschall Med 2017;38:33-43. 2. Sidhu PS, Cantisani V, Dietrich CF, Gilja OH, Saftoiu A, Bartels E, Bertolotto M, et al. The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Short Version). Ultraschall Med 2018;39:154-180. 3. Cui XW, Ignee A, Maros T, Straub B, Wen JG, Dietrich CF. Feasibility and Usefulness of Intra-cavitary Contrast-Enhanced Ultrasound in Percutaneous Nephrostomy. Ultrasound Med Biol 2016.

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SESSION 11A: MSK & RHEUMATOLOGY Ultrasound for pelvic neuralgia Le-Anne Grimshaw Sonographer, Castaways Beach, QLD, Australia This presentation will discuss in detail the anatomy of the nerves of the lumbar plexus which are:  Iliohypogastric nerve  Ilioinguinal nerve  Genitofemoral nerve  Lateral femoral cutaneous nerve  Obturator nerve  Femoral nerve The etiology of nerve injury and clinical symptoms the patient may experience in these nerve entrapment syndromes will be reviewed. Ilioinguinal and Iliohypogastric nerves are commonly entrapped in the fascia between the internal oblique and transversus abdominis muscles. Entrapment usually occurs after surgery to this area or the presence of an inguinal hernia. Symptoms are generally pain at the region of entrapment. The genitofemoral nerve can be entrapped throughout its course either due to adhesions from previous surgery or intrapelvic trauma. Symptoms may be chronic groin pain and / or paraesthesia in the upper anterior thigh below the inguinal ligament. Entrapment of the lateral femoral cutaneous nerve occurs at ASIS under the inguinal ligament causing burning and numbness over the anterolateral thigh. Obturator tunnel syndrome is a common cause of groin pain in athletes where the obturator nerve is entrapped either in the obturator tunnel or within the proximal adductor muscles. The femoral nerve is the largest branch of the lumbar plexus and can be entrapped at 2 sites superiorly between the psoas and iliacus muscles and inferiorly at the level of the inguinal ligament. Intrapelvic causes of entrapment can be previous surgery or breech lie in utero or the nerve can be compressed by surrounding pathology such as iliopsoas bursitis or a large hip joint synovitis. The patient may complain of groin pain with numbness in the anterior thigh to the knee. They may have difficulty going up and down stairs and cannot stand from a seated position. The aim of this presentation is to highlight the ease of which these nerves can be assessed with ultrasound and to encourage routine imaging of them in a hip or groin ultrasound study.

SESSION 11B: POCUS Lung ultrasound is not a fishing expedition Kylie Baker,1,2 Stephen Brierley,1 Frances Kinnear,2,4 Katherine Isoardi,2,3 Georgia Livesay,3 Geoffrey Stieler,2 Geoffrey Mitchell2 1 Ipswich General Hospital, Ipswich, QLD, Australia, 2 University of Queensland, Brisbane, QLD, Australia, 3 Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia, 4 The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia Lung ultrasound(LUS) has rapidly gained favour in critical care setting, due in part to its safety profile, speed and convenience. We must guard against over-enthusiastic application leading to unconscious incompetence. Lung ultrasound combines the interrogation of real pathologies (consolidations, diaphragm and pleural fluid), with interpretations of artefacts originating at the pleural surface (A, and B lines). Two