Lippincott Williams & Wilkins, Philadelphia, PA, pp– Sivit CJ, Siegel MJ ( a) Invaginación intestinal. In: Siegel MJ (ed) Ecografía Pediátrica, 2nd edn., . Get this from a library! Ecografía pediátrica. [Marilyn J Siegel]. Libros de Segunda Mano – Ciencias, Manuales y Oficios – Medicina, Farmacia y Salud: Ecografia pediatrica, por siegel en excelente estado. Compra, venta y.
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R e pela S. A ultrassonografia tem sido utilizada para avaliar o canal medular desde . Spinal dysraphism is a term used for a group of disorders characterized by incomplete fusion or lack of fusion of midline structures during the fourth week of embryogenesis .
The incidence of these defects shows significant geographical variation from 0. Its prevalence is greater among females and in poor people . Basedon thephysicalfindings, cases of spinal dysraphism can be grouped into two categories: Occult spinal dysraphism is defined as a group of dysraphic conditions present below an intact cover of dermis and epidermis.
It is therefore more difficult to diagnose on antenatal ultrasonography.
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It may be suspected in asymptomatic newborns because siegep is generally associated with abnormalities of pediateica adjacent skin, such as cutaneous stigmas, hemangiomas, hair tufts, cutaneous appendices, sacrococcygeal dimples, and subcutaneous masses, particularly in the lumbosacral region . The following abnormalities can be included as forms of occult spinal dysraphism: Lipomyelomeningocele is a form of spinal dysraphism in which the lipoma invades the dural sac, and it may envolve the nerve roots and medullary cone .
In this abnormality, the spinal cord is lowand anchored by the lipoma . Ultrasonography has been used to evaluate the spinal canal since the s . The incomplete ossification of the posterior elements of the more caudal vertebrae in children of up to five or six months of age provides a good acoustic window for viewing siebel content of the vertebral canal and the bone structures . Echography is considered to be an effective low-cost noninvasivemethod and plays a critical role in diagnosing or ruling out occult spinal dysraphism at birth .
Magnetic resonance imaging is another diagnostic imaging method for evaluating cases of occult spinal dysraphism. In T1 and T2 views, this technology enables detailed evaluation of the skin, medullary, canal ecogragia intervertebral discs, thus making adequate planning for corrective surgery possible .
Here, ecografiz present a case of a five-day-old neonate with occult dysraphism of lipomyelomeningocele type who presented cutaneous stigmas, and we demonstrate the main ultrasonographic and magnetic resonance findings from the spine. A five-day-old white female neonate was sent to our service for transfontanellar ultrasonography to be performed, because of the presence of cutaneous stigmas in the lumbar region.
Physical examination on the newborn showed a skin appendage resembling a tail, on the midline in the lumbosacral region. This feature was approximately 2 cm in length andwas associated with violaceous ecoyrafia Figures 1 a and 1 b and polydactyly on the hands and feet Figures 1 c and 1 d. A neurological examination done earlier had not shown any abnormalities.
Images in B and color Doppler modes were obtained. Sweeps in longitudinal and transverse planes were performed, with the aims of making a detailed assessment of the contiguity of the anatomical features with themedullary canal: The ultrasonographic findings from the spine were 1 discontinuity of the posterior bone layers in the L5 and S1 projections, with an intracanal solid formation presenting undefined margins and a heterogenous hyperrefringent interior, adhering to the distal segment of the medullary cone; 2 a medullary cone extending beyond the L3 body Figure 2.
The diagnostic hypothesis was that a defect of the pediatricaa canal was present in the region of the cutaneous stigma, with anchored spinal cord and an intracanal solid medullary formation with apparent peripheral eckgrafia that was continuous with the spinal sieggel, suggestive of a lipoma.
Transfontanellar ultrasonography did not show any abnormalities. In order to obtain additional information pediztrica elucidate the diagnosis, magnetic resonance imaging was performed on the spine.
Siegel – Ecografía Pediátrica
This produced the following findings: The magnetic resonance findings were compatible with lipomyelomeningocele, and the neonate was referred to a tertiary-level pediatric neurosurgery service. The neonate underwent corrective surgery and, over a six-month followup, presented normal neuropsychomotor development. Cases of spinal dysraphism are rare, even in newborns with cutaneous stigmas. In three prospective studies in the literature, the highest incidence reported, in an evaluated population of 2, patients, was 7.
Of these, only 5. Some stigmas have been proven to present greater risk of occult spinal dysraphism, such as deep or atypical sacrococcygeal dimples, hemangiomas, cutaneous aplasia, subcutaneous masses, and exophytic skin lesions such as tails and hair tufts.
Cases of multiple stigmas comprise another group at risk . In our case, the neonate presented exophytic skin lesions in the lumbar region and hands postaxial polydactyly.
In our service, the protocol to neonates with high risk of occult spinal dysraphism with cutaneous stigma is accomplishment of spinal ultrasound using the linear transductor. Theultrasound has great capacity to assess the vertebral canal.
The magnetic resonance imaging has the capacity to identify the type and the level of lesion. This case was different from our protocol because the neonate was referenced to realize the transfontanellar ultrasound, and only after the observation of cutaneous stigma, the protocol of occult spinal dysrapism was performed. Early diagnosis of spinal dysraphism is very important in order to minimize the sequelae that occur in patients who are not diagnosed before the growth spurt, who may suffer neural disorders due to medullary ischemia.
Ultrasonography is a fast, safe, noninvasive, and low-cost method, and it also presents good correspondence with the findings from magnetic resonance imaging.
Siegel – Ecografía Pediátrica
The echographic findings suggestive of occult spinal dysraphism include a low position for the rcografia cone, bulbous medullary cone, thick filum terminale, dorsal attachment of the spinal cord, and loss of cardiorespiratory pulsatory movement of the spinal pediatrca .
Magnetic resonance imaging should be reserved for patients with positive or inconclusive results from ultrasonography, for confirmation of the diagnosis and surgical planning, as reported in the present case, in which the ultrasonographic findings were fully confirmed by the magnetic resonance imaging. Early diagnosing of occult spinal dysraphism prevents progressive neurological dysfunction.
However, detecting this condition in neonates is difficult since the neurological signs in these patients are not apparent. Because of the possibility of irreversible sequelae through delayed diagnosis, a screening method for patients at high risk of occult spinal dysraphism becomes necessary .
High-resolution ultrasonography is a fast and accurate method epdiatrica screening for occult dysraphic lesions.
Hence, this method is reserved for situations in which abnormal findings are seen, or when the normal maturation of the skeleton limits the possibility of viewing the medullary canal . The protocol to neonates with high risk of occult spinal dysraphism has demonstrated good results; however, the physicians should be aware of neonates with cutaneous stigma because of high incidence of occult spinal dysraphism.
In summary, we have presented a case of a ssiegel with occult ecografoa dysraphism associated with cutaneous stigmas.
High-resolution ultrasonography using a linear transducer made it possible to identify and characterize the lesion, and magnetic resonance imaging confirmed the type of lesion lipomyelomeningocele and enabled adequate surgical planning. We believe that ultrasonography should be performed on patients who are at high risk of occult spinal dysraphism, such as those presenting cutaneous stigmas, congenital abnormalities, or neurological alterations, as ameans of early diagnosis, thereby avoiding neuropsychomotor sequelae later on.
Baixe o PDF deste artigo. Atendimento ao Aluno 11 Agendamento de exames 11 Indique a um amigo Imprimir. Ultrassonografia Geral Relato de Caso: CASE REPORT A five-day-old white female neonate was sent to our service for transfontanellar ultrasonography to be performed, because of the presence of cutaneous stigmas in the lumbar region.
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