Page 377 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-015
Ultrasonography as a Tool in Early Detection of Subperiosteal Abscess
in Beta Thalassemia Major Patient

2
Diko Anugrah , Naella Fadhila , Haryanti Fauzia Wulandari 2
1
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Subperiosteal abscess is a well-known complication of osteomyelitis in children with beta
thalassemia major. Osteomyelitis affects primarily young children, with half of all pediatric cases in children
younger than 5 years of age. There is no data of subperiosteal abscess in children, especially in thalassemia
patients. Ultrasonography is particularly useful tool in confirming the existence of a subperiosteal abscess
and in localizing it precisely in children with diffuse swelling and tenderness of a limb owing to late-acute
osteomyelitis. Objective To inform the appearance of a subperiosteal abscess by ultrasonography.Case A
14-year-old boy presented with non-traumatic onset of the posterior thigh pain. There were swelling on
all four extremities. Complaints had been felt since 6 months ago. On arrival, the swelling was bluish in
color, feels warm, and slightly painful. There were several sizes with the smallest size was 4 x 4 x 6 cm
and the largest was 6 x 8 x 12 cm. The ultrasound showed hypoechoic collection with internal tiny echoes
abutting the posterior femoral cortex at the site of pain pointed by the patient. The femoral cortex was intact
without obvious irregularity. There was no collection involving the local muscles. Ultrasonography has the
advantage of being a simple and fast procedure which can be performed without undue delay, even at the
bedside. Surgical drainage of pus can be avoided in patients without ultrasound features of an abscess and
can be better planned in those who require it. Conclusion Sonography is helpful tool for determining its
complications. It should be used as initial routine examination beside conventional radiograph, to facilitate
early diagnosis of subperiosteal abscess and to limit further imaging work up
Keywords: beta thalassemia major; ultrasonography; subperiosteal abscess

P-PI-016
Identification of Lymph-Hemangioma of the Spleen by Ultrasound
in Klippel-Trenaunay Syndrome
2
Gendis Ayu Ardias , Naela Fadhila , Evita Karianni Bermanshah
2
1
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Klippel-Trenaunay Syndrome (KTS) was first described in 1900, which was characterized
by the triad of varicose veins, bony and soft tissue hypertrophy, and cutaneous hemangiomas. It is a rare,
usually sporadic condition with death to live birth ratio of 1:100.000. Lymph-hemangioma or hemangioma
in visceral has been reported, such as in the colon, small bowel, urinary bladder, kidney, spleen, and liver.
Objective This study aims to explain that ultrasound can be used to identify splenic lymph-hemangioma in
KTS. Case A 4-year-old girl, came with chief complaints abdominal distention in the last 2 months before
admitted to the hospital. Since the patient was born, her right leg seemed bigger and purple bruises on her
both feet and hands were started to appear. There was spleen enlargement and liver margin were difficult to
assess. We found hypertrophy of the right leg with purple bruises along the right lower extremity. Abdominal
ultrasound showed spleen enlargement with multiple cystic in the whole spleen with slightly increasing
blood flow correspond to lymph-hemangioma of the spleen. Conclusion Abdominal ultrasound can be used
as alternative tool to evaluate the presence of visceral and subcutaneous vascular malformations in KTS.
Keywords: Klippel-Trenaunay Syndrome; lymph-hemangioma; ultrasound

KONIKA XVIII Abstract Book 329