Page 383 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-026
Diagnosis of Tethered Cord Syndrome Using Spinal Ultrasound

Ratna Eka Lestari , Naela Fadhila , Evita Karianni Bermanshah 2
1
2
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 Tethered cord syndrome (TCS) is a rare neurological condition with incidence of TCS estimated
at 0.25 per 1,000 births. A high percentage of TCS in pediatric cases show cutaneous tufts of hair, skin tags,
dimples, benign fatty tumors, skin discoloration or hemangiomas, therefore it is necessary to carry out
imaging studies. Magnetic resonance imaging is the gold standard for diagnosis TCS, but spinal ultrasound
can be performed as initial screening. Objective To describe a case of tethered cord in a neonate diagnosed
with spinal ultrasound. Case Two months old baby was referred to Cipto Mangunkusumo hospital because
of increasing work of breathing due to cardiac problem (small to moderate ventricular septal defect and
moderate patent ductus arteriosus). There was a sac formation on the area of sacrum which appeared on
birth and enlarged to the present. The baby had no neurological signs and symptoms. Physical examination
showed bulging cyst-like structure, dimple and cutaneous tufts of hair on the lower parts of vertebrae. Spinal
ultrasound showed conus medullaris ended at S-1, indicated the presence of tethered cord. Conclusion Spinal
ultrasound can be recommended in infants with cutaneous tufts of hair, skin tags, dimples, benign fatty
tumors, skin discoloration or hemangiomas. Sonography plays a very important role in the early detection
of a tethered cord. Limitation of spinal ultrasound is difficult to perform after bone ossification has occurred.
In older children MRI is the best modality.
Keywords: tethered cord syndrome; spinal ultrasound; neonate

P-PI-027
Abdominal Ultrasound as Standard Imaging Technique f
or Diagnosing Hypertrophic Pyloric Stenosis

Resita Sehati, Haryanti Fauzia Wulandari
Pediatric Imaging Division, Departement of Child Health,
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Hypertrophic pyloric stenosis (HPS) is abnormal thickening of the pylorus muscles marked by
hypertrophy and hyperplasia of the circular and longitudinal muscles leading to gastric outlet obstruction.
The incidence is 2-5 in 1000 births per year, more common in male. Gastric outlet obstruction induces
projectile, non-bilious vomiting that may occur intermittently or after each feeding. The classic finding of
‘olive’ may be found, as well as reverse peristaltic waves and signs of dehydration. Ultrasonography has
become standard imaging technique for diagnosis HPS due to its high sensitivity and specificity and it can be
performed easily. Pyloric wall thickness >3 mm and pyloric channel length >15 mm are considered abnormal
and indicate HPS. Objective To describe a case of HPS in a neonate diagnosed with abdominal ultrasound.
Case A male, 20-day-old term baby came with vomiting after each feeding, a classic sign of HPS, from 2
days prior to admission. He looked lethargic; body weight was decreased from 3045 grams to 2805 grams.
There was no temperature instability. Abdominal X-ray that was done on admission visualized paucity of
bowel gas with gastric dilatation. Abdominal ultrasound performed 6 days later revealed 5.5 mm pylorus
wall thickness and 19 mm pylorus segment length, indicating HPS. Pyloromyotomy was done 9 days later, at
35-day-old. Post-op report confirmed pylorus hypertrophy and dilatation with 2 cm pylorus segment length.
Conclusion Abdominal ultrasound can be used in infants with classic signs of HPS as standard imaging
technique.
Keywords: hypertrophic pyloric stenosis; neonate; abdominal ultrasound

KONIKA XVIII Abstract Book 335