Page 384 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-028
The Role of Head Ultrasonography in Diagnosing Patient with Chiari II
Malformation in Neonate

Rivaldi Ardiansyah , Naela Fadhila , Evita Karianni Bermanshah 2
1
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
2
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Chiari malformation is a condition in which brain tissue extends into the spinal canal, present
at birth. Chiari II malformation (CM-II) is a complex malformation that includes downward displacement
of the cerebellar vermis and tonsils and encountered almost exclusively in patients with neural tube defects.
The prevalence of CM-II in the general population has been estimated at less than one in 1000. Head
ultrasound (HUS) can be used as initial modality to diagnose CM-II in neonates with neural tube defects.
Objective To demonstrate the role of HUS in diagnosing patient with suspected Chiari II malformation in
neonate Case A full term baby girl was born with birth weight of 2,880 grams. Mother only took folic acid
after first semester. Physical examination revealed head circumference was normal. There was midline
lumbosacral lesion with plaquecord pattern surrounded with yellowish slough diagnosed as infected of spina
bifida aperta. Head ultrasonography findings are the brainstem appears 'pulled' down with an elongated and
low-lying fourth ventricle, the ventricular margin may have a “pointed” appearance, occipital horn that is
“pointed” rather than rounded, downward displacement of the cerebellar vermis and tonsils accordance to
CM II. These findings confirmed by magnetic resonance imaging. Conclusion HUS can be used as a first-
line screening investigation for CM II for initial diagnosis because it’s easy to access, low cost, portability,
lack of ionizing radiations and exemption from sedation or anaesthesia.
Keywords: head ultrasound; chiari malformation II; pointed ventricular

P-PI-029
Role of Abdominal Ultrasonography Compare to Plain Radiography
to Diagnose Perforated Preterm Necrotizing Enterocolitis

Stephanie , Naela Fadhila , Evita Karianni Bermanshah 2
1
2
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
1
2
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Necrotizing enterocolitis (NEC) is intestinal necrosis leading to perforation, generalized
peritonitis and death. NEC is a leading cause of morbidity in neonatal intensive care units (NICU) especially
preterm < 1000 gram birth weight, mortality 40% higher in preterm baby. Plain abdominal radiography is
the current standard imaging modality for evaluation of NEC. Ultrasound provides real time of abdominal
structures, detect the thickness of intestinal wall, peristalsis movement, and the presence of fluid in peritoneal
cavity before perforation. Objective To compare the effectiveness of two modality in early diagnosis perforated
necrotizing enterocolitis between plain radiograph and abdominal ultrasound (AUS) because many cases
undetected. Case A newborn baby with gestational age 33 weeks, 1990 grams birth weight was born from
mother with preeclampsia with severe feature, delivered by C-section. We did resuscitation after birth, early
intubation and positive pressure ventilation. Physical examination showed distention of abdomen, and no
peristalsis sound. He was treated at NICU with clinical deterioration, we did plain radiograph and abdominal
sonography, and was found perforated NEC with septae ascites, minimal vascularization, then aspirated dark
color intraperitoneal fluid ultrasound guided. Conclusion Abdominal ultrasound (AUS) used as a realiable
tool, easy bedside of NICU patients showed early complication of NEC compare to plain radiograph. Early
findings with AUS play important role than plain radiograph, earlier detection of NEC before perforation
could improve morbidity and mortality.
Keywords: perforated necrotizing enterocolitis; neonatal; ultrasound

336 KONIKA XVIII Abstract Book