Page 387 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-034
The Role of Ultrasound in The Diagnosis of Spina Bifida

1
Widdy Winarta , Naela Fadhila , Evita Karianni Bermanshah 2
2
1
2
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 The tethered cord syndrome could be related to ranges of condition including spina bifida
occulta and myelomeningocele. Magnetic resonance imaging (MRI) is the gold standard for diagnosis,
however ultrasound could be used to evaluate spina bifida. Objective To describe a case of tethered cord
syndrome in a neonate diagnosed with spine ultrasound. Case A 15-days old term newborn was referred to
Cipto Mangunkusumo Hospital because of sac formation on the back. The baby was born by caesarian section
from a healthy mother with no active resuscitation. Mother does not consume any folic acid supplementation
during pregnancy. The baby was well appearing, with no hypotonia, urinary or fecal incontinence nor other
neurological signs and symptoms. Physical examination shows a soft, mobile, nontender cystic sac with
flat surface on top of the sacrum measuring 4 x 5 x 3 cm and positive transillumination test. Ultrasound
examination of the spine shows myelomeningocele and tethered cord syndrome with conus medullaris
ending at S1. Head ultrasound shows no abnormalities. Conclusion Ultrasound can be used as the initial
modality for the evaluation of spina bifida and to screen for myelomeningocele and tethered cord syndrome
in a neonate. Ultrasound of the head must be routinely evaluated for those with spina bifida to look for
associated Chiari II malformation.
Keywords: neonate; tethered cord syndrome; ultrasound

P-PI-035
The Preeminence of Abdominal Sonography in Evaluation of Neonate
with Necrotizing Enterocolitis: A Case Report

William Cheng , Naela Fadhila , Evita Karianni Bermashah 2
2
1
Department of Child Health and Pediatric Imaging Division, Departement of Child Health ,
2
1
Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Necrotizing enterocolitis (NEC) is the most prevalent life-threatening gastrointestinal emergency
in premature infants. Abdominal ultrasonography (AUS) is promising adjunct to abdominal radiography
(AXR) in evaluation of NEC in term of avoidance from radiation, availability, and providing more detail
features. Application of AUS in evaluation of NEC in Indonesia is still challenging due to lack of awareness
among clinicians. Objective To depict application of AUS in evaluation of NEC and then raising awareness
among clinicians Case A preterm baby girl 28 weeks gestational age, was born by C-section from mother
with twin pregnancy and severe preeclampsia. There was no risk of intrauterine infection. The infant was
intubated due to respiratory distress syndrome. On the third week, feeding intolerance occurred with green
gastric residual, bloody stool, abdominal distention, and reduced bowel sound. AXR showed hepatomegaly,
gastric and intestinal dilatation, thickening of bowel wall, but pneumatosis intestinalis was not visible.
According to these equivocal findings of NEC and conflicting clinical manifestation, AUS was performed.
Intestinal dilatation, thickening and thinning of the wall, pneumatosis intestinalis, back and forth flow of
echogenic material suspect of bowel obstruction, were revealed from AUS. Doppler ultrasound showed
hyperemic and absent of intestinal blood flow. Therefore, diagnosis of intestinal obstruction due to NEC
grade II was established. Conclusion NEC is a the most frequent gastrointestinal disease in preterm. Imaging
has a critical role in prompt diagnosis to reduce morbidity and mortality. With greater accessibility to AUS,
awareness and proficiency among pediatrician in evaluation of NEC should be raised.
Keywords: necrotizing enterocolitis; NEC; abdominal ultrasonography; AUS; abdominal
radiography; AXR

KONIKA XVIII Abstract Book 339