Intussusception is the most common cause of intestinal obstruction in children between 3 months and 6 years. Intussusception occurs when a more proximal portion of bowel invaginates into more distal bowel. These patients often present with a wide range of non-specific symptoms, with less than one quarter presenting with the classic triad of vomiting, abdominal pain, and bloody stools. Thus, the diagnosis continues to rely on clinical suspicion. This review article discusses the clinical presentation of intussusception and the state-of-the art diagnostic and treatment options, as well as a review of the pertinent literature.

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Superficial palpable masses of the head and neck are common in the pediatric population, with the vast majority of the lesions ultimately proven to be benign. Duplex ultrasonography (US) has emerged as the first-line imaging modality for the evaluation of superficial pediatric masses. Without utilizing radiation, iodinated contrast material, or sedation and/or anesthesia, US provides a means for quick and cost-effective acquisition of information, including the location, size, shape, internal content, and vascularity of the mass. In this review, the US findings are described for a variety of common and uncommon pediatric head and neck masses diagnosed in our practice. Specifically, the entities covered include neonatal scalp hematoma, craniosynostosis, dermoid and epidermoid cysts, Langerhans cell histiocytosis, lymph nodes and their complications, fibromatosis colli, thyroglossal duct cyst, branchial cleft cyst, cervical thymus, congenital goiter, thyroid papillary carcinoma, parathyroid adenoma, hemangioma, lymphangioma, jugular vein phlebectasia, Lemierre syndrome, acute parotitis and parotid abscess, leukemia and/or lymphoma, neurogenic tumor, and rhabdomyosarcoma. Ultimately, in situations in which the head or neck mass is too large, deep, or hyperechoic to be fully assessed within the US field of view, or if malignancy or a high-flow vascular lesion is suspected, then further evaluation with cross-sectional imaging is warranted. Online supplemental material is available for this article. RSNA, 2018.

Duplex/color Doppler ultrasound is the imaging modality of choice for the evaluation of soft tissue masses of the pediatric neck. Information regarding the size, shape, borders, location, internal consistency and vascularity of the mass, and its relationship to the major neck vessels may be rapidly obtained. If the lesion is too large to be completely imaged within the ultrasound field of view available or malignancy is suspected, computed radiography or magnetic resonance imaging is required before surgical removal. Scintigraphy is reserved for evaluation of midline masses, which are thought to be due to ectopic thyroid, to determine preoperatively if the mass is the patient's only functioning thyroid tissue. Correlation of the sonographic findings with the clinical information narrows the differential diagnosis; thus, more appropriate therapeutic decisions can be made. When indicated, ultrasound-guided interventional procedures can be performed for diagnosis and/or treatment.

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The variable sonographic appearance of duplication cysts is presented. Eighteen sonograms from 14 patients, aged 1 day to 8 years, were reviewed over an 8 year period. Water and other aqueous contrast agents were used in six patients as part of the sonographic evaluation. All lesions were confirmed by surgery. All but two patients were symptomatic. Twenty-four cysts were detected, ranging in size from 1.7 to 15.5 cm. The duplication cysts revealed a spectrum of sonographic findings (cystic to solid appearing masses). The mass characteristics, including the "muscular rim sign," and internal debris or hemorrhage, were demonstrated. Multiple unsuspected cysts (3 of 14 or 20%) and complications such as perforation were readily seen with ultrasonography. Serial sonograms demonstrated the changing morphology of two cysts. Other unsuspected intra-abdominal and pelvic pathologic conditions, including pyloric stenosis and ovarian cysts, were identified. Identification of the muscular rim sign is the most reliable indication of a duplication cyst. Multiple masses as well as possible accompanying anomalies in the abdomen and pelvis are readily evaluated with sonography. Lesions are easily followed with serial studies if there is no surgical intervention.

High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secondary to obstructive congenital anomalies of the biliary tract, total parenteral nutrition, furosemide treatment, phototherapy, dehydration, infection, hemolytic anemia, and short-gut syndrome, whereas in older children, stones are usually associated with sickle cell disease, bowel resection, hemolytic anemia, and choledochal cyst. Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes.