Purpose: Focal splenic lesions are difficult to differentiate in any imaging modality, even using contrast media.
The experience in using intravenous contrast-enhanced ultrasound (CEUS) in different paediatric diseases involving the spleen is very limited. However, CEUS may be of value in the differentiation of childhood nontraumatic splenic focal lesions. Possible differences in the differential diagnosis compared to the adult population will be discussed.
Patients and Methods: In the Paediatric Ultrasonography Unit at Hannover Medical School, 11 children were investigated with CEUS because of unclear lesions of the spleen. Dosages of 0.5-2 ml SonoVue and low MI technique were used.
Results: There was a huge variety of different findings in the spleen: two children had a splenic involvement of a newly diagnosed lymphoma (“bulky disease”). One female adolescent had a splenic involvement of a post-transplant-lymphoproliferative disease (PTLD) after acute lymphatic leukaemia and bone marrow transplantation; another female adolescent revealed a splenic metastasis of a leiomyosarkoma of the brain in Fanconi anaemia and bone marrow transplantation. Two children had splenic abscesses due to chronic granulomatous disease. Futhermore there were single patients with splenic involvement of Rosai-Dorfman´s disease and one adolescent with an isolated echinococcal splenic cyst.
Two children had inconclusive results.
None of the infants required sedation, none of the parents refused written informed consent because of off-label use.
Conclusion: CEUS was of individual diagnostic benefit in children with focal splenic lesions, leading to changes in the further management of the patient.
Further experience with CEUS in the management of children with focal splenic lesions has to be gained.
