Children with ambiguous genitalia form a major subset of children with Disorders of sexual differentiation (DSD). Genital ambiguity invariably results in significant parental anxiety and social issues. Management requires involvement of multiple medical specialties. Accurate delineation of anatomy on imaging is a very important step in clinical decision making. The imaging tools consist of conventional genitogram, pelvic ultrasound and magnetic resonance imaging (MRI). Drawback of MRI lies in the lengthy acquisition process; whereas conventional fluoroscopic genitogram is an invasive procedure, and bears the hazards of ionizing radiation. Pelvic ultrasound is good for visualization of the gonads, and internal genital organs. However, the details of lower genital tract anatomy can not be well evaluated in a pelvic ultrasound. Trans-Perineal ultrasound (TPUS) is a technique where high resolution transducers are placed on the perineum of the child; and detailed imaging of the lower genital tract and anorectum can be performed. It has the advantages of easy availability and portability, lack of radiation exposure and avoidance of general anesthesia/ sedation. This educational exhibit will describe normal male and female lower genital tract anatomy. Various anomalies, namely, urogenital sinus, hypospadias, hypertrophied clitoris, aphallia, will be described. Technique and pitfalls will also be discussed. Normal ossification of the pubic symphysis is variable, depending on the age of the child. Selection of suitable acoustic windows in subpubic and perineal positioning of transducers is crucial. Performed by trained radiologist, TPUS can be useful adjunct imaging modality, both useful and acceptable.
SPR 2022 Annual Meeting & Postgraduate Course