Splenic vessel thrombosis is a rare but potentially serious condition in the pediatric population. It may occur secondary to systemic infections, sickle cell hemoglobinopathies, dehydration, hypercoagulable states, or inflammatory and traumatic abdominal processes. Clinical presentation is variable including pain and fever but may be quite nonspecific, especially in infants. Although CT and MRI can confirm the diagnosis, US remains the first-line imaging modality and the most appropriate for follow-up, as it is non-invasive, radiation-free, widely available, and easily repeatable. We present four pediatric cases (three boys and one girl, aged 55 days to 2 years) from our institutional database, demonstrating the US spectrum and evolution of splenic vessel thrombosis. In the acute phase, US shows a hypoechoic spleen or ill-defined, wedge-shaped peripheral hypoechoic lesions. Doppler imaging reveals absent or markedly reduced flow in splenic arterial or/and venous branches. In later stages, the spleen appears small and diffusely echogenic. Crucially, preservation of even subtle vascularity within small central or peripheral splenic areas, and most importantly the presence of an accessory spleen, represent favorable prognostic signs. Accessory spleens and viable subcapsular parenchymal areas, as in 3 out of 4 our cases, enlarge and progressively hypertrophy over subsequent months, maintaining splenic function. High-frequency linear transducers are indispensable for detecting subtle flow signals and viable parenchymal remnants, which are missed with standard curvilinear probes or even cross-sectional imaging. US ability to reveal these early details has been proved crucial in all our cases in assessing thrombosis extent, monitoring evolution and predicting outcome. In conclusion, although rare, splenic vessel thrombosis in children requires high clinical suspicion and meticulous US evaluation. The use of high-frequency probes and careful grayscale and Doppler interrogation are key to early detection and prognosis assessment. In skilled hands, US not only serves as the initial diagnostic tool but often provides the decisive detail that determines outcome. Read More

Meeting name: IPR 2026 Congress , 2026

Authors: Koutrouveli Eleni, Pitsoulaki Evangelia, Antoniou Maria, Fezoulidi Georgia, Alatza Maria, Sarri Vrisiis, Kouriotis Apostolos, Vakaki Marina

Keywords: Spleen, Thrombosis, Ultrasonography

Lingual tonsils are part of the Waldeyer ring, located at the base of the tongue in continuity with the palatine tonsils. Situated at the common entry of the respiratory and the digestive system, they play a pivotal role in initiating and maintaining immune response. Lingual tonsil hypertrophy (LTH) is rare in children with no comorbidities. However, an accumulating body of evidence suggests that LTH is associated with obesity and Down Syndrome, particularly in cases where palatine tonsillectomy and adenoidectomy have been performed. Recent research has indicated positive correlation between LTH and obstructive sleep apnea, which constitutes a significant cause of morbidity in children. Therefore, prompt diagnosis is critical, as a timely tonsillectomy can easily resolve this life-threatening condition. Although the role of CT and MRI in identifying LTH has been discussed in literature, there remains limited evidence concerning ultrasound’s value in its accurate diagnosis, while avoiding radiation exposure. The following case highlights ultrasound’s reliable evaluation of the lingual tonsil and its potential position as a screening method for patients with obstructive sleep apnea. We present a case of a 14-year-old boy with Down syndrome, who had undergone a previous palatine tonsillectomy. The patient presented with dysphagia and sleep apnea. Upon direct laryngoscopy performed by an experienced otolaryngologist, a suspicion arose of a mass adherent to the anterior surface of the epiglottis. As a result, he was referred to our radiological department for further evaluation, and an ultrasound examination was performed. Ultrasound revealed an ovoid-shaped, well-defined mass located at the base of the tongue. The mass demonstrated a hypoechoic echogenicity, with a striated appearance consisting of alternating linear hyperechoic and hypoechoic bands. These sonographic characteristics were compatible with palatine tonsils. No residual palatine tonsillar tissue was recognized upon meticulous examination. A dynamic, real-time examination followed, with the patient instructed to take deep breaths. The movement of the mass within the retroglossal space was observed, proving its role in obstructive apnea. Correlating the ultrasound findings with the patient’s medical history, a diagnosis of enlarged lingual tonsil was made, also demonstrated on CT and confirmed by post-surgical pathology. Read More

Meeting name: IPR 2026 Congress , 2026

Authors: Koutrouveli Eleni, Zamparas Athanasios, Sfakiotaki Rodanthi, Sofokleous Valentinos, Antoniou Maria, Fezoulidi Georgia, Vekrakou Artemis, Vakaki Marina

Keywords: Dysphagia, Down's Syndrome, Adolescent

This educational exhibit provides an overview of the embryologic development and postnatal anatomy of the umbilical region, emphasizing its sonographic evaluation and the clinical relevance of congenital remnants in pediatric patients. Understanding how transient fetal structures transform into definitive postnatal ligaments and potential remnants is essential for accurate diagnosis and differentiation of midline abdominal pathologies. A diagram-based embryologic summary will clarify the relationships among the umbilicus, allantois, and vitelline (omphalomesenteric) duct—structures often confused in imaging. Step-by-step visuals illustrate how the allantois forms the urachus, which fibroses into the median umbilical ligament; how the umbilical arteries and vein become the medial umbilical ligaments and ligamentum teres hepatis; and how the vitelline duct contributes to the omphalomesenteric duct and portal venous system. Incomplete regression may result in Meckel’s diverticulum or urachal anomalies. High-frequency ultrasound of the umbilical and prevesical (Retzius) space will be presented, depicting the normal relationships of the bladder dome, medial umbilical ligaments, and urachal remnant. A summary diagram will link each embryologic structure with its potential anomaly if regression fails. Representative sonographic and schematic images will highlight characteristic appearances and practical scanning tips for accurate evaluation. Two illustrative pediatric cases demonstrate how these remnants may mimic surgical emergencies: an infected urachal cyst presenting as right-lower-quadrant pain, and a Meckel’s diverticulum acting as a lead point in ileoileal intussusception. Recognition of their embryologic origin and ultrasound appearance prevents misdiagnosis and guides appropriate management. Read More

Meeting name: IPR 2026 Congress , 2026

Authors: Sfakiotaki Rodanthi, Fezoulidi Georgia, Koutrouveli Eleni, Alatza Maria, Zamparas Athanasios, Pitsoulaki Evangelia, Chountala Anna, Antoniou Maria, Vakaki Marina

Keywords: Pediatric Imaging, Embryology, Umbilical