Paediatric neck ultrasound: a two-year retrospective study J. Chia, I. Moorthy, K.Iliadis Royal Alexandra Children’s Hospital Brighton & Sussex University Hospitals NHS Trust Why did we do this study? iRefer lists just two indications for paediatric neck ultrasonography (US) : atraumatic torticollis (P16) and neonatal hypothyroidism (P20). We found that this does not reflect our practice. This study aimed to clarify the main indications and findings in children attending our tertiary service, serving a population of 2 million. Materials and Methods Studies were identified by searching the hospital Radiology Information System (CRIS) for the period 7/12/2014 -7/12/2016 (2 years) Microsoft Excel 2010 used for data analysis Results : Referrals CYSTIC HYGROMA Palpable lump, left upper back. US shows a large well-defined anechoic area in the left upper back MRI: hyperintense on T2 weighted sequence, hypointense on T1 weighted sequence. These are congenital lymphatic malformations, more commonly encountered in the neck. May be uni or multi-locular. PERSISTENT GENERALISED ADENOPATHY Ultrasound: nonspecific reactive node, with increased vascularity Morphology normal Histology: Langerhan’s cell histiocytosis. FIBROMATOSIS COLLI 2 month old boy with a two week history of a firm neck lump. Fusiform dilatation of the right sternocleidomastoid (solid white arrow). Normal left sternocleidomastoid (dashed arrow) shown for comparison. May present with torticollis. Slightly commoner in males. Resolves spontaneously. THYROID STORM Enlarged thyroid lobe with heterogeneous echotexture Avid colour flow Doppler bilaterally RECURRENT JUVENILE PAROTITIS Loss of uniform echogenicity Scattered round hypo-echoic areas ( ) present in the contralateral gland also. Clinical presentation: Recurrent fever + malaise (may mimic Mumps) Typical Indications Persisting palpable lump– US for characterisation Goitre on examination – US for characterisation ? Drainable collection ? Thrombus complicating central line insertion/prior to long term line insertion Sparse information provided on referral forms: e.g. symptom duration omitted in 180 cases, omission of full blood count/thyroid function test results. Seasonal workload variation. Results: Findings References https://www.irefer.org.uk/ - Making the best use of clinical radiology version 8.0.1 accessed June 2017 https://my.statdx.com/ - Elsevier StatDx accessed June 2017 Golriz F, Bisset G.S III, D’Amico B, et al.(2017) A clinical decision rule for the use of ultrasound in children presenting with acute inflammatory neck masses. Pediatric Radiology 47: 442-449 Conclusions The majority of paediatric neck ultrasonography exams at our institution were normal. With hindsight, It is tempting to dismiss many studies as unnecessary, but to perform them is not time-consuming to the radiologist, and may be very reassuring to patients and their families. Ultrasound is ideal for characterising abnormalities in children’s necks and often the only imaging necessary. (No ionising radiation involved) COLLECTION Clinical history: Firm 3 inch left submandibular mass. Ultrasound: Lymph node abscess N/A*: Drained in theatre Other*: Cystic lesion decreasing in size; No acute findings (known cystic hygroma); Organising midline haematoma decreasing in size.