Ultrasonographic prediction of the presence and severity of esophageal varices in children.
Twenty-eight consecutive children with either chronic liver disease or portal vein obstruction were investigated to study the presence of gastroesophageal collaterals due to portal hypertension by ultrasound and endoscopy. Sonographic measurements of the ratio of the lesser omentum thickness to aortic diameter (LO/Ad) and of portal vein diameter to body surface (Pv/m2) were significantly higher in children with esophageal varices than in those without varices. With a lower limit for the LO/Ad ratio of 1.3, no false negatives and only three false positives (91% predictive value of esophageal varices) could be detected. The combination of LO/Ad and Pv/m2 would exclude the possibility of detecting esophageal varices if the LO/Ad ratio is less than 1.8 and the Pv/m2 is less than 12 mm. All children with an LO/Ad ratio greater than 1.9 had varices. Even in the presence of an overlap between children with small and large varices, it is possible to identify with high probability a child with large varices if the LO/Ad ratio is greater than 2.5. This study confirms the value of ultrasound in the diagnosis and management of children with portal hypertension and suggests an algorithm to screen children with small and large varices.
De Giacomo
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C
Clinica Pediatrica, IRCCS Policlinico S. Matteo, Pavia, Italy.
Tomasi
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G
Gatti
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C
Rosa
G
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Maggiore
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G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014463:Ultrasonography