Genitourinary

Adrenal Gland

Normal Adrenal Gland Size as a Function of Age¹

Age Length (cm) Thickness (cm) Width (cm)
Neonate 0.9 - 3.6
(mean, 1.5)		 0.2 - 0.5
(mean, 0.3)		 0.2 - 0.5
(mean, 0.3)
Adult 4 - 6 0.2 - 0.6 2 - 3

  adrenal measurements ref 1

Adrenal Gland: Sonographic features of normal adrenal glands versus age²

Age Shape & Size Echogenicity
Newborn Cortex>>Medulla thickness
Convex borders		 Cortex hypoechoic
Medulla hyperchoic
1.5 to 2 months Changes gradually to medulla>cortex thickness
Convex borders		 Cortex hypoechoic
Medulla hyperechoic
5 to 6 months Decreasing size
Straight borders		 Hyperechoic, loss of corticomedullary differentiation
> 1 year Adult appearance
Concave/straight margins		 Entirely hypoechoic

 

References:

  1. Oppenheimer DA, Carroll BA, Yousem S.  Sonography of the normal neonatal adrenal gland.  Radiology 146:157-160, January 1983 Diagram used with permission for this Website.
  2. Kangarloo H, Diament MJ, Gold RH, et al. Sonography of adrenal glands in neonates and children: changes in appearance with age.  J Clin ultrasound.  1986; 14: 43-47.  (modified)

Ovaries

Normal Ovarian Size as a Function of Age

Age Group Mean Ovarian volume (ml)* SD (ml) 95% Confidence Interval % Ovaries Imaged
1 day to 3 months1 1.06 0.96 0.03-3.56 70
4-12 months1 1.05 0.67 0.18-2.71 100
13-24 months1 0.67 0.35 0.15-1.68 90
2 years2 0.8 0.4
3 years2 0.7 0.2
4 years2 0.8 0.4
5 years2 0.9 0.02
6 years2 1.2 0.4
7 years2 1.3 0.6
8 years2 1.1 0.5
9 years2 2 0.8
10 years2 2.2 0.7
11 years2 2.5 1.3
12 years2 3.8 1.4
13 years2 4.2 2.3
Menstruating Females3 9.8 5.8 2.5-21.9

*ovarian volume = 0.523 x length x width x depth (ml)
**> 80% ovaries seen over age 5 years2

Note

Cysts:

>80% of girls 1 day to 24 months.
<70% of girls between 2 and 12 years.
macrocysts (>9mm) may be seen in <20% of cystic ovaries.1

Small cysts are seen in more than 80% of patients older than 5 years of age (mean <7.5 mm).
Cysts were seen in 68% of  premenarcheal 2 to 12 year olds, 90 -95% of which were < 9mm (mean 6 mm).

Ovarian Volume correlated with Age5

Ovarian Volume correlated w/ Age

References:

  1. Cohen HL, Shapiro MA, Mandel FS, Shapiro ML.  Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old.  AJR 1993; 160: 583-586.
  2. Orsini LF, Salardi S, Pilu G, et al.  Pelvic organs in premenarcheal girls: real-time ultrasonography.  Radiology 1984; 153:113-116.
  3. Cohen HL, Tice HM, Mandel FS. Ovarian volumes measured by US: bigger than we think. Radiology 1990. 177:189-92.
  4. Siegel MJ.  Pediatric Sonography. Raven Press: New York.  1995. pp 438
  5. Ivarsson S-A, Nilsson KO, Persson P-H.  Ultrasonography of the pelvic organs in prepubertal and postpubertal girls.  Arch Dis Child 1983, 58, 352-354 (Used with permission from BMJ Publishing Group)

Ovaries Tanner Score

Ovaries & Uterus Correlated with Tanner Score¹

Ovaries & Uterus correlation with Tanner Score

Upper Curve = uterine volume
Lower curve = ovarian volume


References:

  1. Ivarsson S-A, Nilsson KO, Persson P-H.  Ultrasonography of the pelvic organs in prepubertal and postpubertal girls.  Arch Dis Child 1983, 58, 352-354 (Used with permission from BMJ Publishing Group)

Ovarian Doppler

Age Type of flow/ menstrual phase   Arterial waveform pattern 
pre- pubertal low diastolic flow low diastolic flow
post- pubertal* follicular (0-7 days) low to absent diastolic flow
follicular/ luteal (11-17 days) increasing diastolic flow
late luteal decreasing diastolic flow


*flow detectable in 90% of adolescents
*arterial flow can be detected occasionally  in twisted adnexa

References:

  1. Siegel MJ.  Pediatric Sonography 2nd Edition.  Raven Press, New York 1995, p 440-441, 458.

 

Renal Ultrasound

Renal Ultrasound Measurements

Graph of Normal Renal Volume vs Weight1

Graph of Normal Renal Volume vs Weight

Length vs Age1

Graph of Renal Length vs. Age

References:

  1. Han BK, Babcock DS. Sonographic measurements and appearance of normal kidneys in children. AJR 1985; 145(3):611-616.  Tables used with permission.

Testicle

Normal Size of the Testicle as a Function of Age

Age Width (cm) Length (cm) Volume ± SE (cm3)
at Birth1,4 1.0 1.5 1.0 ± 0.14
1-3 months1,4 1.2 2.0 1.9 ± 0.11
4-6 months1 1.7 ± 0.11
1-10 years6 1.6 0.7 ± 0.9
11-12 years6 1.7 increasing to 1.9 1.5 increase to 2.0
13-16 years6 2.3 increasing to 3.5 5.0 increase to 13.0
Adult 2 - 3 3 - 5 15 - 20

References:

  1. Cassorla Fg, Golden SM, Johnsonbaugh RD, et al.  Testicular volume during early infancy.  J Pediatrics 1981; 99:742-743.
  2. Daniel WA Jr, Feinstein RA, Howard-Peebles P, et al.  Testicular volumes of adolescents.  J Pediatrics 1982; 101:1010-1012.
  3. Krone KD, Carroll BA.  Scrotal ultrasound.  Radiol Clin North Am 1985; 23:121-139.
  4. Siegel MJ, Pediatric Sonography, 2nd Ed. 1995 Raven Press
  5. Atkinson GO, Patrick LE, Ball TI, et al.  The normal and abnormal scrotum in children:  evaluation with color doppler sonography.  AJR 1992;158:613-617
  6. Kaplan SA.  Clinical pediatric & adolescent endocrinology.  W.B. Saunders. p. 307-308
 

Graph of Testicular Volume by Chronological Age¹

Measurement of Testicular Volume

Comment:

Testicular volume < 5 ml can be considered as infantile¹

 

Reference:

  1. Rundle AT, Sylvester PE.  Measurement of Testicular Volume.  It's application to assessment of maturation, and its use in diagnosis of hypogonadism.  Arch Dis Child 37:514-517, 1962  (Permission requested from publisher:  BMJ Publishing Group)

Testicle-Tanner Score

Testicular Volume correlated with Tanner Score ¹

(based on external physical measurement of length and width)

Tanner Score Left (cm³) SD Right (cm3) SD
1 4.76 2.76 5.2 3.86
2 6.4 3.16 7.08 3.89
3 14.58 6.54 14.77 6.1
4 19.8 6.17 20.45 6.79
5 28.31 8.52 30.25 9.64

References:

  1. Daniel WA, Feinstein RA, Howard-Peebles P, Baxley WD. Clinical and laboratory observations. Testicular volumes of adolescents. J Peds Dec 1982:1010-1012 (Modified: Permission requested from publisher)

Testicular Doppler

Doppler Flow in Testes*¹

Testicular Volume % detectable color flow
< 1 cc 70 (capsular arteries)
40 (central arteries)
> 1 cc +/- 100 (central & capsular)
* waveforms typically low resistance, high diastolic flow
  compare for symmetry
  lack of flow may be due to gain settings/high wall filter/high PRF etc²

References:

  1. Atkinson GO, Patrick LE, Ball TI, et al. The normal and abnormal scrotum in children: evaluation with color doppler sonography. AJR 1992;158:613-617
  2. Siegel MJ, Pediatric Sonography, 2nd Ed. 1995 Raven Press

Uterus

Normal Uterine Appearance and Dimensions

Uterine Stage Gross Features Length (cm)  Fundal Width of Body (cm)  Cervical Width (cm) 
Neonatal*¹ Cervix Fundus 2.3 - 4.6 0.8 - 2.1 0.8 - 2.2
Prepubertal+
1 - 12 years³		 Fundus/ Body Cervix 2.0 - 3.3 0.5 - 1.0
Postpubertal
13 - 20 years³		 Fundus > Cervix 5 - 8 1.6 - 3.0

*neonatal uterus regresses to about 2.5 cm at 1 month1

+After 7 years of age, there is uterine growth4 

Neonatal uterus: 30% of neonatal uteri have a hypoechoic halo surrounding the endometrial canal, which is thought to represent the inner third of the myometrium, which is vascularly engorged1.    

 Uterine Volume correlated with Age2

Uterine Volume correlated with Age

References:

  1. Nussbaum AR, Sanders RC, Jones MD.  Neonatal uterine morphology as seen on real-time US.  Radiology 1986; 160: 641-643.
  2. Ivarsson SA, Nilsson KO, Persson PH.  Ultrasonography of the pelvic organs in prepubertal and postpubertalgirls.  Arch Dis Child.  1983; 58:352-354. (Used with permission from BMJ Publishing Group)
  3. Sample W, Lippe B, Gyepes M.  Gray scale ultrasonography of the normal female pelvis.  Radiology 1977; 125:477-483.
  4. Orsini LF, Salardi S, Pilu G, et al.  Pelvic organs in premenarcheal girls: real-time ultrasonography.  Radiology 1984; 153: 113-116.

Uterus-Tanner Score

Ovaries & Uterus Correlated with Tanner Score¹

Ovaries & Uterus correlation with Tanner Score

Upper Curve = uterine volume
Lower curve = ovarian volume


References:

  1. Ivarsson S-A, Nilsson KO, Persson P-H.  Ultrasonography of the pelvic organs in prepubertal and postpubertal girls.  Arch Dis Child 1983, 58, 352-354 (Used with permission from BMJ Publishing Group)

Urinary Bladder

Volume Calculation:

V = (H x W x D) X 0.625 mL¹

H=height, W= width, D=depth

Volume by age = (age in years + 2) x 30 mL

Bladder wall thickness*²

Degree of Distention Thickness (mm) SD (mm)  Range (mm) 
Full 1.55

0.56

1 - 3
Empty 2.76 0.58

2 - 4.5

*(ages 1 day to 19 years)

Site of measurement:

Sagittal plane: posterior inferior wall (away from rectum)
Transverse plane: lateral to trigone


References:

  1. Haken berg OW, Ryall RL, Langlois SL, et al: The estimation of bladder volume by sonocystography. J Urol 1983; 130:249-251
  2. Jequier S, Rousseau O. Sonographic measurements of the normal bladder wall in children. AJR 149:563-566, Sep 1987