Mini Review Volume 6 Issue 1 - January 2018 DOI: 10.19080/JOJCS.2018.06.555676 JOJ Case Stud Copyright © All rights are reserved by Seyed Ali Alamdaran The New Applications of Trans-Perineal Ultrasound in Pediatrics Seyed Ali Alamdaran* Department of Surgical Oncology, Mashhad University of Medical Sciences, Iran Submission: January 25, 2017; Published: January 31, 2018 *Corresponding author: Seyed Ali Alamdaran, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, Email: JOJ Case Stud 6(1) JOJCS.MS.ID.555676 (2018) 001 Mini Review The Improvement of spatial resolution of new ultrasound machines were enabled us for better understanding of perineal anatomy, better characterization of perineal lesions and more usage of ultrasound in suspicious perineal abnormalities. Views and Normal Anatomy The child was placed in lithotomy position and trans-perineal ultrasound was done at two sagittal and coronal standard views. In sagittal view, tip of coccyx, anal tract, vagina, urethra and pubis are seen together. In this view, cartilages coccyx is seen as a tapered hypoechoic structure in alignment of sacral bone. It formed as a curved shape from five body of vertebra. The anal tract has a curved pathway with 45 degree direction to posterior. It has two internal echogenic layers that were surrounded by a thick hypoechoic musculature layer. Vagina has a similar echo pattern with a straight forward direction with minor angulations of perpendicular path; in comparison with anus, internal echogenic mucosa is more prominent and muscular layer is thinner. The female urethra is seen as a small extremely hypoechoic outer layer with small echogenic inner layer at anterior wall of vagina (Figure 1b). On male sex, posterior and anterior urethra is larger and easily is identified as it has specific anatomy in the posterior wall of pubic symphysis (Figure 1). Figure 1: Sagittal and coronal view of ultrasound images of normal perineal area; A-B) sagittal view of male urethra and of female perineum: anal tract, vagina, urethra and pubis are seen together C) Coronal view of anal muscle complex and ischiopubic fossa. On coronal view, you can better evaluate anal musculature and ischiopubic fossa (Figure 1c). The other views are used occasionally. For example; in order to ischial bone examination, the probe must be a parasagittal position with 30 degree angulations of midline. Applications Imperforate anus: In last, the ultrasonography is mainly used In pediatric patients with Imperforate Anus to existence of recto-urethral fistula and determination of the level of disorder (low and high) in according to the distance between perineal skin surface and rectal pouch. Although, there wasn’t an exact cut off for their differentiation and there is some diagnostic overlap [1-3]. Todays, the position and state of the anal pit, sphincter complex, internal fistula and type of imperforate anus is easily identified by ultrasound examination (Figure 2). The closed anal pit was detected as a surface multi-layered structure that was exactly similar to gut signature. It is only visualized in the coronal plane as a peripheral hypoechoic layer with two central parallel echogenic lines.