OBJECTIVE: Comparison of the diagnostic findings of MRI, CT and CEUS in children with benign and malignant and portal venous anomalies of the liver. MATERIALS/METHODS: Retrospective analysis of the diagnostic findings of CEUS, MRI and CT scans in 56 children (age 0–17 years) with a total of 60 benign and malignant liver lesions and anomalies of the portal vein/perfusion. All patients underwent CEUS using sulphur hexafluoride microbubbles and a multi-frequency probe (1–5 MHz, 6–9 MHz). Cine-loops were stored up to 3 minutes. MRI was performed in 38 lesions. CT was performed in 8 lesions. RESULTS: Out of the 56 patients 49 liver lesions (48 benign, 1 malignant), 9 anomalies of the portal vein/perfusion and 2 of the biliary system were detected. 16/49 lesions were analyzed histopathologically. Using CEUS, the characterization of the lesions was possible in 45 out of 49 cases. In 32 cases, CEUS provided the exact diagnosis. Only two benign lesions were falsely categorized as malignant. Findings of MRI and CEUS were concordant in 84% of cases ( n = 32/38). CEUS considered 1 benign lesion to be malignant. 2 lesions were not detectable and in 3 lesions no definite diagnosis was established using MRI. Findings of CT and CEUS were concordant in 5 of 8 cases. In 21 lesions CEUS as the only imaging modality was found to be sufficient for diagnostics. CONCLUSION: Despite the restricted indications for using CEUS in children, it offers a high diagnostic detection rate (93%) for characterization of liver lesions and portal vein anomalies.

Background: The development of graft fibrosis after pediatric liver transplantation (PLT) remains a major concern as it can lead to graft failure and ultimately graft loss. Elastography is a non‐invasive method to assess liver fibrosis, but its role in the posttransplant setting is unclear. The aim of our study was to evaluate shear wave elastography (SWE) in the assessment of liver fibrosis after PLT, including split‐liver recipients.Methods: We retrospectively analyzed data from PLT recipients who underwent surveillance liver biopsy and concurrent 2D‐SWE during the study period from April 2018 to July 2021. Spearman's correlation was used to compare histologic fibrosis stages with liver stiffness measurements (LSM) by 2D‐SWE. AUROC analysis was performed to evaluate the performance. One sample t‐test was used to compare results with reference values of healthy children.Results: 62 cases were included. 29% showed histologic fibrosis. LSM by 2D‐SWE were feasible in all children regardless of age or graft type. There was a significant correlation between LSM and fibrosis stage for all three scoring systems used (Ishak, p = 0.003; METAVIR, p = 0.005; LAF Score, p = 0.003). Patients with a history of biliary complications had increased liver stiffness (p = 0.015). The AUROC of 2D‐SWE for predicting significant liver graft fibrosis was 0.81. Liver stiffness after PLT without graft fibrosis was higher than in healthy subjects, but comparable to that in children with chronic liver disease without fibrosis.Conclusion: 2D‐SWE can reliably detect children with significant liver graft fibrosis, even in split‐liver recipients. This study demonstrates the value of a non‐invasive tool for fibrosis staging after PLT. 2D‐SWE has the potential to improve long‐term outcomes after PLT and to reduce the number of surveillance liver biopsies. But elastography is not a substitute for liver biopsy.

Background: Patients with an aortic aneurysm are at high cardiovascular risk. Pulse wave velocity (PWV) is used as a parameter for risk stratification but may be affected by aortic disease (AoD). This study aimed to investigate the dependence of PWV on treated or untreated AoD and to identify modifiable factors of PWV. Methods: The measurement of PWV with the Mobil-O-Graph was performed fully automatically in a collective of 381 patients (75.6% male and 24.4% female). Of all patients, 53.8% had nonaortic atherosclerotic vascular disease (AVD), 28.9% had treated AoD, and 17.3% had untreated AoD. Results: There was a statistically significant effect of age (R² = 0.838) and current systolic blood pressure (SBP) on PWV (p_{age corrected} < 0.05). After correction for age, no statistically significant difference was found between the PWV of men and women, patients with different body weights or degrees of chronic kidney disease, diabetics and nondiabetics, and smokers and nonsmokers. Comparison between patients with nonaortic AVD and treated or untreated AoD revealed no statistically significant differences (PWV_{nonaortic AVD} 10.0 ± 1.8 m/s, PWV_{treated AoD} 10.0 ± 1.5 m/s, PWV_{untreated AoD} 9.8 ± 1.6 m/s; p_{age corrected} > 0.05). Conclusions: PWV determined with the Mobil-O-Graph correlated with age and current SBP. Neither aortic disease versus nonaortic AVD, its treatment, nor other cardiovascular risk factors had a significant effect on PWV. Successful blood pressure control is crucial to avoid high PWV and thus an increase in cardiovascular events.

Background: After pediatric split liver transplantation, intra‐abdominal loss of domain due to large‐for‐size left lateral grafts is a frequent problem for fascial closure and potentially leads to reduced liver perfusion and abdominal compartment syndrome. Therefore, delayed fascial closure with the use of temporary silastic meshes and reoperation or alternative fascial bridging procedures are necessary.Methods: Between March 2019 and October 2021, biologic meshes were used for abdominal wall expansion in 6 cases of pediatric split liver transplantation. These cases were analyzed retrospectively.Results: One male and 5 female children with median age of 6 months (range: 0–57 months) and weight of 6 kg (range: 3.5–22 kg) received a large‐for‐size left lateral graft. Graft‐to‐recipient weight ratio (GRWR) was 4.8% (range: 1.5%–8.5%) in median. Biologic mesh implantation for abdominal wall expansion was done in median 7 days (range: 3–11 days) after transplantation when signs of abdominal compartment syndrome with portal vein thrombosis in 3 and of the liver artery in 1 case occurred. In 2 cases, bovine acellular collagen matrix and 4 cases ovine reinforced tissue matrix was used. Median follow‐up was 12.5 months (range: 4–28 months) and showed good liver perfusion by sonography and normal corporal development without signs of ventral hernia. One patient died because of fulminant graft rejection and emergency re‐transplantation 11 months after the initial transplantation.Conclusions: Biologic meshes can be used as safe method for abdominal wall expansion to achieve fascial closure in large‐for‐size liver transplant recipients. Usage for primary fascial closure can be considered in selected patients.

Background: Intrahepatic arterial pseudoaneurysms are a rare, life-threatening complication after pediatric liver transplantation. Treatment of choice represents interventional radiological management with endovascular embolization of the segmental artery proximal and distal to the aneurysm. However, this technique results in loss of arterial perfusion distal to the aneurysm with subsegment arterial ischemia.Case presentation: We report a case of a 1-year-old girl with a pseudoaneurysm in the split-liver graft. Direct percutaneous, transhepatic access to the pseudoaneurysm was performed followed by super selective coil application into the aneurysm.Conclusion: Super selective percutaneous, transhepatic coil application is feasible even in pediatric patients after liver transplantation and results in preservation of the entire course of the liver artery.