Adrenal Gland

Normal Adrenal Gland Size as a Function of Age1

Age Length (cm) Thickness (cm) Width (cm)

0.9 - 3.6 0.2 - 0.5
Neonate --
(mean, 1.5) (mean, 0.3)
Adult 4-6 0.2 - 0.6 2 -3

ref 1.

Adrenal Gland: Sonographic features of normal adrenal glands versus age 2

Age Shape and Size Echogenicity

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

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.
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)
 Ovarios
Normal Ovarian Size as a Function of Age

Mean Ovarian volume SD 95% Confidence % Ovaries

Age Group
(ml)* (ml) Interval Imaged
1 day to 3
1.06 0.96 0.03-3.56 70
months1
4-12 months1 1.05 0.67 0.18-2.71 100
13-24 months1 0.67 0.35 0.15-1.68 90
3
2 -12 years 0.46 -- 0.13-0.9(range) --**
3
13-20 years 4.0 -- 1.8-5.7(range) --

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 = 0.523 x length x width x depth (ml)

**> 80% ovaries seen over age 5 years2

Ovarian Volume correlated with Age4

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. Sample W, Lippe B, Geypes M. Gray scale ultrasonography of the normal female pelvis. Radiology 1977; 125:477-483.
In Source: Siegel MJ. Pediatric Sonography. Raven Press: New York. 1995. pp 438
2. 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 & Uterus correlated with Tanner Score 1

Upper curve = uterine volume

Lower curve = ovarian volume

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)
Renal Ultrasound Measurements
Graph of Normal Renal Volume vs Weight1
 Renal Ultrasound Measurements
Length vs. Age1

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

American Journal of Roentgenology

 Testicle

Normal Size of the Testicle as a Function of Age

Volume
Age Width (cm) Length (cm) ±
SE(cm3)
1.1 ±
At Birth1,4 1.0 1.5
0.14
1.9 ±
1-3 months1,4 1.2 2.0
0.11
1.7 ±
4-6 months1
0.11
1-10 years6 1.6 0.7 - 0.9
1.5 incr
11-12 years6 1.7 increasing to 1.9
to 2.0
5.0 incr
13-16 years6 2.3 increasing to 3.5
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
 Uterus
Normal Uterine Appearance and Dimensions

Fundal
Uterine Gross Cervical
Length (cm) Width of
Stage Features Width (cm)
Body (cm)
Cervix >
Neonatal*1 2.3 - 4.6 0.8 - 2.1 0.8 - 2.2
Fundus
Prepubertal+ Fundus/Body
2.0 - 3.3 0.5 - 1.0
1-12 years3 < Cervix
Postpubertal Fundus >
3 5-8 1.6 - 3.0
13-20 years Cervix
*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

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, Geypes 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.
 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 thickness2

(ages 1 day to 19 years)

Site of measurement: sagittal plane: posterior inferior wall (away from rectum)

transverse plane: lateral to trigone

Degree of distention Thickness (mm) SD (mm) Range (mm)

Full 1.55 0.56 1-3
Empty 2.76 0.58 2-4.5

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
 Sinuses
Visualization of the Paranasal Sinuses*

Maxillary 2 - 3 mo
Ethmoidal 3 - 6 mo
Sphenoidal 1-2 y
Frontal 8 -10 y

* The radiographic visualization of the sinuses lags the actual gross

appearance based on autopsy.

Kirks DR. Griscom NT. Practical Pediatric Imaging. Lippincott - Raven:

Philadelphia. 1998.
 Thyroid
Sonographic Normal Thyroid Lobe Measurements (cm)

Transverse Longitudinal AP
Age
(cm) (cm) (cm)
Infants and
0.2 -
Young 1 - 1.5 2-3
1.2
Children
Adolescents
2-4 5-8 1 - 2.5
& Adults

Cole-Beuglet C. Ultrasonography of
the thyroid, parathyroid and neck
masses. In: Sarti DA, ed. Diagnostic
ultrasound: text and cases. Chicago:
Year Book Medical Publishers;
1987:608-618. (Modified)
 Normal GI Tract: Wall Thickness on CT

Organ Wall Thickness (mm)

Stomach 3-5
Duodenum <3
Colon <3

References:

1. Desai RK, Tagliabue JR, Wegryn SA, Einstein DM. CT evaluation of wall thickening
in the the alimentary tract. Radiographics 1991;11:771-783.

2. Fisher JK. Abnormal colonic wall thickening on computed tomography. J comput

assist tomogr 1983; 7: 90-97.

In Siegel MJ. Pediatric Body CT. Lippincott Williams & Wilkins: Philadelphia. 1999.
pp 204, 207, 219.

Appendix
Normal Appendix

Modality Transverse Diameter (mm) Appendiceal wall thickness (mm)

US < 6 (and compressible) Usually < 2

CT <8 <2-4

References:
1. Kao SC, Smith WL, Abu-Yousef MM, et al. Acute appendicitis in children: sonographic findings. AJR 1989; 153:375-379.
2. Curtin KR, Fitzgerald SW, Nemcek AA, Hoff FL, Vogelzang RL. CT diagnosis of acute appendicitis: imaging findings. AJR 1995;
164:905-909.

Sonographic Measurements of the Normal Pediatric

Gallbladder and Biliary Tract
 Normal Gallbladder Measurements vs. Age1

Coronal Wall
AP AP Coronal Wall
Length Length
Diameter Thickness
Age Diameter Thickness
Diameter Diameter
(cm) (cm)
(cm) (cm) (cm) (mm)
(y) (cm) (mm)
Mean Range
Mean Range Range Mean
Mean Range
0-1 0.9 0.5-1.2 0.9 0.7-1.4 2.5 1.3-3.4 1.7 1.0-3.0
2-5 1.7 1.4-2.3 1.8 1.0-3.9 4.2 2.9-5.2 2.0 None
6-8 1.8 1.0-2.4 2.0 1.2-3.0 5.6 4.4-7.4 2.2 2.0-3.0
9-11 1.9 1.2-3.2 2.0 1.0-3.6 5.5 3.4-6.5 2.0 1.0-3.0
12-
2.0 1.3-2.8 2.1 1.6-3.0 6.1 3.8-8.0 2.0 1.0-3.0
16

Normal Sonographic Common Hepatic Duct Sizes vs. Age1

Common Hepatic Duct Common Hepatic Duct
Size Size
Age
(mm) (mm)
(y)
Mean Range
0-1 1.3 1.0 - 2.0
2-5 1.7 1.0 - 3.0
6-8 2.0 None
9-11 1.8 1.0 - 3.0
12-16 2.2 1.0 - 4.0

1. McGahan JP, Phillips HE, Cox KL. Sonography of the normal pediatric gallbladder and biliary tract.
Radiology 1982; 144(4): 873-875. Tables modified and used with permission for this Website.

Pancreas
 Normal Pancreas Size as a Function of Age (Ultrasound)*1

Head in cm Body in cm Tail in cm (±

Age
(± 1 SD) (± 1 SD) 1 SD)
< 1 month 1.0 ± 0.4 0.6 ± 0.2 1.0 ± 0.4
1 month to 1
1.5 ± 0.5 0.8 ± 0.3 1.2 ± 0.4
year
1 to 5 years 1.7 ± 0.3 1.0 ± 0.2 1.8 ± 0.4
5 to 10 years 1.6 ± 0.4 1.0 ± 0.3 1.8 ± 0.4
10 to 19
2.0 ± 0.5 1.1 ± 0.3 2.0 ± 0.4
years

Portal Vein
Normal Main Portal Vein Size on Ultrasound as a Function of
Age

Main Portal Vein

Age Transverse Diameter
(mm)
<10 years 8.5 ± 2.7
10 to 20 years 10 ± 2

References:
1. Patriquin HB, Perreault G, Grignon A, et al. Normal portal venous diameter in children. Pediatric Radiol
1990; 20: 451-453.
2. Weinreb J, Kumari S, Phillips G, Pochaczevsky R. Portal vein measurements by real-time sonography. AJR
1982; 139(3):497-499.
In source: Siegel MJ. Pediatric Sonography. Raven Press: New York. 1995 . p 175.

Normal Lymph Nodes Seen on CT

 Normal Abdominal Lymph Nodes in Adolescents and Adults: CT1

Location Short Axis Nodal Diamter(mm)

Retrocural <6
Paracardiac <8
Mediastinal <102
Gastrohepatic ligament <8
Upper paraaortic <9
Portacaval < 10
Portahepatis <7
Lower paraaortic < 11

References: < br>1. Dorfman RE, Alpern MB, Gross BH,

Sandler MA. Upper abdominal lymph nodes:criteria for
normal size determined with CT. Radiology 1991;
180:319-322. Table modified and used with permission for
this Website.
2. Newman B, Arcement CM, Siegel MJ. CT and MR
imaging of mediastinal masses in children. Current
Concepts in Body Imaging at the Millenium. RSNA
Syllabus 1999

2. Weinreb J, Kumari S, Phillips G, Pochaczevsky R. Portal vein

measurements by real-time sonography. AJR 1982; 139(3):497-499.
In source: Siegel MJ. Pediatric Sonography. Raven Press: New York.
1995 . p 175.

Pylorus
 Pyloric channel length < 17 mm
Muscle thickness < 3.0 mm

Muscle wall thickness: measured as a single hypoechoic layer

between serosa and echogenic submucosa. (muscle thickness
exaggerated for illustration) .

Note: PRETERM INFANTS. Borderline muscle

thickness measurements are more likely to occur in
premature infants than in term infants. In preterm
infants, the thickness of the pyloric muscle relative
to the rest of the stomach and the pyloric canal
length is more important than the absolute muscle
thickness.

References:
1. Blumhagen JD, Maclin L, Krauter D, Rosenbaum DM, Weinberger E. Sonographic diagnosis of hypertophic pyloric stenosis. AJR
1988; 150:1367-1370.
2. Blumhagen JD, Weinberger E. Pediatric gastrointestinal ultrasounography. In : Ultrasound annual. New York: Raven Press; 1986;
99-140.
3. O'Keefe FN, Stansberry SD, Swischuk LE, Hayden CK Jr. Antropyloric muscle thickness at US in infants: what is normal?
Radiology 1991; 178: 827-830.
3. Rollins MD, Shields MD, Quinn RJM, et al. Pyloric stenosis: congential or acquired? Arch Dis Child 1989; 64:138-147.
 Spleen
Ultrasound: Normal Spleen Size versus Age1

Age Spleen Length (cm)*

0 - 3 months <6
3 - 6 months < 6.5
6 - 12 months < 7
1 - 2 years < 8
2 - 4 years < 9
4 - 6 years < 9.5
6 - 8 years < 10
8 - 10 years < 11
10 - 12 years < 11.5
12 - 15 years < 12
15 - 20 years (female) < 12 (female)
15 - 20 years (male) < 13 ( male)

*Measurement obtained in the coronal longitudinal

plane
1. Rosenberg HK, Markowitz RI, Kolbeg H, et al. Normal splenic size in infants and
children: sonographic measurements. AJR 1991; 157:119-121. Table modified and used
with permission.

American Journal of Roentgenology

 Thyroid
Sonographic Normal Thyroid Lobe Measurements (cm)

Transverse Longitudinal
Age AP (cm)
(cm) (cm)
Infants and
Young 1 - 1.5 2-3 0.2 - 1.2
Children
Adolescents
2-4 5-8 1 - 2.5
& Adults

Cole-Beuglet C. Ultrasonography of the

thyroid, parathyroid and neck masses. In:
Sarti DA, ed. Diagnostic ultrasound: text
and cases. Chicago: Year Book Medical
Publishers; 1987:608-618. (Modified)