1 - Serviço de Radiologia, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
2 - Radiology Department, King’s College London, Evelina London Children’s Hospital, London, United Kingdom
3 - Paediatric Nephrology Department, King’s College London, Evelina London Children’s Hospital, London, United Kingdom
- Apresentação oral no 57th European Society of Paediatric Radiology Annual Meeting
Introdução e objectivos: The authors propose a diagnostic imaging algorithm to best identify children being evaluated for hypertension who may have renovascular disease (RVD) as a cause of secondary hypertension.
Métodos: Proposed management algorithm retrospectively tested in a database of 85 patients who were referred to a tertiary paediatric hypertension service for evaluation of sustained high blood pressure. Patients underwent MBUS and/or RDUS as part of their investigation to identify underlying renovascular disease. All but one patient with RVD were confirmed by formal angiography (8 of 9).
Resultados: Seventy-five out of the 85 (88%) children underwent MBUS, 57 (67%) underwent RDUS and 7 (8%) CT or MRA. MBUS was positive in 6 of 9 with confirmed renovascular hypertension, representing a sensitivity of 67% (and specificity of 82%). RDUS was performed on 57 patients and was positive in 5 of 9 with confirmed RVD, attaining a sensitivity of 67% and specificity of 82%. Based on the proposed algorithm only 33/85 (39%) of RDUS would have been indicated [25/33 (76%) because of high clinical suspicion and 8/33 (24%) as positive mode-B ultrasound]. All the patients with confirmed renovascular hypertension would have had RDUS evaluation as per the algorithm. Adequate patient selection as per proposed algorithm would reduce RDUS by 28%.
Conclusões: MBUS may be sufficient in many patients with hypertension and may provide alternative diagnosis (other causes of hypertension). In high risk patients for renovascular hypertension RDUS may be the appropriate initial test and may direct further work-up. However, RDUS has high specificity but low sensitivity and therefore is not ideal as screening for RVD.
Palavras Chave: Algorithm, Children, Doppler, Hypertension, Secondary