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 age2

Age Shape and Size Echogenicity

Cortex >>Medulla
Cortexhypoechoic
Newborn thickness
Medullahyperchoic
Convex borders
Changes gradually to
medulla>cortex Cortexhypoechoic 
1.5 to 2 months
thickness Medullahyperechoic
Convex borders
Hyperechoic, loss of
Decreasingsize
5-6 months corticomedullary
Straightborders
differentiation
Adult appearance
> 1 year Concave/straight Entirelyhypoechoic
margins

Ovaries
  Normal Ovarian Size as a Function of Age

 
Mean
SD 95% %
AgeGroup Ovarianvolume
(ml) ConfidenceInterval OvariesImaged
(ml)*
1 dayto 3
1.06 0.96 0.03-3.56 70
months1
4-12
1.05 0.67 0.18-2.71 100
months1
13-24
0.67 0.35 0.15-1.68 90
months1
2 -12 years3 0.46 -- 0.13-0.9(range) --**
13-20 years3 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

 Ovarian Doppler1
Age Type of flow/menstrual phase Arterial waveformpattern
pre-pubertal lowdiastolicflow lowdiastolicflow
post-pubertal* follicular  (0-7 days) low to absent diastolic flow
follicular/luteal (11-17 days) increasingdiastolicflow
late luteal decreasingdiastolicflow
*flow detectable in 90% of adolescents
*arterial flow can be detected occasionally  in twisted adnexa

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

RIÑONES
 Volume
Age Width (cm) Length (cm) ±
SE(cm3)
1.1 ±
Normal Size of the At Birth1,4 1.0  1.5
0.14
Testicle as a Function
of Age 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
1.7 increasingto
11-12 years6   incrto
1.9
2.0
2.3 increasingto 5.0 incr
13-16 years6  
3.5 13.0

Adult 2-3 3-5 15-20

Graph of Testicular Volume by Chronological Age1

 Testicular Volume correlated with Tanner score1
(based on external physical measurement of length and width)

Tanner Score Left    Right  

  cm stddeviation cm stddeviation
3 3

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:

Doppler Flow in Testes* 1

Testicular Volume % detectable color flow

70 (capsular arteries)
< 1 cc
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 etc.2

Uterus

Normal Uterine Appearance and Dimensions

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

Uterine Volume correlated with Age2

Ovaries & Uterus correlated with Tanner Score1

 Upper curve = uterine volume
Lower curve = ovarian volume

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 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

Appendix

Normal Appendix
 TransverseDiameter Appendicealwallthickness
Modality
(mm) (mm)
< 6 (and
US Usually< 2
compressible)
CT < 8   < 2 - 4
 

Normal Sonographic  Common Hepatic Duct Sizes vs. Age1

Common Hepatic Common Hepatic

Duct Size Duct 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

Sonographic Measurements of the NormalPediatric Gallbladder and

Biliary Tract

Normal GallbladderMeasurements 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 GI Tract: Wall Thickness on CT

 Organ Wall Thickness (mm)
Stomach 3 - 5 
Duodenum  < 3
Colon  < 3 
References:

Portal Vein

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

Main Portal
Age
VeinTransverseDiameter (mm)
<10 years 8.5 ± 2.7
10 to 20 years 10  ±  2
 
 

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
Gastrohepaticligament <8
Upperparaaortic <9
Portacaval < 10
Portahepatis <7
Lowerparaaortic < 11

Pancreas

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

Head in cm (± Body in cm (± 1 Tail in cm (±

Age
1SD) SD) 1SD)
 < 1 month 1.0  ± 0.4 0.6  ± 0.2 1.0  ± 0.4
1 monthto 1 year 1.5  ± 0.5 0.8  ± 0.3 1.2  ± 0.4
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 years 2.0  ± 0.5 1.1  ± 0.3 2.0  ± 0.4

Pylorus

Pyloricchannellength <17 mm
Musclethickness <3.0 mm

Spleen

Ultrasound: Normal Spleen Size versus Age1

Age SpleenLength (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

Neonatal Brain
 

SonographicNormal Cerebral Ventricle Measurements by Age

Frontal Horn ThirdVentricle 

Age Body (mm)
(mm) ( mm)
Prematureinfant -- < 10*  
Terminfant -- 10 - 11*  
Newborn <3 -- <4

*Body --Measured in a transaxial view from its lateral edge to the midline. (This is not
truly the width of the lateral ventricle but the distance from the superolateral ventricular
wall to the falx).

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.
Thymus
Normal Measurements of the Thymus on CT: Mean Values

AP Thickness Craniocaudal
 Width in
Age (y) Diameter in of Limbs in Length in cm
cm (SD)
cm (SD) cm (SD) (SD)
0-10 2.52 (0.82) 1.5 (0.46) 3.53 (0.99) 3.13 (0.85)
10-20 2.56 (0.88) 1.05 (0.36) 4.99 (1.25) 3.05 (1.17)

Thyroid

SonographicNormal 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&Adults 2-4 5-8 1 - 2.5
Cole-Beuglet C.  Ultrasonography of the thyroid, parathyroid and neck masses.  In:
Sarti DA, ed. Diagnostic ultrasound: text and

Cardiothoracic Index
(made on upright frontal view of chest at 72 inches during quiet breathing)

Aorta

Measurement of Pediatric Thoracic Aorta1

Fromcontrastenhanced axial CT
 Key:
Level A = 1 cm
below aortic arch
Level B = 1 cm
cranial to aortic root
Level C = 1 cm
cranial to dome of
right hemidiaphragm

A1 = (0.72 x age) +
11.55 mm
A2 = (0.629 x age) +
9.54 mm
B1 = (0.668 x age) +
13 mm
B2 = (0.572 x age) +
9.56 mm
C   = (0.559 x age) +
8.44 mm

Retropharyngeal Soft Tissues1

(Lateral radiographs of the neck)
Age(yrs) Maximum (mm)
0-1 1.5 x C5*
 1-3 0.5 x C5
3-6 0.4 x C5
6-14 0.3 x C5

Hip
Acetabular Center Medial
US Hip Types
Angle EdgeAngle JointSpace

Normal Acetabular Angles* (Caffey)

AP radiograph of pelvis

Acetabular Angle Acetabular Angle--

Age
--Female (Degrees) Male (Degrees)
Newborn 28.8 ± 4.8 26.4 ± 4.4
3 Month Old 25 ± 3.5 22 ± 4
SixMonth Old 23.2 ± 4.0 20.3 ± 3.7
OneYear Old 21.2 ± 3.8 19.8 ± 3.6
TwoYear Old 18 ± 4 19 ± 3.6

 
 Kyphosis and Lordosis

  Normal Angles for Thoracic Kyphosis and Lumbar Lordosis

Standing Lateral Radiographs

  Normal Angle MeasuredFrom

ThoracicKyphosis 21 - 33º T3 - T12

Lumbar Lordosis 31 -50º  L1 - L5
Thoracic kyphosis is usually measured using the superior end plate of T3 and the
inferior end plate of T12.
Lumbar lordosis is measured using the superior end plate of L1 and the inferior end
plate of  L5

Measurement of the Metaphyseal-Diaphyseal Angle

diagrams under construction

for Differentiation between Physiologic Bowing and Tibia Vara

Metaphyseal- DiaphysealAngle
Age (months)
(degrees)
Physiologicbowing  Average (Range)
11-20  5.1 + 2.8  (0-11)
21-30  3.7 + 3.1(0-10)
Tibia vara 
11-20  16.4 + 4.3(8-22)
21-30  13.7 + 4.3 (7-22)