Abnormal Fetal Abdomen (O.12.3) PDF

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PalatialLiberty

Uploaded by PalatialLiberty

RRC Polytech

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fetal anatomy sonography obstetrics medical imaging

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This document is a presentation on abnormal fetal abdomen and includes topics such as abnormal GI tract, liver, spleen, adrenal glands, and abnormal abdominal wall. The PowerPoint presentation includes textbook references and discussions of sonographic features.

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ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 1 2 Fetal Abdomen textbook reference Module O.12 Abnormal Fetal Heart & Abdomen • • Abnormal Abdomen • • 3 Curry 5th Edition Chapter 22 (p. 396‐397, 402‐405, 409‐410, 414, 416, 420) Rumack 5th E...

ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 1 2 Fetal Abdomen textbook reference Module O.12 Abnormal Fetal Heart & Abdomen • • Abnormal Abdomen • • 3 Curry 5th Edition Chapter 22 (p. 396‐397, 402‐405, 409‐410, 414, 416, 420) Rumack 5th Edition Chapter 38 4 Abnormal Abdomen Abnormal GI Tract • Liver • GI tract anatomy • Spleen • Stomach • Gallbladder & biliary tree • Intra‐abdominal cysts • Adrenals • Situs inversus • Abdominal vessels • Bowel • Other GI tract atresias • Echogenic bowel 5 6 Abnormal Abdominal Wall • Anterior abdominal wall • Physiologic midgut umbilical herniation • Congenital anomalies • AFP screening • Amniotic band syndrome Liver 1 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 7 8 Liver • General anatomy Liver – general anatomy • Sonographic features • • Abnormalities Large right and left lobes • Left lobe will become proportionately smaller after birth • Smooth margins Textbook of Diagnostic Sonography, 7th Edition (Hagen‐Ansert fig 60‐4) 9 10 Liver Liver – sonographic features • Homogeneous echotexture • Large right and left lobes • Major portal and hepatic veins seen • Smooth margins Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 14‐5) 11 12 Normal liver L: liver RPV: right portal vein Arrows: US‐LPV / pars transversa S: stomach Sp: spleen Liver – abnormalities Lt Sp S RPV L • Hepatomegaly • Calcifications • Congenital cysts • Tumours Most common Uncommon Very rare Rt 2 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 13 14 Hepatomegaly Hepatomegaly Abnormal enlargement of the liver • • • Multiple causes Most common fetal liver abnormality Causes: • Isoimmunization (maternal‐fetal blood incompatibility) Isoimmunization • TORCH infections Rt Lt Production of antibodies against another individual of the same species (e.g. transplant, pregnancy, etc.) 15 16 Liver calcifications Liver calcifications – idiopathic • Normal outcome • Uncommon • Causes: • Idiopathic • Tumours • Infections (TORCH) • Vascular accidents 17 Idiopathic Of unknown cause 18 Spleen Spleen • Spatial relationships • Sonographic features • Abnormalities 3 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 19 20 Spleen Spleen – spatial relationships Rt • Left upper quadrant of abdomen • Posterolateral to stomach • Superior to left adrenal and kidney Lt Sonography: Introduction to Normal Structure and Function, 5th Edition (Curry fig 22.24) 21 22 Spleen – sonographic features Normal spleen • Homogeneous echotexture • Right lateral axial view • Smooth margins • 28 weeks GA – normal • Best visualized at normal AC level • Seen after 20 weeks GA Rt Sp: spleen St: stomach St Sp Lt 23 24 Spleen – abnormalities • Splenomegaly • Congenital cysts • Cardiosplenic syndromes Rare Very rare Splenomegaly • Causes: • Isoimmunization Most common • Infections • Overgrowth disorders (like Beckwith‐Wiedemann) Isoimmunization Forming antibodies against another individual 4 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 25 26 Hepatosplenomegaly with Beckwith‐Weidemann syndrome Microcephaly Visceromegaly Macrosomia Macroglossia Splenic cyst • Left upper quadrant • Kidney was seen separate from the mass Arrow: splenic cyst Arrowheads: diaphragm Omphalocele Diagnostic Ultrasound, 5th Edition (Rumack fig 38.26) 27 28 Cardiosplenic syndromes • Asplenia • Congenital absence • Polysplenia • Multiple spleens (splenuli) Polysplenia • Sagittal LUQ • Multiple, widely spaced splenules superior to LK LK Cardiosplenic syndromes Complex congenital cardiac malformations, splenic dysgenesis 29 30 Gallbladder & Biliary Tract Gallbladder & Biliary Tract • Sonographic features • Abnormalities 5 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 31 32 • Seen in majority of fetuses after 14‐16 weeks GA • Conical, fluid‐filled, anechoic structure • Situated to the right of the umbilical vein • Distinguishable from vascular structures by: • Location, shape, and lack of Doppler flow Rt Normal gallbladder • Right lateral axial fetal abdomen • Slightly caudal to the UV‐LPV complex Gallbladder – sonographic features GB: gallbladder UV: umbilical vein St: stomach 33 Lt 34 GB & biliary tree – abnormalities • Cholelithiasis (arrows) UV: umbilical vein Non‐visualization of GB • May indicate anomalies • Cholelithiasis, sludge • May resolve • Biliary atresia • Choledochal cyst Rt UV Lt 35 36 Cholelithiasis • Lateral axial abdomen • 37 weeks GA Fetal gallbladder sludge Rt Arrows: stones in GB ST: stomach May mimic liver or peritoneal calcifications Lt 6 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 37 38 Choledochal cyst Choledochal cyst types • Focal cystic dilatation of bile duct • Type 1 most common (see next slide) • Ddx: cyst in liver, kidney or bowel Most common Rare 39 cyst Type: 1 cyst 2 3 cyst 40 Choledochal cyst (26 wks GA) • arrow: cyst ST: stomach • Lt Separation of cyst and stomach Adrenals ST Ddx: duodenal atresia (DA) • Dilatation of the duodenum • If DA, cystic mass would communicate with stomach 41 Rt 42 Adrenals • General anatomy Adrenals – general anatomy • Sonographic features • Proportionally large in fetus relative to adult • Abnormalities • Anteromedial suprarenal location • Thick outer cortex • Thin inner medulla • Develop in superoposterior abdomen independent of kidneys which develop in the pelvis and ascend superiorly 7

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