Abnormal Fetal Abdomen (O.12.3) PDF

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