Abnormal Fetal Abdomen PDF

ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 43 44 inferior vena cava Normal adrenals • aorta Normal adrenals 13 weeks GA • Develop normally even if the kidney fails to develop normally • Diagram shows unilateral renal agenesis with nor...

ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 43 44 inferior vena cava Normal adrenals • aorta Normal adrenals 13 weeks GA • Develop normally even if the kidney fails to develop normally • Diagram shows unilateral renal agenesis with normal adrenals adrenal gland RK pelvis bladder Atlas of Human Anatomy, 7th absence of ureteric bud Developing Human: Clinically Oriented Embryology, 9th Edition (Moore fig. 12‐13) Edition (Netter plate 368) 45 metanephric mesoderm 46 Adrenal glands – sonographic features • Thin, relatively flat shape • Hypoechoic cortex • Hyperechoic medulla Normal right adrenal (arrow) cortex medulla 47 • Lateral axial abdomen • 36 weeks GA 48 Normal adrenal • Oblique abdomen • 34 weeks GA • Adrenal gland and long axis kidney kidney Adrenals – abnormalities • Neuroblastoma • Most common malignant tumour • Complex US appearance • Hemorrhage Very uncommon • Most commonly associated with fetal distress in older fetuses • Similar US appearance to adrenal tumours 8 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 49 50 Neuroblastoma Neuroblastoma • Transverse abdomen • Coronal abdomen • 2nd trimester • Partially cystic mass • Large paraspinal solid mass with single cystic component Sp: spine S: spine Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 16‐66 A) 51 Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 16‐66 B) 52 Adrenal hemorrhage A: 26 weeks GA B: smaller size at 32 weeks GA (resolving) A 53 Abdominal Vessels B 54 Abdominal Vessels • General anatomy & development Abdominal vessels – anatomy & sonographic features • Sonographic features • • Persistent right umbilical vein Know general location, course, and sonographic appearance 9 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 55 56 Abdominal vessels – basic anatomy Arrow: umbilical vein RA IVC hepatic veins aorta liver pars transversa ductus venosus UV segment of LPV umbilical vein Diagnostic Medical Sonography: Obstetrics and Gynecology, 3rd Ed. (Raatz Stephensen fig 20‐33) Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 7‐16) umbilical arteries 57 58 Mid‐sagittal fetus • Normal vascular anatomy L: liver B: small bowel UV: umbilical vein US‐LPV: umbilical segment of LPV Ao: aorta Umbilical vein • Courses cranially from umbilicus to join LPV • Anterior mid‐sagittal fetal abdomen best view to show: • Course • Long axis 59 US‐LPV UV Ao L B 60 Left portal vein • Hepatic continuation of UV • Mostly posterior and cephalic course • Anterior mid‐sagittal fetal abdomen best view to show: • Course • Long axis • Relationship to UV and ductus venosus Umbilical vessels • Sagittal abdomen and pelvis c: cord b: bladder UA: umbilical artery UV: umbilical vein DV: ductus venosus 10 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 61 62 Pars transversa AKA portal sinus • Transverse segment of LPV • Courses transversely to the right joining RPV • Transverse best view to show: • Long axis PT • RPV UV‐LPV: umbilical vein segment LPV RP: RPV PT: pars transversa AR: anterior branch RPV MH: middle hepatic vein SP: spleen S: stomach Ad: right adrenal gland RC, LC: right and left diaphragmatic crura Ad PT UV/LPV Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 9‐70) 63 64 Rare Abdominal vessels – variant • Persistent right umbilical vein Persistent right umbilical vein 65 • Remnant from early development • Normally right UV regresses between 6 ‐ 8 weeks GA • Normal right UVs are not seen sonographically • A persistent right UV typically replaces the left UV • Though may coexist with a left UV • A thorough anatomic survey including echocardiography should follow the diagnosis of a persistent RUV (Callen) 66 Normal development of umbilical and portal veins Normal development of umbilical and portal veins IVC Right umbilical vein 7 weeks GA Main 9 weeks GA 11 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 67 68 Persistent right umbilical vein • • Speculated causes: • Teratogens • Early obstruction of left UV • Several syndromes Speculated cause of gastroschisis Persistent right umbilical vein superior right left Ductus venosus Right umbilical vein Gastroschisis Abdominal wall defect allowing bowel to herniate out of the peritoneal cavity; typically to the right of the umbilicus 69 Liver Left umbilical vein 70 Persistent right umbilical vein (with regression of LUV) • Sonographic features: • RUV connects with RPV • Pars transversa curves toward stomach (rather than away) • GB seen to the left of the UV (instead of to the right) • Between stomach and UV Ductus venosus Right umbilical vein Left umbilical vein 71 72 Persistent right UV • Portal vein curves toward stomach S: stomach Normal left UV Persistent right UV Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 35‐102 A) 12 ULTR‐3014 OBGYN Sonography 3 Module O.12: Abnormal Fetal Heart & Abdomen 3 Abnormal Fetal Abdomen 73 74 Persistent right UV • Persistent right UV UV curves toward the left • GB: gallbladder UV: umbilical vein L: left R: right St: stomach Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 15‐67) 75 GB to the left of the UV Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 35‐102 B) 76 Persistent right UV • Persistent right UV GB to the left of the UV • Colour Doppler St: stomach GB: gallbladder UV: umbilical vein ST Ultrasonography in Obstetrics and Gynecology, 5th Edition (Callen fig 15‐67) 77 78 Recent case from practicum students • Persistent right UV? Module O.12 Abnormal Fetal Heart & Abdomen Abnormal Abdomen Continued in Abnormal GI Tract 13