Download - fetal imaging omphalocele
FREE LANCE RADIOLOGY
Fetal sonogram with Herniated anterior abdominal mass ( MEDIAN) with liver and small bowel as contents of herniation. The herniated contents are covered with membrane ( contained ) . These findings are s/o OMPHALOCELE( extra corporeal liver)
DEFINITION PATHOGENESIS
Extrusion of the fetal abdominal contents into the base of the cord .
Herniated mass is covered with parietal peritoneum and amniotic membrane with wharton’s jelly in between peritoneum and amniotic membrane.
Intracorporeal Liver ( only bowel herniates , No liver in the herniated contents) . This type of omphalocele is diagnosed after 12wks ( physiological herniation of bowel is a d/d before 12 wks ) . The etiology for this type of omphalocele is Persistence of primitive body stalk and failure of the bowel to return to abdomen after 12wks .
Extra corporeal liver ( only liver is herniated ) . This type of omphalocele can be diagnosed before 12 wks also . This type of omphalocele is sequel to defective growth of the lateral abdominal folds .
ASSOCIATIONS
Trisomy 18, 13, 21 Turners Klinfelter CNS anomalies GI anomalies GU anomalies Cardiac anomalies ( 50
%). Beckwith wiedmen
syndrome . Cloacal exstophy .
The extent of the Association with anomalies is high when herniated contents have smll bowel with oligohydramnios / polyhydramnios .
DIAGNOSISRADIOLOGICAL
FINDINGS
MSAFP Acetylcholinesterase
positive .
Anterior abdominal mass is appreciated in median plane
Define the site of cord insertion ( in omphalocele cord insertion is on the apex of the herniated mass).
Define the covering membranes with associated ascites .
In ompahloccele hernaited visera is contained ( c/f gastroschisis where herniated viscera is free floating and paramedian : Rt sided ) . Due to presence of the protective memberanes : Bowel thickening or dilation is not usually seen in omphalocele ( c/f gastroschisis)
THE RADIOLOGICAL RESPONSIBILITY SUGGESTIVE …………….
Define the appearance of the omphalocele .
Look for covering memberanes / ascites .
Define the presence / absence of the liver . ( intra / extra corporeal ) .
Ratio of the herniated mass to transverse diameter of the abdomen ( >60 % in omphalocele )
Fetal echocardiography
Karyotype . Delivery in tertiary
care Genetic counselling .
Anterior abdominal mass with covering membranes . Note is made of herniation of the liver .
ANTERIOR ABDOMINAL WALL WITH ECHOGENIC BOWEL AS HERNIATED
CONTENT .
MEDIAN HERNIATION OF THE ABDOMINAL CONTENTS INTO THE BASE OF THE UMBILICAL CORD WITH CORD INSERTION ON THE TOP OF THE HERNIATED CONTENTS
CORD INSERTION ON THE TOP OF HERNIATION ( GREY SCALE)
CORD INSERTION ON THE TOP OF HERNIATION ( COLOR DOPPLER)