fetal abnormalities and anomalies
DESCRIPTION
Fetal Abnormalities and Anomalies. Brain Anencephaly Hydrocephalus Chiari deformities Encephalocele Spine Spina bifida cystica Myelomeningocele. Renal Hydronephrosis Renal agenesis Cardiac Chambers Orientation General Abdominal wall defects Lung abnormalities. - PowerPoint PPT PresentationTRANSCRIPT
Fetal Abnormalities and Anomalies
Fetal Abnormalities Detectable by Ultrasound
• Brain– Anencephaly– Hydrocephalus– Chiari deformities– Encephalocele
• Spine– Spina bifida
cystica– Myelomeningocel
e
• Renal– Hydronephrosis– Renal agenesis
• Cardiac– Chambers– Orientation
• General– Abdominal wall
defects– Lung abnormalities
Hydrocephalus
• Dilated ventricles• Large sausage like
hypoechoic area represents dilated lateral ventricle
Intestinal Tract AbnormalitiesDetectable by Ultrasound
• Omphalocele• Abdominal wall defects and
gastroschisis• Midgut malrotation• Focal intestinal atresia
Normal Development of Intestinal Tract
• At 9 weeks there is physiologic herniation of the small bowel into the umbilical cord
• The small bowel rotates 90 degrees counterclockwise around the superior mesenteric artery
• At 12 weeks the small bowel returns into the abdominal cavity while rotating an additional 180 degrees counterclockwise around the superior mesenteric artery
• Total rotation of 270 degrees
Omphalocele• Midline
defect• Covering
membrane• Contains
organs or bowel
• Cord from apex of mass
Omphalocele• Axial view mid-
abdomen• Soft tissue
mass extending to right
• Abdominal contents outside the fetal abdomen
• Note: enclosed by a membrane (arrows)
FetalAbdomen
Gastroschisis• Defect of
anterior wall• Lateral to
umbilicus• Bowel loops
float in amniotic fluid
• Cord separate
Gastroschisis• Lobulated
echogenic mass
• Free floating loops of bowel in the amniotic fluid
FetalAbdomen
UmbilicalCord
AbdominalContents
Normal UGI, Small Bowel
• Small bowel distributed throughout the abdomen primarily to the left
Mid-gut Malrotation• Barium UGI• Stomach
normal position
• Small bowel completely on right side of abdomen
Normal Barium Enema
• Normal colon frames the margins of the abdomen
Mid-gut Malrotation
• Barium enema• Colon located
entirely on the left side of the abdomen
• Same case as earlier mal-rotation case
Duodenal Atresia
• Plain film upright abdomen
• “Double bubble” sign• Air distended
stomach and proximal duodenum
• Atresia involves second portion of the duodenum
Image donated by Dr. Nancy Fitzgerald – Texas Children’s Hospital Houston Texas
Skeletal Development Long Bones
• Diaphysis ossified at birth (shaft of long bone)
• Epiphysis radiolucent (cartilage) at birth except for distal femoral epiphysis– Develop Epiphyseal Ossification Centers
(EOC) later in life
Skeletal Development Long Bones
• Physis– Cartilaginous plate between EOC and
metaphysis– Responsible for growth in length– When ossifies (closes) – longitudinal growth
stops– Weak point in the bone
• Metaphysis– Active bone formation via formation and
calcification of osteoid
Bone Growth Abnormalities
• Cartilage growth deficiency– Example: Achondroplasia
• Ossification growth deficiency– Example: Osteogenic imperfecta
• Metabolic defect– Example: Hypophosphatasia
Osteogenesis Imperfecta
• Deficient peri- and endosteal ossification
• Multiple fractures• Healing with
deformities of bones• Limb shortening
Achondroplasia
• Dwarfism• Deficient cartilage
growth• Lower limbs with
ruler to measure leg length
• Short limb bones with flaring metaphyses
Cardiovascular System- Developmental Abnormalities
• Congenital heart disease– Intra-cardiac septal defect (VSD, ASD)– Patent ductus arteriosus (PDA)– Tetralogy of Fallot (VSD, Pulmonary stenosis,
Overiding Aorta, RV hypertrophy)– Endocardial cushion defect– Pulmonary stenosis (PS)
• Congenital vessel anomaly– Coarctation of aorta– Transposition of the great vessels
Normal Cardiac Anatomy• Right heart border
– Upper portion - SVC and ascending aorta
– Lower portion – right atrium
• Left heart border– Upper portion – aortic
arch– Mid portion – main
pulmonary artery– Lower middle portion –
left atrium– Lower portion – left
ventricle
Normal Chest Lateral
• Anterior heart border– Upper portion –
aortic arch– Mid portion –
pulmonary artery– Lower portion – right
ventricle• Posterior heart border
– Upper portion – left atrium
– Lower portion – left ventricle and IVC
Atrial Septal Defect• Increased
pulmonary vascularity
• Small aortic arch
• Large main pulmonary artery
• Right atrial and ventricular hypertrophy
Tetralogy of Fallot• “Boot-shaped” heart• Pulmonic stenosis
(infundibulum)• VSD• Right ventricular
hypertrophy• Overriding aorta• Pulmonary
circulation decreased
Renal Abnormalities• Anomalies in size and form
– Horseshoe kidney• Anomalies in position
– Malrotation– Ectopia
• Anomalies in structure– Polycystic kidney
• Anomalies of drainage system– Duplicated kidney, ureter
Normal Kidney
• Intravenous urogram
• Opacification of collecting systems and ureters
Duplication of Kidney
• Both kidneys with 2 collecting systems
• Right and Left upper system dilated
• Lower units smaller• Ureters join before
bladder
• Horseshoe kidney
• Joined at inferior aspect
• Moderate hydronephrosis
Horseshoe Kidney
Horseshoe Kidneys• Axial images
demonstrate kidneys joined across the midline anterior to the aorta and inferior vena cava
Pelvic Kidney
• AP tomogram
• Both kidneys in the pelvis
Polycystic Kidneys
• Axial scan with contrast
• Enlarged lobulated kidneys
• Multiple cysts• Varying size
CT Multiple Cysts
MultipleRenal Cysts
CT Renal Cysts
Ultrasound Renal Cyst
Renal Abnormalities
• Hydronephrosis– Hypoechoic
(Dark areas)• Thinning of
renal cortex indicates long standing process
Hydronephrosis
Massive Hydronephrosis