Download Fetal hydrops

산부인과 초음파
부산백병원 박현경
Basic Ultrasound Examination
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1st trimester
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G-sac location
Embryo identification
CRL
Fetal heart motion
Fetal number
Uterus & adnexal
evaluation
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2nd & 3rd trimester
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Fetal number
Presentation
Fetal heart motion
Placental location
Amnionic fluid volume
Gestational age
Survey of fetal anatomy
Evaluation for maternal
pelvic masses
Fetal Measurements
• CRL
• BPD : accurate predictor of menstrual age
before 20 weeks
• HC
• AC
• FL
Amnionic Fluid Volume
• Maximal vertical fluid pocket
oligo : < 2cm
normal : 2~8cm
hydra : > 8cm
• amnionic fluid index
oligo : < 6cm
hydra : > 24cm
Fetal CNS
• BPD : gestational age
• CNS anomalies : TMC birth defects
• 3 transverse view
– Transthalamic view
– Tranventricular view
– Transcerebellar view
• Errors in interpreting mormal anatomy
: ventriculomegaly
Insula (lat fissure)
Pseudohydrocephalus
Basic axial plane
1. Transthalamic view
CSP, 3rd ventricle, thalamus
malformation of midline development
2. Transventricular view
ventricular atrium, cbr.hemisphere
ventriculomegaly
3. Transcerebellar view
cbll, cbll vermis, cisterna magna, 4th
ventricle
DW malformation, myelomeningocele
Transthalamic view
Transventricular view
Transcerebellar view
Hydrocephalus
1. Measurement :
trans. diameter of ventricular atrium
at the level of glomus of the CP
2. Overt ventriculomegaly
> 15 mm
“danging” choroid plexus
3. Mild ventriculomegaly
10 mm ~ 15 mm
4. further evaluation :
targeted US, fetal karyotyping,
test for congenital viral infection (TORCH)
Dangling choroid plexus
Open Neural Tube Defect
• TMC birth defect after CHD
• Increased MSAFP in 16~18 wks
-> targeted ultrasound
Anecephaly
Frog’s face
Brain tissue
Encephalocele
• The least common ONTD
• Protrusion of intracranial contents
through a cranial defects
• Site
occipital(75%), frontal(13%), parietal
• DDx : cystic hygroma
meningocele
Choroid plexus cyst
• Incidence : 1% in midtrimester
• Majority : isolated & resolve by 24 weeks
• Probability of aneuploidy :trisomy 18
: -> targeted ultrasono : fetal anomalies
-> amniocentesis
: over 32 -> genetic counselling
Holoprosencepahly
• Failure of n’l forebrain development
• Classification
alobar, semilobar, lobar
• US of alobar/semilobar type
absent falx & IHF → monoventricle
fusion of thalamus
absence of midline structure
: corpus callosum, fornix, optic tract,
olfactory bulb
Agenesis of corpus callosum
• US
tear drop sign
distension of interhemisphere fissure
upward displacement of 3rd ventricle
absence of corpus callosum
** normal cavum septum pellucidum
excludes complete ACC
Tear-drop sign
Lateral ventricle
3rd ventricle
Dandy-Walker complex
• Post. Fossa anomaly의 spectrum
– abnormal development of the cbll /c ass.
– mal-development of 4th ventricle
• Dandy-Walker malformation
– Complete/partial agenesis of cbll vermis
– Enlarged post. Fossa & elevated tentorium
• Dandy-Walker variant
– Variable hypoplasia of cbll vermis
• Megacisterna magna
– Enlarged cbll-medullar cistern
Lip
Cleft lip
Spine
• 15-16 weeks: seen well
• 3 ossification center : centrum & lamina
transverse plane
lamina : parallel or inward angulation
sagittal & axial plane
lamina : parallel
Coronal view
Transverse view
Spina Bifida - Myelominingocele
• The second most common ONTD
• Associated anomalies
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Arnold-Chiari (type II) malformation
Cranial signs on targeted sono
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Small BPD
Ventriculomagaly
Frontal bone scalloping : lemon sign
elongated cbll : bsnana sign
Obliteration of cisterna magna
Myelomeningocele
Myelomeningocele
Lemon sign
Banana sign
Chiari II malformation
ventriculomagaly
meningocele
Nuchal translucency & nuchal fold thickness
• Most sensitive & specific single marker for 1st
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& midtrimester detection of Down’s syndrome
Nuchal translucency : >3mm, at 13wks
midsaggittal plane
Nuchal fold thickness : > 6mm, at 15~20 wks
suboccipital-bregmatic plane
CSP, cbr peduncle, cbll hemisphere, CM
Cystic hygroma
• Cong. malformation of the lymphatic
system
• Location : posterolat. aspect of neck
• Ass. anomalies : Turner syndrome
• US
thin walled, multiseptated cystic mass
Ass. hydrops fetalis
Hydrops fetalis
Cong. diaphragmatic hernia
• Bochdalek hernia: 90%
posterior, 1/3,000
• Morgagni hernia
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anteromedial, 1/100,000
US
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Cystic mass in chest
Shift the heart to contralateral side
Loss of stomach shadow
Polyhydroamnios
CCAM,
congenital cystadenomatoid malformation
• Terminal bronchiole의 overgrowth
• Unilat. : 80-95%
• Type
Type I: large cystic lesion
Type II: uniformed small cystic mass
Type III: Solid mass
• Large CCAM
echogenic mass
displacement of mediastinal structures
Echogenic mass on thorax
Pulmonary sequestration
• Nonfunctioning pulmonary ts. /s TB tree
• Type
intralobar & extralobar
• US
echogenic mass
CDI: arterial supply from descending
aorta
Pleural effusion
Fetal heart
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Transverse view of abdomen
Four chamber view
Three vessel view
LV long axis view
RV long axis view
Short axis view
Aortic arch view
Ductal arch view
Abdomen transverse view
• helpful to
determine the fetal
situs
• heart position &
axis
stomach, liver &
spleen
Four chamber view
• ASD
• AVSD
• Inlet VSD
• Ebstein anomaly
Three vessel view
PA, AA, SVC
Hypoplasia
TGA
TA
SVC
Aorta
Pul trunk
LVO tract view
• Outlet VSD
• TOF
• TA
RV
LA
LV
• LV obst.
RVO tract view
TOF
TA
TGA
RV obstruction
Aortic arch view
COA
Interruption of A arch
Hypoplasia of A Ao
LA
Ductus arch view
MPA
AO
LA
LSA
DAO
VSD
Echogenic intracardiac focus
Duodenal atresia
• TMC cause of fetal small bowel obst.
• 1/10,000
• Ass. anomaly
50% : rotational anomaly, EA
30% : Down syndrome
20~30% : CHD
• US
Hydramnios
Double bubble sign
Obst. of small bowel dist. to
duodenum
• 1/2,700
• normal diameter :< 6 mm
• Cause
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atresia, volvulus, malrotation, meconium ileus,
peritoneal band
US
multiple dilated small bowel loops
hydramnios
Obstruction of large bowel
• Diameter < 20 mm
• US
intraluminal calcification
U or V-shaped dilated loop
• Hydramnios & dilated bowel loop
: not typical
Congenital megacolon
Fetal ascites
• Causes
Fetal hydrops
Urinary tract obstruction
Meconium peritonitis
Body wall defect
Gastroschisis
Omphalocele
Cause
Vascular accident
fusion 장애
Site
Paramedian (Rt.)
Median
Organs
Bowels
Liver, Bowels
Membrane
Absent
Present
Surface
Irregular
Smooth
Ascites
Absent
Present
Ass.anomaly
Less common
50~70%
Chr anomaly
Normal risk
35~60%
Survival rate
80~90%
44%
Omphalocele
Gastroschisis
Hydronephrosis
• Pelvis diameter
33 주 이전 : ≥ 4 mm
33 주 이후 : ≥ 7 mm
< 10 mm : physiologic
• pelvis/kidney ratio : ≥ 0.28
• caliceal dilatation
UPJO
• TMC cause of neonatal hydronephrosis
• Causes
idiopathic
high ureteral insertion
band
anomalous vessels
valve
stricture
ischemia
MCDK
• Atresia of ureteral bud system
• US
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numerous cysts of variable sizes
mostly unilateral
not communicating cysts
DDx
hydronephrosis : centrally located cysts
communicating
ARPCK : bilateral, echogenic kidney
cysts size는 kidney siㅋe와 비례하지 않는다.
MCDK
ARPCKD
Bilat. Echogenic kidney
Adrenal gland
Post.urerthral valve
• US
dilatation of bladder & prox. urethra
→ key hole appearance
hydronephrosis
oligohydramnios
Key-hole apperance
Ureterocele
Duplicating coll. system & ureterocele
Hydrocele
hydrocele
Club foot
Femur bowing
Musculoskeletal system
• Thanatophoric dysplasia
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shortened extrimities
Cloverleaf skull
Bowed limbs
Small thorax
• Osteogenesis imperfecta
– Hypomineralization of skull
– Multiple rib fracture
• Achondroplasia
– Cloverleaf skull
– Large head
– Short long bone
UC cysts or pseudocysts
Umbilical Vein & Ductus Venosus
Umbilical artery
Cord around neck