A Case of Fetal Herpes Simplex Encephalitis Diagnosed Prenatally by Ultrasonography in the Third Trimester

Almost all reported incidences of herpes simplex virus (HSV) infection in newborns result as a complication of rupture of the amniotic membranes or the delivery of the baby, but infection via the placenta and amniotic membranes is rare. Ventriculomegaly was detected at 36 weeks of gestation by prenatal ultrasonography, and an emergency cesarean section was then performed at 36 weeks of gestation. We report a case of herpes simplex encephalitis detected at 36 weeks of gestation by prenatal ultrasonography, which was confirmed by a postnatal serologic test and CSF test with a brief review of literature.

Sonographic Measurement of the Fetal Cerebellar Vermis

PURPOSE: To obtain a reference value for fetal vermian size measured with sonography. MATERIALS AND METHODS: A prospective study of normal singleton pregnancies was performed. The fetal vermian width and anterior-posterior (AP) diameter were measured with axial image by transabdominal sonography between 18 and 37 weeks of gestation in 264 singleton fetuses. Linear regressions of the vermian width and AP diameter as a function of gestational age (GA), biparietal diameter (BPD), head circumference (HC) and transcerebellar diameter (TCD) were calculated. RESULTS: Adequate vermis measurements were obtained in 264 fetuses. Vermian width was correlated well with GA (r2 = 0.851), BPD (r2 = 0.824), HC (r2 = 0.844) and TCD (r2 = 0.859). AP diameter was also correlated with GA (r2 = 0.826), BPD (r2 = 0.843), HC (r2 = 0.814) and TCD (r2 = 0.836). All the correlation coefficients were highly statistically significant (p < 0.001). Nomograms of the vermian width and AP diameter according to the gestational age were obtained. CONCLUSION: Measured fetal vermian size was correlated well with GA which confirmed the usefulness of the rermian size as a reference value for the assessment of vermian development.

Ultrasonographic Findings of Fetal Congenital Intracranial Teratoma

PURPOSE: To evaluate the sonographic findings of fetal congenital intracranial teratoma. MATERIALS AND METHODS: From 1994 to 2002, of the 11 fetuses which had been diagnosed with fetal intracranial tumors after second level fetal ultrasonography, the six that were confirmed after autopsy as congenital intracranial teratomas were included in our study. The sonographic findings, including size, homogeneity, echogenicity compared with surrounding normal brain tissues, cystic components, and tumor related calcification, were retrospectively evaluated. RESULTS: The incidence of fetal congenital intracranial teratoma out of all fetal intracranial tumors was 54.5% (6 of 11 cases) during the 8-year period. The mean mass size was 7.4 cm (3.0-15.0 cm). Two thirds of (4/6) of the teratoma cases showed high echogenicity compared with normal brain tissues, and two thirds (4/6) showed heterogeneous echogenicity. Four teratoma cases (67%) showed cysts in the mass with a mean size of 1.9cm. One third (2/6) showed calcifications within the tumor. Out of the six cases, two had oropharyngeal teratoma with extension into the intracranial portion (so called epignathus) and showed homogenous mass without any cysts or calcifications. CONCLUSION: The typical sonographic appearance of intracranial teratoma was a heterogeneous, hyperechoic mass with cysts. In the epignathus cases, the sonographic appearances differed somewhat from the others. An understanding of the sonographic findings of fetal intracranial teratoma will help in the timely counseling of the parents and in obstetric decision making.

Outcome of Fetal Omphalocele According to Omphalocele Content Combined with Associated Anomaly

PURPOSE: To evaluate the risk of chromosomal abnormality and outcome of fetal omphalocele according to the omphalocele contents combined with associated anomalies. MATERIALS AND METHODS: We retrospectively reviewed the sonograms and case records of 39 fetuses with an omphalocele prenatally detected by ultrasound between 1996 and 2004. We categorized them into two groups according to the omphalocele contents, and the two groups were further subdivided according to the presence or absence of associated anomalies on the prenatal ultrasound. We compared the risk of chromosomal abnormality and fetal outcome according to the omphalocele contents combined with associated anomalies. RESULTS: We categorized the 39 fetuses with an omphalocele into 20 cases with a liver- and bowelcontaining (group I) omphalocele and 19 cases with a bowel-only (group II) omphalocele. Seven of 20 (35%) fetuses with group I omphalocele and 17 of 19 (89%) with group II omphalocele had associated anomalies. Fetal karyotyping was performed in 31 of the 39 fetuses: in group II omphalocele, 13 of the 14 tested fetuses (93%) had chromosomal abnormalities, while in group I omphalocele, one of the 17 tested fetuses (6%) had chromosomal abnormalities. All 13 group II omphalocele with associated anomaly showed abnormal karyotype. Fourteen of 39 (36%) fetuses survived, including 13 fetuses with group I omphalocele (13/20, 65%) and one with group II omphalocele (1/19, 5%). Eleven of 13 (85%) fetuses with isolated group I omphalocele showed good outcome, while no group II omphalocele with associated anomaly survived. CONCLUSION: The bowel-only omphalocele with associated anomalies suggests a very high risk of chromosomal abnormality and a poor outcome. The isolated liver- and bowel-containing omphalocele has a good outcome with a low risk of chromosomal abnormality. Sonographic evaluation of the omphalocele contents and associated anomalies is essential to predict the prognosis of the fetal omphalocele.

Prenatal Sonographic Diagnosis of Focal Musculoskeletal Anomalies

Focal musculoskeletal anomalies vary, and can manifest as part of a syndrome or be accompanied by numerous other conditions such as genetic disorders, karyotype abnormalities, central nervous system anomalies and other skeletal anomalies. Isolated focal musculoskeletal anomaly does, however, also occur; its early prenatal diagnosis is important in deciding prenatal care, and also helps in counseling parents about the postnatal effects of numerous possible associated anomalies. We have encountered 50 cases involving focal musculoskeletal anomalies, including focal limb dysplasia [radial ray abnormality (n=3), mesomelic dysplasia (n=1) ]; anomalies of the hand [polydactyly (n=8), syndactyly (n=3), ectrodactyly (n=1), clinodactyly (n=6), clenched hand (n=5) ]; anomalies of the foot [clubfoot (n=10), rockerbottom foot (n=5), sandal gap deformity (n=1), curly toe (n=2) ]; amniotic band syndrome (n=3) ; and anomalies of the focal spine [block vertebra (n=1), hemivertebra (n=1) ]. Among these 50 cases, five [polydactyly (n=1), syndactyly (n=2) and curly toe (n=2) ] were confirmed by postnatal physical evaluation, two (focal spine anomalies) were diagnosed after postnatal radiologic examination, and the remaining 43 were proven at autopsy. For each condition, we describe the prenatal sonographic findings, and include a brief review.

Prenatal Sonographic and MR Imaging Findings of Extensive Fetal Lymphangioma: A Case Report

We report the imaging findings in a case of fetal lymphangioma involving the retroperitoneum and right lower extremity, and diagnosed by ultrasonography and magnetic resonance (MR) imaging at 26 weeks of gestation. Prenatal ultrasonograms and T2-weighted single-shot fast spin-echo MR images clearly revealed an extensive, multilocular cystic mass with internal hemorrhage in the retroperitoneum extending to the lower extremity.

Ultrasound Evaluation of Normal and Abnormal Fetuses: Comparison of Conventional, Tissue Harmonic, and Pulse-Inversion Harmonic Imaging Techniques

OBJECTIVE: To determine the usefulness of tissue harmonic imaging (THI) and pulse-inversion harmonic imaging (PIHI) in the evaluation of normal and abnormal fetuses. MATERIALS AND METHODS: Forty-one pregnant women who bore a total of 31 normal and ten abnormal fetuses underwent conventional ultrasonography (CUS), and then THI and PIHI. US images of six organ systems, namely the brain, spine, heart, abdomen, extremities and face were compared between the three techniques in terms of overall conspicuity and the definition of borders and internal structures. RESULTS: For the brain, heart, abdomen and face, overall conspicuity at THI and PIHI was significantly better than at CUS (p < 0.05). There was, though, no significant difference between THI and PIHI. Affected organs in abnormal fetuses were more clearly depicted at THI and PIHI than at CUS. CONCLUSION: Both THI and PIHI appear to be superior to CUS for the evaluation of normal or abnormal structures, particularly the brain, heart, abdomen and face.

Fetal Pericallosal Lipoma: US and MR Findings

We report a case of fetal pericallosal lipoma occurring at the anterior interhemispheric fissure and associated with agenesis of the corpus callosum. During targeted prenatal ultrasonography at 26 weeks' gestation, the lesion was seen as a highly echogenic mass. MR imaging performed at 35 weeks' gestation and during the postnatal period revealed a pericallosal fatty mass and agenesis of the corpus callosum.

Ultrasonographic Measurement of Fetal Foot Length and Femur/Foot Length Ratio in Second Trimester of Normal Pregnancy in Korean Women

PURPOSE: The aim of this study was to determine, using prenatal ultrasongraphy, normal fetal foot length and the femur length ratio during the second trimester of a normal pregnancy in Korean women. MATERIALS AND METHODS: From May to July 1999, and in September of the same year, 1018 normal Korean singleton pregnancies showing no abnormality on prenatal sonograms were included in this study. The gestational age ranged from 19 to 30 weeks. Femur and foot length were measured by one radiologist. Regression analysis was performed for foot length and gestational age, and the mean value of the femur/foot length ratio and 95th percentile confidence interval of that mean value were calculated. The data obtained was compared with that obtained from caucasians. RESULTS: Foot length correlated with gestational age (r 2=0.87, p value = 0.0001). The regression formula was as follows; Gestational age (days) = 70.98-2.15 x foot length (mm). Mean foot length at each gestational week was not different from the corresponding figure for Cancasians. The mean (+/-SD) value of the femur/foot length ratio was 0.96 (+/-0.05) and the 95th percentile confidence interval of that mean value was 0.96+/-0.000301, figures which are significantly lower than those for Caucasians. CONCLUSION: Fetal foot length during the second trimester of a normal pregnancy in Korean women is a reliable parameter for use in the assessment of gestational age. In our study the fetal foot length was not different from that of caucasians, while the femur/foot length ratio was lower than the value in that group. The nomogram depicted in of this study will serve as a useful adjunct in the screening of chromosomal abnormality or skeletal dysplasia among Koreans.

Mixed Form of Congenital Cystic Adenomatoid Malformation and Extralobar Bronchopulmonary Sequestration: A Case Report

Bronchopulmonary sequestration(BPS) and congenital cystic adenomatoid malformation (CCAM) are rare, but both should be included in the differential diagnosis of fetal lung mass. We experienced a mixed form of Stocker type-III CCAM and extralo-bar BPS, and present this case, together with a rev i ew of the related literature.