Ultrasonographic diagnosis and misdiagnosis of hepatic pregnancy / 中国医师杂志

Objective:To investigate the ultrasonographic characteristics and misdiagnosis of hepatic pregnancy.Methods:The clinical data and preoperative ultrasound characteristics of 2 cases of hepatic pregnancy admitted to the Affiliated Hospital of Jining Medical College were retrospectively summarized, and related literatures were retrieved from January 1, 1956 to December 31, 2021.Results:A total of 37 cases of hepatic pregnancy were included, among which 35 cases showed liver nodules on ultrasound examination, which were classified into four types: pregnancy cystic (24 cases), thick-walled cystic echo (6 cases), heterogeneous hyperecho (3 cases) and mixed cyst solid echo (2 cases), the exact diagnosis coincidence rate of each type was 100%, 4/6, 1/3, 0, respectively. Among the 35 liver nodules, 29(82.8%) cases were diagnosed correctly by ultrasound, 1 case was misdiagnosed as choriocarcinoma liver metastasis, 1 case was misdiagnosed as hepatic hemangioma, and 4 cases were diagnosed as liver nodules without suggestive diagnosis. No liver nodules were found in the other 2 cases, including 1 case misdiagnosed as retroperitoneal hematoma and 1 case misdiagnosed as ruptured ovarian cyst.Conclusions:Ultrasonography of hepatic pregnancy may show pregnancy sac, thick-walled cystic echo, hyperecho and mixed echo in liver. The first type is easy to be diagnosed accurately by ultrasound, while the other types are easy to be misdiagnosed. Combined with clinical conditions and the result of enhanced computed tomography (CT), the correct diagnosis rate of hepatic pregnancy can be improved.

Prenatal ultrasonic diagnosis of submucosal cleft palate / 中华超声影像学杂志

Objective:To summarize the ultrasound manifestations of submucosal cleft palate, and explore the diagnostic value of prenatal ultrasound for submucosal cleft palate.Methods:A total of 21 146 pregnant women who underwent fetal ultrasound examination in the second and third trimesters in the Affiliated Hospital of Jining Medical University from January 2013 to May 2018 were collected. They were all singleton pregnancy. The ultrasound image which was the horizontal plate of the palatine bone at the posterior border of the fetal hard palate was routinely obtained. The presence of bone loss at the posterior border of the hard palate was defined as a positive case. Then the palate targeted ultrasound examinations of the positive cases were performed to observe the continuity of the soft palate. The ultrasound images of positive cases were compared with the results of induction or delivery, and their postpartum diagnosis and treatment were tracked.Results:A total of 44 simple cleft palate were detected in 21 146 fetuses, including 23 dominant cleft palate and 21 submucosal cleft palate. Two cases of 21 submucosal cleft palate were induced because of other deformities, the other 19 cases were born. The follow-up of the 19 submucosal cleft palate cases showed that 15 cases visited to stomatology department before 3 years of age, and 2 cases of newborns with dominant cleft palate were misdiagnosed as submucosal cleft palate by prenatal ultrasound, and the other13 of them were clinically diagnosed as submucosal cleft palate. The ultrasound of the submucosal cleft palate showed there was no inverted "V" -shaped bone in the posterior edge of the hard palate which was connected by a membranous connection, and the soft palate was complete, but the center of soft palate was thinner or even present membranous hyperechoic in ultrasound.Conclusions:Submucosal cleft palate has characteristic ultrasound features, and prenatal ultrasound make a diagnosis and provide some basis for obtaining early diagnosis and treatment after birth.

Sonographic characteristics of fetal intestinal volvulus: report of four cases / 中华围产医学杂志

Objective:To investigate the characteristic of ultrasound in diagnosing fetal intestinal volvulus.Methods:From April 2015 to May 2018, four cases of fetal intestinal volvulus indicated by prenatal ultrasound in the Affiliated Hospital of Jining Medical College and confirmed either by autopsy or by postnatal surgery, were retrospectively analyzed. A total of 11 ultrasound scans had been performed on the four cases, and the dynamic and static ultrasound features were summarized. Pregnancy outcomes and concomitant malformations were also followed up. Descriptive statistical analysis was used.Results:The direct ultrasonographic patterns of intestinal volvulus in the four cases were "whirlpool" signs (six times), clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery (five times), and "coffee bean" sign (three times); the indirect signs included dilated small intestine (11 times), ascites (eight times), polyhydramnios (five times), peritoneal calcification(four times), pseudocysts(once). Out of the 11 ultrasound examinations, early-stage volvulus was detected on three occasions, all with "whirlpool" signs and clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery. As the disease progressed to the meconium peritonitis stage, indirect signs emerged while the initial two signs can diminished. Postnatal surgery or autopsy after labor induction confirmed the segmental volvulus in the four cases, of which three were complicated by intestinal atresia. No intestinal malrotation was found.Conclusion:Typical direct signs and atypical indirect signs could be identified in the sonogram findings of fetal volvulus, and are important for diagnosing fetal volvulus.

Ultrasonic Diagnosis of Fetal Hypospadias / 中国医学影像学杂志

Purpose To investigate the prenatal ultrasonic features of fetal hypospadias and to compare the diagnostic accuracy.Materials and Methods The clinical data of 28 patients with suspected or confirmed hypospadias were retrospectively analyzed.The prenatal ultrasonic features,missed diagnosis and misdiagnosis of the patients were analyzed,and the diagnostic accuracy of different ultrasonic features for hypospadias was compared.Results In 28 cases,21 cases of hypospadias were confirmed by examination after birth or induced abortion with 2 cases of missed diagnosis by ultrasound,and 7 cases of non hypospadias were misdiagnosed by prenatal ultrasound.The diagnostic accuracy rate of 2D ultrasound was 67.9％ (19/28),and that of 3D ultrasound combined with 2D ultrasound was 92.9％ (13/14).The diagnostic accuracy rates of ultrasonic features such as abnormal urinary jet,abnormal urethra,tulip sign,abnormal penis tip,scrotum separation with or without penoscrotal transposition and short penis were 100.0％ (6/6),92.9％ (13/14),88.2％ (15/17),83.3％ (5/6),25.0％ (1/4) and 33.3％ (1/3),respectively.Conclusion The ultrasonic features including abnormal urinary jet,abnormal urethra,tulip sign and abnormal penis tip have great value for prenatal diagnosis of fetal hypospadias.3D ultrasound is more intuitive than 2D ultrasound and provides more details.Comprehensive analysis of all ultrasonic features is helpful for prenatal diagnosis.