Spontaneous improvement of intrathoracic masses diagnosed in utero.

The diagnosis and pregnancy outcome for 14 fetuses with sonographically detected chest masses were reviewed retrospectively. Six lesions became smaller or less apparent during gestation or resolved between antenatal and perinatal imaging studies; these included all three types of cystic adenomatoid malformation (CAM), as well as one case of pulmonary sequestration (PS). This information is extremely important in counseling patients in the second trimester who are considering termination of pregnancy. The poor prognosis traditionally assigned to type II and type III CAM needs changing to reflect the phenomenon of improvement with excellent long-term outcomes. Sonographic indicators of poor outcome were polyhydramnios, hydrops or marked cardiac deviation.

Second-trimester echogenic bowel and chromosomal abnormalities.

OBJECTIVE: Our objective was to examine the outcomes of pregnancies in which echogenic bowel was detected in the second trimester. STUDY DESIGN: Twenty-two cases with a prospective diagnosis of echogenic bowel were reviewed. Karyotypic studies were performed in 19 cases, and 17 families had deoxyribonucleic acid-based risk assessment for cystic fibrosis. The echogenicity of the bowel was retrospectively reviewed and graded as mild or bright. RESULTS: Five cases of trisomy 21 and one case of trisomy 18 were detected; four of these had other ultrasonographic abnormalities. Twenty-seven percent of fetuses with echogenic bowel were aneuploid. Risk was greatest for cases with brightly echogenic bowel. No cystic fibrosis mutations were detected. The diagnosis of echogenic bowel was reproducible. CONCLUSION: Brightly echogenic bowel in the second trimester was found to be associated with a significant risk of fetal aneuploidy.

Fetuses aren't small children.

Although great strides in prenatal diagnosis have been made by sonography, interpretation has been complicated by failure to recognize fundamental differences between the uterine and extra-uterine environment. Furthermore, extrapolation of knowledge concerning the same disorders in childhood to fetuses produces misleading information about diagnosis and often, prognosis.

The Radiological Society of North America. Diamond Jubilee lecture. Seeing with sound.

The concept of making images from reflected sound waves is not new. Its origin, however, was not in medicine, but in industrial warfare. Much present-day technology derives from U.S. Navy research in World War II. Introduction to medicine began at the war's completion, but practical applications have been available only for the past 2 decades. In this short span, ultrasonography has been applied to nearly all specialties of medicine. It is now an indispensable adjunct to diagnosis, and in some areas, such as obstetrics, modern practitioners could not function without it. It is estimated that by the year 1991, 25% of all imaging studies (worldwide) will be sonograms. While such widespread use invariably leads to turf and training problems, the end result has been very positive for patients.

The reliability and predictive value of an amniotic fluid scoring system in severe second-trimester oligohydramnios.

Sixty-two cases of oligohydramnios diagnosed by ultrasound between 13-28 weeks' gestation were reviewed. Three experienced ultrasonographers used a subjective scale to rate the oligohydramnios as mild, moderate, severe, or anhydramniotic. Interobserver reliability was excellent (intraclass correlation coefficient 0.81). The overall perinatal mortality rate was 43%, and the incidence of pulmonary hypoplasia was 33%. One-third had lethal congenital anomalies. The frequency of adverse outcome correlated strongly with the most severe degrees of oligohydramnios; 88% of the fetuses with severe oligohydramnios or anhydramnios had lethal outcomes, compared with 11% in the mild/moderate group. The presence of an anuric urinary tract anomaly was associated with the most severe grades of oligohydramnios and was uniformly fatal. Pulmonary hypoplasia was diagnosed in 60% of the severe group versus 6% in the moderate group. We conclude that subjective grading of oligohydramnios by experienced observers is both reliable and predictive of outcome. The finding of severe oligohydramnios in the second trimester is highly predictive of poor fetal outcome and should stimulate a thorough search for etiology and consideration of intervention. Moderate grades of reduced amniotic fluid may be managed with relative optimism.

Sonographic evaluation of the fetal stomach: significance of nonvisualization.

The stomach was successfully visualized in 1051 (98%) of 1071 consecutive sonograms obtained in 995 fetuses after 14 weeks gestational age. All patients were studied prospectively. Stomach nonvisualization was associated with an abnormal outcome in 55% of the fetuses studied after 14 weeks and in 100% of the fetuses studied after 19 weeks. Fetal abnormalities included gastrointestinal and CNS malformations. Oligohydramnios was often present. The absence of a stomach on fetal sonograms obtained after 14 weeks gestational age strongly suggests fetal abnormality. Repeat sonograms should be obtained in all such cases.

Follow-up of infants with bilateral renal disease detected in utero. Growth and renal function.

We studied 69 infants who had urinary tract abnormalities detected by antenatal ultrasound examination. There were 21 intrauterine or immediate neonatal deaths; in all 21 infants, severe bilateral renal disease incompatible with life was found at autopsy. Six of the live-born infants with abnormal results of antenatal ultrasound examinations had a normal urinary tract after birth. Of the remaining 42 infants, the prenatal diagnosis was confirmed with renal ultrasound and other studies during the first week of life. Twenty-one of 42 infants had bilateral renal disease. We obtained follow-up data on 19 of 21 of these infants. Twelve of 19 had obstructive uropathy that was treated surgically. After one to 51 (mean, 18) months of follow-up, renal function varied. Ten of 19 patients had a calculated glomerular filtration rate greater than or equal to 79 mL/min/1.73 m2. One infant required long-term ambulatory peritoneal dialysis. Renal function (glomerular filtration rate, 74 +/- 5 mL/min/1.73 m2) and growth (height percentile, 41 +/- 8) were unexpectedly good considering the severity of the urinary tract abnormalities. Prenatal detection of bilateral renal disease followed by careful medical and surgical management results in a favorable outcome with good growth and renal function.

Sonography of gallstones and biliary dilatation without a visible aetiology: the infrequency of obstructing choledocholithiasis.

This paper describes 50 consecutive patients who sonographically had gallbladder stones and dilated bile ducts, but no visible aetiology for the dilatation. We reviewed these cases to determine the frequency of choledocholithiasis in this setting. Common duct stones caused obstruction in only 36% of these patients. Other aetiologies included strictures due to chronic pancreatitis or prior stone passage in 24% of the patients, and malignant obstruction in 16%. In 24% of the patients, no cause was found for biliary dilatation; common duct stones or obstructing tumours were excluded in the group. Since aetiologies other than stones are likely in a majority of cases, further preoperative workup (CT, percutaneous transhepatic cholangiography, ERCP) or intraoperative cholangiography (if the patient requires urgent cholecystectomy) is indicated. The additional studies should provide a diagnosis, help determine whether or not the common duct should be explored, or avoid unnecessary operation in case of incurable malignancy.

Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients.

Gallbladder and biliary tract abnormalities were observed on sonography in eight patients with AIDS. The studies were obtained to evaluate right upper quadrant pain (two patients), tenderness (three patients), and abnormal liver function tests (eight patients). The two major sonographic findings were gallbladder wall thickening (eight patients), which often was marked, and bile duct dilatation (two patients). Gallbladder wall thickness varied from 4 to 15 mm and was greater than 1 cm in four patients. Follow-up sonograms in five patients showed increasing wall thickness in four and decreasing thickness in one, but these findings did not correlate well with the clinical status of the patient. Pericholecystic fluid was shown in three cases. None of the patients had gallstones. Common bile duct dilatation varied from 12 to 15 mm; no specific cause for dilatation was found by cholangiography. Mycobacterium avium intracellulare was recovered from the gallbladder in one patient, and Cryptosporidium was recovered from the duodenum in two patients. AIDS should be considered in the differential diagnosis of gallbladder wall thickening or bile duct dilatation in the appropriate clinical setting. These findings may indicate opportunistic infection of the biliary tract. A disparity may exist between the mild symptoms and signs (or lack of symptoms and signs) related to the gallbladder and bile ducts and the sometimes marked sonographic abnormalities.