Prenatal Sonographic Clues to Diagnose External Genital Anomalies: Is It a Girl or a Boy?

Introduction The purpose of this study was to present the prenatal sonographic findings of external genital anomalies and determine diagnostic clues. Methodology In a single-center retrospective study, a total of 15,320 pregnant women underwent a routine ultrasound (US) screening between 18 and 40 weeks of gestation from March 2015 to January 2022. The fetuses with indeterminate sex and suspected genital anomalies were enrolled in the study. B-mod and three-dimensional (3D) imaging of the external genital organs were performed according to a local protocol in cases of genital anomalies. Prenatal and postnatal data were retrieved from the electronic health records. Results A total of 88 fetuses were included in the study. The prevalence of external genital anomalies was found to be 0.6%, and the degree of correspondence (DC) between prenatal and postnatal diagnoses of external genital anomalies was 94.3%. The most common genital anomaly was hypospadias with a frequency of 59%. Severe hypospadias was detected in five of six cases with chordee where the penoscrotal angle was below 30°. Approximately 70% of clitoromegaly cases with labial hypertrophy had a horseshoe sign on 3D images. Conclusions The DC between prenatal and postnatal diagnoses of external genital anomalies is high in this study. The novel diagnostic clues, such as horseshoe sign and penoscrotal angle may be useful in diagnosing and determining the severity of the external genital anomalies.

Echogenicities in the fetal gallbladder: Prevalence, sonographic findings, and postnatal outcomes.

PURPOSE: To investigate the prevalence of echogenicity in the fetal gallbladder (EFG) and to present prenatal sonographic findings and their postnatal outcomes. MATERIALS AND METHODS: We performed a retrospective study within 17420 pregnant women during a 66-month period. Fetuses with an incidental finding of EFG in their 2nd or 3rd trimester of pregnancy were followed until birth per two weeks with sonographic examinations. RESULTS: Out of 5977 fetuses, 44 fetuses were found to have EFG with a prevalence of 0.74%. Nine (20%) of 44 fetuses had single echogenicity, 25 (56%) had multiple echogenicities, 10 (22%) had sludge-like echogenicities. In Doppler sonography, 28 fetuses with EFG exhibited twinkling artifacts; however, none of the echogenicities had obvious acoustic shadowing. All of the cases were resolved either in utero or after birth before 10 months of age. CONCLUSION: EFG is a late third-trimester phenomenon with a prevalence of 0.74%. Most EFGs presented as twinkling artifacts, suggesting they had a cholesterol component.

Differentiation of benign and malignant superficial soft tissue lesions using real-time strain elastography

Background/aim: To evaluate benign and malignant cutaneous-subcutaneous lesions using real-time strain elastography (RTSE) and to compare the findings with histopathologic results. Materials and methods: Over a period of 10 months, 72 patients (38 with benign and 34 with malignant cutaneous and subcutaneous lesions) were prospectively included in this study. Elasticity patterns and strain ratios were examined for each lesion. Lesions were evaluated in 4 groups as yellow-red (soft; pattern-1), green-yellow (moderate; pattern-2), blue-green (hard; pattern-3) and blue (hardest; pattern-4). The stiffness of the lesions was displayed with strain ratios by comparing of a nearby reference tissue. The recorded images were compared with histopathologic findings. Results: On sonoelastograms, considering patterns 1-2 as benign and patterns 3-4 as malignant, the sensitivity, specificity, and positive and negative predictive values for the differentiation of malignant from benign lesions were 100%, 68.5%, 74%, and 100%, respectively. Considering a cut-off value of the strain ratio as > 3.05, the sensitivity, specificity, and positive and negative predictive values were 91%, 89%, 88%, and 92%, respectively. The area under the curve (AUC: 0.972) showed the excellent ability of strain elastography to differentiate benign and malignant lesions. Conclusion: RTSE is an important imaging tool to differentiate benign and malignant superficial soft tissue lesions. Our results suggest that RTSE can be used to predict malignancy since malignant lesions are more confidentially diagnosed than benign superficial soft tissue lesions on elastograms.

Is congenital dacryocystocele a benign, self-limited disorder? A review of the literature with four new cases.

Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.

Significant associated MRI findings in patients with anterior cruciate ligament stump entrapment.

OBJECTIVE: Objective of this study was to determine the relationship between development of stump entrapment (SE) lesions and associated injuries in patients with knee extension deficits who underwent anterior cruciate ligament (ACL) reconstruction surgery. MATERIALS AND METHODS: This retrospective study included 79 patients who had an arthroscopy-proven ACL rupture causing knee extension loss. Presence and type of the SE lesions, injuries of collateral-cruciate ligaments and bones, and tears of the menisci were evaluated and recorded on magnetic resonance imaging. RESULTS: The SE lesions were significantly more common in patients who had compressive posterior lateral tibial plateau fractures, tibia medial plateau edema and medial collateral ligament (MCL) injuries compared to the patients without stump lesions (p < 0.05). Posterior cruciate ligament (PCL) partial tears or sprains were significantly more common in patients with SE 1 lesions compared to the patients with SE 2 lesions (OR = 6.72; 95 % CI: 1.56-28.93). CONCLUSION: SE is significantly more common in patients with compressive posterior lateral tibial plateau fractures, tibia medial plateau edemas and MCL injuries. PCL injury is more common in patients with type 1 SE.