Spontaneous resolution of atrioventricular dissociation in utero.

Fetal atrioventricular dissociation is a dysrhythmia associated with significant antenatal and postnatal morbidity and mortality. We present a case of a 19-week-old fetus with atrioventricular dissociation, which spontaneously resolved. The mother had no signs of autoimmune disease. The fetus had an uneventful gestation and, after delivery, had a normal cardiac and transesophageal electrophysiological evaluation.

Ejaculatory duct obstruction: diagnosis and treatment with transrectal sonography.

Ejaculatory duct obstruction is thought to be a relatively uncommon but readily treatable cause of male infertility. Obstruction is frequently caused by cysts originating from or impinging on the ejaculatory ducts. The use of transrectal sonography has facilitated identification of patients with ejaculatory duct obstruction and has led to the realization that this abnormality is more common than was previously recognized. Transrectal sonography now plays a critical role in both the diagnosis and the treatment of this condition. The purpose of this pictorial essay is to illustrate the use of transrectal sonography in the diagnosis and treatment of ejaculatory duct obstruction.

The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography.

The association between male subfertility and varicocele has long been recognized. Physical examination is the most widely used method for detecting varicoceles but other techniques may be more sensitive. Color Doppler sonography has the theoretical advantage of allowing direct demonstration of reversed flow in the testicular veins. The frequency of detection of reversed flow by color Doppler ultrasound in a normal population is, however, unknown. We evaluated 34 asymptomatic young men with physical examination, standard scrotal sonography and color Doppler evaluation of the scrotal veins. Findings were correlated with semen analysis. Of the subjects 15% had varicoceles by physical examination and 18% by scrotal sonography, while 35% had retrograde flow by color Doppler evaluation. The majority of men in this population did not exhibit retrograde flow within the gonadal veins when evaluated by color Doppler sonography. The physiological significance of retrograde flow, however, remains to be defined.

Infection in utero: US findings in 19 cases.

The results of antenatal sonographic studies of 19 fetuses with congenital infections were retrospectively reviewed by the authors. Recognizing the significance of these antenatal sonographic findings is important because in utero infections can have devastating effects on the developing fetus. An infectious viral agent was isolated in laboratory tests at birth in 11 patients, and the effects of a viral agent were proved clinically in eight. Antenatal sonography demonstrated abnormalities in 18 fetuses: Multiple organ systems were affected in 47%; intracranial abnormalities, cardiac abnormalities, and parenchymal calcifications occurred in 42%, 37%, and 32%, respectively; large placentas were seen in 32%; and the volume of amniotic fluid was decreased in 37% and increased in 37%. Sixty-three percent of fetuses were either aborted or died at birth; the 37% that lived were all developmentally impaired. On the basis of these sonographic, laboratory, and clinical findings, the authors conclude that when multiple organ system abnormalities are found at antenatal ultrasound, the presence of an in utero infection should be considered. The parents should be informed that there is a poor prognosis for any fetus demonstrating such abnormalities.

Tracheoesophageal fistula in utero. Twenty-two cases.

A retrospective review of 22 infants born with tracheoesophageal fistula (TEF) with in utero sonograms was performed and the literature was reviewed. TEF or esophageal atresia should be considered when there is polyhydramnios and an absent fluid-filled stomach; these findings were seen in 32% of our cases. Amniotic fluid flows freely through some TEFs, resulting in a normal amount of amniotic fluid and a fluid filled stomach (six of 22 patients), while in other cases, the fluid does not traverse the fistula easily and polyhydramnios results. Polyhydramnios was present in 62% of our cases and was the most common sonographic finding. The earliest age at which polyhydramnios was diagnosed was 24 weeks. Sonography will detect approximately one third of fetuses with TEF; an improved outcome is expected in these fetuses.

Fetal lateral ventricular ratio determination during the second trimester.

Ventriculomegaly may be diagnosed sonographically by identifying abnormal ventricular size. The lateral ventricular ratio (LVR) is a useful index in differentiating normal-sized ventricles from ventriculomegaly. The purpose of this study was to validate previously reported data establishing the normal range for LVR during the second trimester. Prior to 24 weeks, the diagnosis of ventriculomegaly may be difficult since the LVR normal range is quite large. The LVRs for 122 normal fetal ultrasound examinations were calculated based on measurements obtained by three observers. Data were obtained for fetuses during each week of gestation from 15 to 25 weeks. Lateral ventricular ratios varied from 56 +/- 18 per cent (mean +/- 2 standard deviations) at 15 weeks to 33 +/- 4 per cent at 25 weeks. The lateral ventricular width (LVW) range for normal fetuses was 0.7 to 1.1 cm as compared with a LVW range of 1.1 to 2.7 cm for 16 fetuses with hydrocephalus diagnosed during the second trimester. In conclusion, the LVR is extremely useful in differentiating ventriculomegaly from normal ventricular size. Serial ultrasound examinations are often mandatory in the second trimester in order to definitely identify ventriculomegaly. In addition, normal ventricular size may be verified with a LVW of less than 1.1 cm.

Normal fetal sacrum simulating spina bifida: "pseudodysraphism".

An erroneous diagnosis of spina bifida may be made using obstetric ultrasound (US) if the examiner is unfamiliar with normal fetal sacral anatomy or the ways in which artifacts can affect the appearance of the normal lumbosacral posterior elements. Two normal neonates who appeared to have sacral dysraphism in utero are described and compared with US and CT studies of an anatomically normal 34-week cadaver specimen. In the event of transducer angulation, lumbosacral spina bifida must be diagnosed with the utmost caution if an associated sac or mass is not present.