Comparison of two- and three-dimensional ultrasonography in lung volume measurement of normal fetuses.

AIM: The purpose of this study was to compare the two- and three-dimensional methods for measuring fetal lung volume of normal fetuses. METHODS: A cross-sectional study was performed with 51 normal pregnant women between 20 and 35 weeks. The ellipsoid formula (X*Y*Z*0.52) was used for volume calculation with the two-dimensional (2D) method. With the VOCAL (Virtual Organ Computer-aided Analysis) method, a rotation angle of 30 degrees was used. Intraclass correlation coefficient (ICC), paired Student's t-test and Bland-Altman plots were used to compare the techniques. To calculate the intraobserver variability we used the ICC and compared the means between the two measures using the paired Student's p-test. RESULTS: VOCAL and 2D methods were highly correlated (ICC=0.919 and 0.873 for the right and left lungs, respectively), however, there was a disagreement. The fetal lung volume means calculated by the 2D method were always overestimated in relation to the means obtained by the VOCAL, for the right lung (24.02 mL x 19.15 mL; P<0.001), as well as for the left (16.03 mL x 13.77 mL; P=0.002). As for the intraobserver variability, a good reproducibility was observed for the volume measurement of the left lung by the 2D technique (mean=0.40 mL; P=0.57) and by the VOCAL (mean=-0.22 mL; P=0.63). The 2D method, however, presented low reproducibility for the right lung (mean=1.73 mL; P=0.31). CONCLUSION: The two-dimensional method had low agreement and low reproducibility in relation to the three-dimensional method for measurement of fetal lung volume in normal fetuses.

Treatment of twin reversed arterial perfusion sequence by septostomy and amniodrainage: a case report.

INTRODUCTION: An acardiac fetus is the most severe malformation seen in humans. It is an extremely rare complication, occurring in approximately 1% of all monozygotic twin gestations, with an incidence of about 1 in 35,000 births. This malformation happens as a result of the syndrome of reversed arterial perfusion of the acardiac twin from the other normal fetus (pump twin), due to the presence of arterio-arterial anastomoses in a monochorionic placenta. Several obstetric and perinatal complications have been associated to this anomaly and several treatments have been proposed to reduce the morbimortality of the pump twin. There's no report in MEDLINE about the treatment of twin gestations with acardiac fetus through septostomy. CASE REPORT: The present article reports a case of reversed arterial perfusion sequence complicated by polyhydramnios diagnosed at 19th week of pregnancy, treated with septostomy and serial amniodrainage. DISCUSSION: This case presented it demonstrate favorable development of the gestation, with labor happening at 35 weeks gestation and pump twin presenting good vitality conditions. In cases with no major factors of bad prognosis, septostomy combined with amniodrainage could be an interesting therapeutic option for a safe and efficacious management of selected cases of TRAP sequence.

[Prenatal ultrasound diagnosis of adrenal neuroblastoma]. / Diagnóstico prenatal ultrasonográfico de neuroblastoma adrenal.

Neuroblastoma is the most frequent solid malignant tumor in the neonatal period; however, its diagnosis is very difficult in the prenatal one. This kind of tumor has a high morbidity and mortality rate due to the metastatic risk. Its prognosis depends on the affected area, on the extension of the tumor, and on the associated abnormalities. The antenatal ultrasound diagnosis is possible by finding a mixed mass in the adrenal gland. We report a case of a bilateral adrenal neuroblastoma diagnosed by antenatal ultrasonography at the 29th week of gestation. We describe the principal findings and show the contribution of the tridimensional ultrasound on the relationship of the tumor with the nearby structures.