Spleen Behind the Heart Complicates Lung-to-Head Ratio Measurement in Left-Sided Congenital Diaphragmatic Hernia.

In fetuses with left-sided congenital diaphragmatic hernia, intrathoracic herniation of the spleen is a common occurrence. The herniated spleen can reside posterior to the left atrium of the heart in the right hemithorax and is increasingly differentiated from the lung with the use of newer sonographic equipment. Estimation of the neonatal prognosis relies on accurate measurement of fetal lung size, particularly with commonly used measurements such as the lung-to-head ratio.

Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach-down left congenital diaphragmatic hernia.

Purpose: The aim of this study was to identify sonographic (US) findings that can assist in prenatal diagnosis of stomach-down left congenital diaphragmatic hernia (CDH), specifically related to positioning of the abdominal contents including the stomach, bladder, and gallbladder.

Methods: All US examinations with a postnatally confirmed diagnosis of stomach-down left CDH over a 13-year period were retrospectively reviewed for abnormal position of the abdominal contents, including whether the fetal stomach was in contact with the urinary bladder. Normal fetuses that underwent comprehensive US surveys were similarly evaluated for comparison in a 2:1 ratio.

A Benign Anomalous Umbilical Vein: Not All Umbilical Veins That Wander Are Lost.

A rare case of an anomalous umbilical vein with a previously unreported outcome is described. Most reported cases of anomalous umbilical veins are associated with significant concurrent fetal anomalies and poor outcomes. Fetal magnetic resonance imaging was used in this case to confirm normal portal and hepatic venous vasculature.

Fetal Stomach Position Predicts Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia.

Introduction: We sought to determine the relationship between the degree of stomach herniation by antenatal sonography and neonatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH).

Materials And Methods: We retrospectively reviewed neonatal medical records and antenatal sonography of fetuses with isolated left CDH cared for at a single institution (2000-2012). Fetal stomach position was classified on sonography as follows: intra-abdominal, anterior left chest, mid-to-posterior left chest, or retrocardiac (right chest).

Outcomes for Prenatally Diagnosed Right Congenital Diaphragmatic Hernia.

Background: Right congenital diaphragmatic hernia (CDH) occurs less frequently than left CDH. Therefore, prognostic indicators for right CDH are not as well studied as for left CDH.

Methods: A retrospective review from a single, tertiary referral center (from 1994 until July 2013) of patients with unilateral right CDH was conducted.

Testicular malakoplakia: a rare sonographic mimic of malignancy.

Testicular malakoplakia is a rare, benign condition that most often occurs in an immunocompromised patient with chronic infection. Its occurrence is acute, with pain and testicular enlargement. Sonography is commonly performed to evaluate the patient for epididymitis or torsion.

Impact of new society of radiologists in ultrasound early first-trimester diagnostic criteria for nonviable pregnancy.

Objectives: New early first-trimester diagnostic criteria for nonviable pregnancy recommended by the Society of Radiologists in Ultrasound via a multispecialty consensus panel extended the diagnostic size criteria of crown-rump length from 5 to 7 mm for embryos without a heartbeat and mean sac diameter from 16 to 25 mm for "empty" sacs. Our study assessed the potential impact of the new criteria on the number of additional follow-up sonograms these changes would engender.

Methods: A retrospective study of all first-trimester sonograms in women with first trimester bleeding from 1999 to 2008 was conducted.

The fetal urinoma revisited.

The fetal urinoma is a rare but important diagnosis, as it indicates substantial underlying obstruction with implications for the functionality of the affected kidney. This case series describes a single center's experience with the diagnosis and management of fetal urinomas. All 25 cases were diagnosed or referred to our medical center over an 11-year period.

The grand unifying theory of bright echoes in the fetal and neonatal brain.

The purpose of this presentation is to illustrate that the high-amplitude reflecting structures in the fetal and neonatal brain can be explained by the echogenicity of their leptomeningeal coverings or leptomeningeal origins. The leptomeninges, especially the pia mater, constitute the "grand unifying theory of bright reflectors" in the fetal and neonatal brain. Images from fetal and neonatal sonograms were selected to illustrate the objectives above.

Value of "minimum menstrual age" in determining early pregnancy failure.

Objectives: The purposes of this study were to assess a discriminatory "minimum menstrual age" (28 days + number of days elapsed between the first positive pregnancy test result and sonogram) for the diagnosis of early pregnancy failure when no embryonic/fetal heartbeat is seen and to compare minimum menstrual age dating with last menstrual period and sonographic dating.

Methods: We conducted a retrospective study of 338 initial first-trimester sonographic examinations among women with suspected early pregnancy failure. A minimum menstrual age for each was calculated, and pregnancy outcomes were assessed.

Further observations on the empty "amnion sign".

Objective: To assess the positive predictive value of the empty "amnion sign" (visualization of an amnion without concomitant visualization of an embryo) for the diagnosis of early pregnancy failure.

Methods: Retrospective study of 882 1st trimester sonographic examinations with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria.

Supratentorial abnormalities in the Chiari II malformation, IV: the too-far-back ventricle.

Objective: The sonographic diagnosis of fetal myelomeningocele (MMC) has improved mainly because the diagnostic focus has shifted from observation of the spinal abnormality to observation of cranial abnormalities. We describe an abnormality in the position of the occipital horn in fetuses with MMC. The occipital horn appears to be too posterior in location when compared to healthy fetuses.

The yolk stalk sign: evidence of death in small embryos without heartbeats.

Objective: The purpose of this study was to assess the positive predictive value for confirming early embryonic death in the clinical sonographic scenario wherein an embryo is identified without a visible heartbeat; the embryonic crown-rump length (CRL) is 5 mm or less; and the embryo is not immediately adjacent to the yolk sac.

Methods: A retrospective study of 882 first-trimester sonograms was performed among women who had an intrauterine pregnancy of uncertain viability based on 1 or more sonographic findings (eg, no visible heartbeat in an embryo with a CRL of < or =5 mm). Eight hundred six cases met the inclusion criteria.

Sonographic anatomy of the gastrohepatic ligament.

Objective: The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself.

Methods: Cases were selected that illustrate the objectives above.

Results: Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms.

The expanded amnion sign: evidence of early embryonic death.

Objective: The purpose of this study was to assess the positive predictive value for confirming early embryonic death in the clinical scenario wherein an embryo is identified without a visible heartbeat, but the embryonic crown-rump length (CRL) is 5 mm or less.

Methods: We conducted a retrospective study of 882 first-trimester sonograms with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria.

Prognostic role of tumor-head volume ratio in fetal sacrococcygeal teratoma.

Objective: To evaluate the ability of a tumor-head volume ratio to predict outcome and incidence of hydrops in fetuses with sacrococcygeal teratoma.

Methods: Seventy-one sonograms were reviewed retrospectively from 28 fetuses with sacrococcygeal teratoma managed in our institution. Head volume (HV) and total tumor volume were calculated from sonograms.

Supratentorial abnormalities in the Chiari II malformation, III: The interhemispheric cyst.

Objective: Our clinical observations noted an interhemispheric "cyst," a protrusion of the posterior superior third ventricle, in fetuses with myelomeningocele (MMC). The study analyzed the frequency of this observation and features that influence its visualization.

Methods: We searched for cases of fetal MMC sonographically detected between 1999 and 2007.

"Empty" sac in pregnant women with bleeding: are measurements answering the right question?

Purpose: To assess the percentage of first-trimester pregnancies with bleeding that demonstrate a visible sac but lack an identifiable embryo and have a mean sac diameter (MSD) in the controversial range of 16-20 mm.

Methods: Retrospective study of all first-trimester sonograms among women with vaginal bleeding during a 4-year interval.

Results: The study cohort consisted of 546 first- trimester sonograms.