US Interesting Case Conference

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US Interesting Case Conference

• July 30, 2007
• Ana Lourenco MD

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34 F HCG Bleeding?Ectopic
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TRV
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Probable Cornual Ectopic

• Follow-Up US 1 wk later ? Embryonic Demise

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Ectopic Pregnancy
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Ectopic

• Risk of fatal hemorrhage with rupture
• Symptoms pain/bleeding early in pregnancy
• Increased risk if history of PID, prior
  ectopic, IVF, tubal ligation, IUD.
• Treatment Methotrexate if lt3.5cm at US
  clinically stable or Surgical

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Normal Tubal Anatomy at HSG
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Normal fimbriated fallopian tube segment
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24 F for dating/viability
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Echogenic Yolk Sac Nonviable IUP
13 mm CRL No HR
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Abnormal Yolk Sac

• Too large (gt 6mm)
• Echogenic or calcified
• Double appearance
• Not present with MSD gt 13mm at TV US
• YS abnormalities most often predict subsequent
  embryonic demise

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24 F with Pelvic Pain
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Endometrioma 2006
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June 2007
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July 2007Hemorrhagic Cyst Contralateral
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36 F bleeding thickened endometrium
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Endometrial Polyp
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38 F Ventriculomegaly outside OB US
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Agenesis Corpus Callosum
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MRI
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Agenesis CC

• Isolated or associated with other malformations
• Partial or complete agenesis
• US Findings enlarged vents, parallel vents,
  upward displacement 3rd vent, absent CC and cavum
  septum. Midline cysts or lipomas can be
  associated.

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33F ?Brain AVM on outside OB US
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Grade IV IVH
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Grading Intraventricular Hemorrhage

• Grade I Germinal Matrix
• Grade II Intraventricular
• Grade III Intraventricular AND enlarged
  ventricles
• Grade IV Intraparenchymal hemorrhage
• Hemorrhagic infarct
• Up to 90 association with neurological impairment

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IVH

• Usually in pre-term neonates
• Highest risk at lt 32 wks GA
• Poor autoregulation of brain blood vessels
• Prognosis worsens with increasing grade of
  hemorrhage

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66 F prior resection of low-grade ovarian
fibrosarcoma 1991 and 1998

• New palpable Rt Adnexal abnormality on exam

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? Solid or Cystic ?
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Recurrent Fibrosarcoma

• Final pathology TBA

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27 F Routine Fetal Survey
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Placental Pitfalls
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Placental Pitfalls
1.2cm
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Placental Pitfalls Transient Contractions
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55 F Follow-up Rt Adnexal Cyst
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2005
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2007
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2007 Increased size, persistent.Probable
neoplasm. Final path TBA.
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Management Post-Meno Cysts

• Correlate with CA-125 level
• Follow
• Size lt 6 cm
• Unilocular, Unilateral, Simple
• Excise
• gt 6 cm
• Complex

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33 F h/o DM, HTNFetal Survey High Risk
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Isolated Cleft Palate at Birth
Single Artery Cord
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Isolated Cleft Palate

• Much less common than cleft lip palate
• Most often not diagnosed prenatally
• US Findings can include micrognathia
• Two Vessel Cord ? More common in diabetics,
  whites
• 20-50 association with other anomalies
• Increased risk IUGR and perinatal mortality

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47 F Abdominal Distension, Nausea
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Mucinous Cystadenocarcinoma
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69 F Abdominal Pelvic Painh/o Hysterectomy
without oopherectomy

• PMH Endometriosis

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Grade 3, Stage III Ovarian Adenocarcinoma

• Ddx
• Peritoneal inclusion cyst
• Endometriomal implants, given h/o endometriosis
• Neoplasm

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37 yo FOB US with fetal ascites s/p fetal
bladder tap at outside facility
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Renal Dysplasia
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• Fetal bladder tap showed increased protein in
  urine, consistent with severe renal dysfunction
• Lung development impaired
• Neonatal dialysis
• Extremely poor prognosis for fetus

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27 yo F h/o DMFetal Survey
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Caudal Regression
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Caudal Regression
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Caudal Regression

• Infants of Diabetic Mothers
• Neurological Impairment
• Associated GI, GU abnormalities

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19 yo F with poorly controlled DM Type 11st
Trimester US
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Asymmetric Right Parietal Encephalocele

• No amniotic bands
• Not of Asian background
• 90 are midline
• 75 are occipital in US
• Associated syndromes, chromosomal abnormalities

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48 yo F IVF using Egg DonorCranial Abnormality
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Encephalocele, Cerebral dysgenesis,
Ventriculomegaly
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34 yo F LLQ pain
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Dermoid
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Dermoid

• Risks
• Torsion
• Malignant degeneration ? Squamous CA
• Treatment
• Surgical resection

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36 yo F Fetal Survey
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Hematoma vs ChorioangiomaBut, no vascular flow,
so chorioangioma unlikely.
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Decreased in size, so hematoma most likely.
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69 yo F evaluate fibroids
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Neoplasm.TAH/BSO planned. Pathology TBA
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62 yo F with bloating
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Final Path

• Papillary Serous CA, widely metastatic
• CA 125 4466
• Normal 0-35

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26 yo F evaluated outsideUS Guidance for
termination
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Ectopia Cordis
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Ectopia Cordis
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Ectopia Cordis

• Fatal
• Extremely rare
• Associated anomalies variable
• Pentalogy of Cantrell
• Anterior abdominal wall defect
• Diaphragm defect
• Pericardium defect
• Sternum defect
• Cardiac anomalies

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21 F for evaluation of Congenital Diaphragmatic
Hernia
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Fetal CDH
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Fetal CDH
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Fetal CDH
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CDH

• Left side (85) gtgtgt Right side
• May be isolated or associated with trisomies /
  syndromes
• Liver in chest associated with worse prognosis
• Prognosis related to lung development

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22 F fetal neck mass
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Neck Teratoma

• Fetal Neck Mass DDx
• Teratoma
• Lymphatic Malformation
• Meningocele
• Encephalocele
• Branchial Cleft Cyst
• Thyroid Goiter
• Sarcoma

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23 F with elevated AFP
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Gastroschisis

• Vascular insult anterior abd wall
• Paramedian, usually right sided
• Bowel floats in amniotic fluid
• Not associated with chromosomal abnormalities
• Bowel stricture common

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23 F fetal cleft abnormality on outside US
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Cleft lip/palate
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Cleft lip/palate
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80 F CT ?endometrial polyp
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Auto-sonohysterogram Cervical stenosis
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37 F post-partum 10 days
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Air in endometrial cavity post-partum