Spectrum of Cranio-facial anomalies during 2 Ultrasound. trimester on

Transcription

1 Spectrum of Cranio-facial anomalies during 2 Ultrasound nd trimester on Poster No.: C-0378 Congress: ECR 2015 Type: Scientific Exhibit Authors: K. Dave, S. Solanki; Ahmedabad/IN Keywords: Obstetrics (Pregnancy / birth / postnatal period), Anatomy, Ultrasound, Ultrasound-Colour Doppler, Normal variants, Obstetrics DOI: /ecr2015/C-0378 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 18

2 Aims and objectives Review the spectrum of cranio-facial anomalies. Recognize the key findings on image to make an early diagnosis To diagnose cranio-facial abnormalities at the week ultrasound examination. Images for this section: Fig. 1: Coverpage Page 2 of 18

3 Fig. 2: Aim and Objectives Page 3 of 18

4 Methods and materials We underwent ultrasound examination in all the pregnant women in their 2nd trimester. We had conducted our study for 2 years. Women were recruited from the antenatal outpatient's and regional midwifery services. Pregnancy duration varied between 14 and 28 weeks (median 20 weeks). Maternal age ranged between 19 and 40 years (median 30 years). Ultrasound images of all patients were retrieved from picture archiving and communication system (PACS) and hospital records from Electronic Medical Record. Images for this section: Fig. 3: Introduction Page 4 of 18

5 Fig. 4: Methods and Material Page 5 of 18

6 Results Results and Discussion: We found following cranio-facial anomalies during our 2 years of observation and study (Figure-5). - Cranial Anomalies: i) Acrania ii) Anencephaly iii) Lemon sign iv) Banana sign v) Choroid plexus cyst vi) Chiari II malformation vii)dandy walker malformation. - Facial anomalies: i) Cleft lip ii) Cleft palate iii) Cleft lip with outgrowth on lip. The most common anomaly we found was anencephaly. We found 4 cases of anencephaly. Next common anomalies were lemon sign, banana sign (3 cases), dandy walker malformation, chiari II malformation (2 cases) and choroid plexus cyst, cleft lip, cleft palate & cleft lip with outgrowth on lip (1 case). The diagnosis of anencephaly (Figure-8) during the second trimester of pregnancy is based on the demonstration of absent cranial vault and cerebral hemispheres on ultrasonography. However, the facial bones, brain stem and portions of the occipital bones and mid-brain are usually present, while in acrania (Figure-8) there is entire absence of skull, including skull base. Lemon sign (Figure-9,10) is flattened or concave frontal bones, which is a marker for open spina bifida. Banana Sign (Figure-10) derives from anterior curving of the cerebellar hemispheres with simultaneous obliteration of the cisterna magna. Dandy-Walker malformation (Figure-11) is known as complete or partial agenesis of the cerebellar vermis and enlarged posterior fossa. On sonography it is diagnosed as cystic dilatation of the fourth ventricle with partial or complete agenesis of the vermis. Also there is associated hydrocephalus. Choroid plexus cysts (Figure-12) are usually bilateral, & located in the choroid plexuses of the lateral ventricles. They are found in about 2% of fetuses at 20 weeks of gestation but in more than 90% of cases they resolve by 26 weeks. Page 6 of 18

7 The sonographic diagnosis of cleft and palate (Figure-14) depends on demonstration of a groove extending from one of the nostrils inside the lip and possibly the alveolar ridge. Both transverse and coronal planes can be used. Images for this section: Fig. 5: List of Cranio-facial anomalies found in our study. Page 7 of 18

8 Fig. 6: Neural tube defects Page 8 of 18

9 Fig. 7: Diagnosis of anencephaly and acrania Page 9 of 18

10 Fig. 8: Images showing acrania and anencephaly. Page 10 of 18

11 Fig. 9: Ultrasound image showing classic "Lemon sign". Page 11 of 18

12 Fig. 10: Two ultrasound images showing Classic lemon and banana signs. Page 12 of 18

13 Fig. 11: Dandy-Walker complex and malformation. Page 13 of 18

14 Fig. 12: Choroid plexus cysts. Page 14 of 18

15 Fig. 13: Facial anomalies. Page 15 of 18

16 Fig. 14: Ultrasound images showing cleft lip and cleft lip with lip outgrowth. Page 16 of 18

17 Conclusion We conclude that ultrasound is the best and most reliable technique for visualizing the fetal cranial vault and face and thus diagnosing cranio-facial anomalies. Images for this section: Fig. 15: Conclusion of our study. Page 17 of 18

18 Personal information References Chitkara U, Cogswell C, Norton K et al: Choroid plexus cysts in the fetus: A benign anatomic variant or pathologic entity? Report of 41 cases and review of the literature. Obstet Gynecol 72: 185, Gabrielli S, Reece AE, Pilu G et al: The clinical significance of prenatally diagnosed choroid plexus cysts. Am J Obstet Gynecol 160: 1207, Van den Hof MC, Nicolaides KH, Campbell S: Evaluation of the lemon and banana signs in one hundred thirty fetuses with open spina bifida. Am J Obstet Gynecol 162: 322, Myrianthopoulos NC. Epidemiology of central nervous system malformations. In: Vinken PJ, Bruyn GW, editors. Handbook of Clinical Neurology. Elsevier: Amsterdam, 1977; Malinger G, Lev D, Kidron D, Heredia F, Hershkovitz R, Lerman-Sagie T. Differential diagnosis in fetuses with absent septum pellucidum. Ultrasound Obstet Gynecol 2005; 25: Filly RA, Cardoza JD, Goldstein RB, Barkovich AJ. Detection of fetal central nervous system anomalies: a practical level of effort for a routine sonogram. Radiology 1989; 172: Page 18 of 18