US Diagnosis of Fetal Congenital Anomalies

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Prof.Safdar Mehmood malik

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US Diagnosis of Fetal Congenital Anomalies : 

US Diagnosis of Fetal Congenital Anomalies PROF SAFDAR ALI MALIK Tamgha-e-Imtiaz Head of Radiology Deptt SIMS / Services Hospital Lahore

Understanding 4D : 

Understanding 4D 2D 3D 4D HISTORY OF ULTRASOUND

Anomaly Scan-12-13 WKS : 

Anomaly Scan-12-13 WKS Anencephaly / Encephaloce

Slide 6: 

2 D Limitation: Suboptimal position Inappropriate median sagittal section of fetus Attachement of nuchal region to amniotic membrane All these result in failure rate & poor reproducibility Nuchal Tranclucency 3D / 4D US

Slide 7: 

Nuchal Translucency Genetic Sonogram

Slide 8: 

3D / 4D Advantages Storage of data on memory disc Volume scanning & Assesment of nuchal translucency 2D TVS 11-14 Wks scan shows 76-100% accuracy 3D TVS 11-14 Wks scan shows 100% accuracy Kurjak A, Kupesis S, Kosuta-Ivancevic M J Peinatal Med 1999; 27-29-102 Nuchal Tranclucency 3D / 4D US

Slide 9: 

Nuchal Tranclucency 3D / 4D US

Slide 11: 

Down Syndrome Nuchal Tranclucency 3D / 4D US

Slide 12: 

Multi-Planar Display 3D / 4D US

Slide 13: 

Nuchal Tranclucency Down Syndrome

Slide 15: 

Anomaly – Acrania/Anencephaly

Acrania: No scalp : 

Acrania: No scalp 3D / 4D US

Slide 17: 

Anencephaly

Slide 18: 

Choroidal cysts

Slide 19: 

Encephalocele

Cystic Hygroma : 

Cystic Hygroma 3D / 4D US

Cystic Hygroma : 

Cystic Hygroma 3D / 4D US

Anomaly Scan18-20 WKS : 

Anomaly Scan18-20 WKS

Slide 24: 

Vein of Gallen

Fetal Malformations : 

Fetal Malformations Brain Hemorrhage

Fetal malformationsMECKLE – GRUBER SYND. : 

Fetal malformationsMECKLE – GRUBER SYND. Autosomal recessive Polycystic Kidneys Encephlocele (Occipital) Oligohydramnias Polydactyly

Abdominal Wall Defects

Slide 32: 

Gastroschisis Omphalocele

Slide 33: 

Gastroschisis Omphalocele

Slide 34: 

Gastroschisis Omphalocele

Slide 35: 

Normal Sutures

Slide 36: 

Craniosynostosis

Hydrocephalus : 

Hydrocephalus Ventricular (atrium) < than 11 mm. LVR (Lat. Vent. Ratio) 70% in 15 weeks 33% in 24 weeks More than 50% in abnormal Dangling choroid

Slide 39: 

Normal Spine and Ribs 3D / 4D US

Slide 40: 

Fetal Malformations 3D / 4D US

Holoprosencephaly : 

Holoprosencephaly Absent or incomplete cleavage of the forebrain or porencephalon during early development.

Slide 43: 

Holoprosencephaly-Alobar

Fetal MalformationsHYDROPS FETALIS : 

Fetal MalformationsHYDROPS FETALIS Ascites (1st Sign) Pleural Effusion Pericardial Effusion Polyhydramnia Placenta (More than 4 cm) Anasarca (More than 5 mm) 25-40% have associated anomalies 55-98% mortality rate

Selective Fetocide : 

Selective Fetocide Gestational age is inversely correlated to gestation at the time of procedure. KCl is optimum as compared to air or exsanguination No failed procedure in dichorionic twins Evans MI,GoldbergJD,Dommergues M et al Am J Obstet Gynecol 1994;171:90-94 Harman CR,ed Blackwell Scientific,1995;315-338

Selective Fetocide : 

Selective Fetocide Dose of KCl 2mEq/ml 2ml for < 16 wks gestation 2-5 ml > 17 wks Evans MI,GoldbergJD,Dommergues M et al Am J Obstet Gynecol 1994;171:90-94 Harman CR,ed Blackwell Scientific,1995;315-338

Take home message : 

Take home message OPD procedure Minimally Invasive Safe Quick Accurate Result oriented Economical

Gender : 

Gender 3D / 4D US

Slide 53: 

drsafdaralimalik @ hotmail.com.pk safdarm@brain.net.pk

Slide 55: 

Malformations Colour Doppler in Gyne & Obs.

PID / TO mass : 

PID / TO mass

Ovarian Cyst : 

Ovarian Cyst TAB / TVS approach

Criteria for Cyst Aspiration : 

Criteria for Cyst Aspiration Size < 9 cm Walls < 3 mm Locules-- unilocular Debri/ Specks—fine few Septae—no preferably Solid component—No Color doppler—No flow No associated findings

Needle Track : 

Needle Track Interventional US

Cystwith Ectopic Pregnancy : 

Cystwith Ectopic Pregnancy

Endometriotic Cyst : 

Endometriotic Cyst TAB / TVS approach

Endometrial PolypHydrosonographay : 

Endometrial PolypHydrosonographay

Slide 83: 

Isthmic Pregnancy

Slide 88: 

Cervical Pregnancy

Ectopic pregnancy : 

Ectopic pregnancy Quick results-6 wks

Ectopic pregnancy : 

Ectopic pregnancy Longest follow up 17 months

Slide 91: 

Cornual pregnancy

Post Procedure Convalascent period : 

Post Procedure Convalascent period Slow fall of B-hCG Lower abdominal pain TVS & CDI for Haematosalpinx , Haemoperitoneum etc

Ectopic pregnancy : 

Ectopic pregnancy Best results-Cornual / Cervical

Multifetal pregnancy reduction( MFPR) : 

Multifetal pregnancy reduction( MFPR) TAB route has 4.4 % to singleton as compared to 12.6 % in TC/TV route. Evan MI , Dommergues M, Timor-Tritch IE et al Am J Obstet Gynecol 1994; 170: 902-909

Selective Feticide : 

Selective Feticide Multiple with malformed

Slide 98: 

FUTURE

Slide 99: 

3D

Slide 100: 

FACE

Slide 101: 

4D

4D Biopsy : 

4D Biopsy

Follicle aspiration : 

Follicle aspiration

Slide 106: 

Take home message US GUIDED BIOPSY /ASPIRATION OF ABSCESS / FLUID COLLECTION

Role of Interventional US in Gyn OBS & Breast : 

Role of Interventional US in Gyn OBS & Breast DR. SAFDAR ALI MALIK Professor of Radiology Fatima Jinnah Medical College / Sir Ganga Ram Hospital Lahore

Slide 114: 

HysteroSalpingoContrastSonography (HYCOSY)

Fetal MalformationsHYDROPS FETALIS : 

Fetal MalformationsHYDROPS FETALIS Ascites (1st Sign) Pleural Effusion Pericardial Effusion Polyhydramnia Placenta (More than 4 cm) Anasarca (More than 5 mm) 25-40% have associated anomalies 55-98% mortality rate

Slide 117: 

Earliest -Ascites

Slide 122: 

Annoyed 3D / 4D US

Slide 123: 

Cleft Lip and Palate 3D / 4D US

Slide 124: 

drsafdaralimalik @ hotmail.com.pk safdarm@brain.net.pk

Fetal Malformations : 

Fetal Malformations Hydrocephalus +Spinal Dysraphism with Meningomyelocele

Selective FetocideIndications : 

Selective FetocideIndications Multifetal pregnancy reduction ( MFPR) Multiple with malformed Malformed Aberg A, Mitelman F, Cantz M, Gehler J Lancet 1978;ii : 990-991

Slide 128: 

Earliest -Ascites

Slide 129: 

Placenta Percreta

Slide 130: 

XTD View

Slide 133: 

1st Trimester 2nd Trimester (18 wks) –Anomaly Scan 3rd Trimester

Protocols of 1st trimester : 

Protocols of 1st trimester Warm uterus G.Sac CRL F.Heart Failed Preg Fetal Number Fetal Structure 8. Nuchal Translucency 9. Placental Localization 10. Cervical Competance 11. Uterine / Ovaian / Adenexal pathology 12. Anomaly Scan

Slide 135: 

Blighted Ovum

Prenatal US Diagnosis & Management : 

Prenatal US Diagnosis & Management PROF SAFDAR ALI MALIK Tamgha-e-Imtiaz Head of Radiology Deptt Fatima Jinnah Medical College / Sir Ganga Ram Hospital Lahore

Dacrocystocele : 

Dacrocystocele

Slide 151: 

Fetal Malformations

Slide 152: 

Fetal Malformations 3D / 4D US

Gender : 

Gender 3D / 4D US

Three Dimensional Ultrasound And Real Time Three Dimensional Ultrasound ( 4D ) Are But A Natural Consequence Of The Evolution Of Newer Computer Technology As Applied To Conventional Ultrasound : 

Three Dimensional Ultrasound And Real Time Three Dimensional Ultrasound ( 4D ) Are But A Natural Consequence Of The Evolution Of Newer Computer Technology As Applied To Conventional Ultrasound