By using transvaginal sonography, the bladder can be seen as early as 11 weeks of gestation. By 12 to 13 weeks, the bladder is visualized in 98% of cases using both transabdominal and transvaginal sonography.
By using transvaginal sonography, the bladder can be seen as early as 11 weeks of gestation. By 12 to 13 weeks, the bladder is visualized in 98% of cases using both transabdominal and transvaginal sonography.
In many fetal skeletal dysplasias ,the skin and s/c tissue continues to grow at a rate proportionately greater than the long bones resulting in relatively thickened skin folds (on occasion mistaken for hydrops fetalis ) .
Polyhydraminos –common .cause –variable combination of the following –oesophageal compression by the small chest ,GI abnormalities ,micrognathia ,or hypotonia .
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
Describes ultrasound appearance of uterus through different ages, basic transvaginal ultrasound and ultrasound of the cervix. It talks of how to do transvaginal ultrasound.
In many fetal skeletal dysplasias ,the skin and s/c tissue continues to grow at a rate proportionately greater than the long bones resulting in relatively thickened skin folds (on occasion mistaken for hydrops fetalis ) .
Polyhydraminos –common .cause –variable combination of the following –oesophageal compression by the small chest ,GI abnormalities ,micrognathia ,or hypotonia .
This lecture proves an overview of assessing the thyrod nodule upon presentation. The use of imaging, including nuclear medicine, PET, CT/MR and Ultrasound is discussed.
There is more detail on ultrasound evaluation with particular emphasis on ACR TIRADS
Describes ultrasound appearance of uterus through different ages, basic transvaginal ultrasound and ultrasound of the cervix. It talks of how to do transvaginal ultrasound.
evaluation of fetal anatomy in 1st trimester.pptxdypradio
EVALUATION OF FETAL ANATOMY IN FIRST TRIMESTER .
FETAL DEVELOPMENT IN FIRST YAER.
NORMAL ULTRASOUND FINDINGS IN THE FIRST TRIMESTER.Evaluation of fetal anatomy, including a detailed fetal cardiac examination, is possible in the late first trimester.
Many anatomic abnormalities can be detected in the first trimester, giving families time to make important decisions regarding pregnancy management and the opportunity for early termination of pregnancy to reduce maternal morbidity risks.Week 6: By the 6th week, the limb buds begin to differentiate into upper and lower limbs with large hand plates, which develop primordial digits. The lower extremities lag behind the upper limbs by approximately 4 to 5 days. The primordial ear develops and the eyes become obvious as the retina becomes pigmented. The fetal liver occupies the majority of the abdominal cavity at the 6th week. As the rapid growth of the intestines exceeds the growth of the abdominal cavity the physiologic herniation of the intestines into the umbilical cord occurs. Spontaneous twitching movements and reflex responses to touch begin to take place.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Fetal genitourinary
1.
2.
3. SONOGRAPHIC
APPEARANCE
FETAL KIDNEYS:
demonstrated at approximately 11 weeks transvaginally and
at 12 weeks using transabdominal probes.
During the first trimester, the kidneys appear as hyper-echoic
oval structures at both sides of the spine
This echogenicity will progressively decrease, and during the
third trimester, the cortical echogenicity will always be less
than that of the liver or spleen.
Simultaneous to the decreased echogenicity, corticomedullary
(CMD) differentiation will appear at approximately 14 to 15
weeks.
. Urine distending the renal pelvis may help in their
identification.
4. BLADDER
Urine is first produced by the kidneys during the 9th
week of embryonic life.
At this stage, the urine in the bladder can be
visualized as a fluid-filled structure within the fetal
pelvis.
During the second and third trimester, the bladder will
empty and refill continuously every 25 to 30 minutes.
The position of the fetal bladder can virtually always
be identified, because it lies between the umbilical
arteries within the fetal pelvis. These arteries are
readily seen with the use of color Doppler imaging.
5. URINARY TRACT
ABNORMALITIES
Systemic approach to assess
prenatal UT abnormalities include:
Assessment of amniotic fluid index
Localisation and characterisation of
urinary tract abnormalities
Search for associated abnormalities
7. BILATERAL
RENAL AGENESIS
Ureteric buds fail to develop
Lethal congenital anomaly
1 in 4000 births and 2.5:1 male preponderance
Associated with potter’s syndrome
Pulmonary hypoplasia is the major cause of death
8. USG FINDINGS
Severe oligohydraminos/anhydraminos
Absent kidneys
“LYING DOWN” adrenal sign
Absent renal arteries on Color Doppler imaging
Non visualisation of bladder (over 1 hour)
9. UNILATERAL
AGENESIS
More common than B/L
AFI, bladder- NORMAL
Contralateral kidney shows compensatory
hypertrophy
The ipsilateral adrenal gland is usually
present, and appears globular and should
not be mistaken for the kidney. Without the
adjacent kidney, the adrenal gland may be
elongated in appearance in what has been
called “the lying down adrenal sign”
Contralateral kidney associated with
abnormalities ,most common—VUR
10. One or both kidneys in abnormal position
Pelvic kidney is the most common
When ectopic kidney is located on opposite side of the abdomen
relative to its urethral insertion in to bladder is defined. CROSSED
FUSED ECTOPIA.
Associated with abnormalities like VUR.
11. Most common fusion anomaly
On usg,
Abnormal longitudinal axis of both
kidneys with bridge of renal tissue
connecting the lower poles
Majority have anterior orientation of
pelvis B/L
Associated with anomalies like turners
syndrome
Higher prevalence of VUR, calculus ,UTI
13. Most common renal cystic disease
Kidney replaced by multiple cysts of varying sizes separated by dense
stromatolites and there is usually no renal parenchyma
The cysts can be large, presenting as a large fetal abdominal mass, or on the
contrary, microcystic.
14. Effect of urinary obstruction on subsequent renal development depends on the
time of onset and severity of obstruction
Fetal urinary tract responds differently than adults to chronic obstruction by
possible development of macroscopic cysts
Unilateral- UPJ OR UVJ obstruction
Bilateral- Bladder outlet. Obstruction
15. AUTOSOMAL RECESSIVE
POLYCYSTIC KIDNEY
DISEASE
ARPKD has an incidence of 1 in 20,000 live births and
often causes fetal and neonatal death.
Renal failure and hepatic fibrosis develop in many
babies who survive the perinatal period
The disease is characterised by marked elongation of
the collecting tubules that expand into multiple small
cysts. The cystic dilatation of the tubules is variable
and predominates in the medulla. The outer cortex is
spared because it contains no tubules. There is
associated biliary dysgenesis. Hepatic fibrosis has been
described on pathologic examination of affected
fetuses.
The sonographic presentation varies according to the
severity of involvement. The most typical presentation
is that of markedly enlarged hyperechoic kidneys
without CMD).
16. Another presentation of ARPKD can be reversed CMD with large kidneys.
This finding is probably related to increased number of interfaces within the
medullae, and to inspissated material within the dilated tubules.
It is an important observation because there are very few other causes of reversed
CMD.
17. AUTOSOMAL DOMINANT
POLYCYSTIC KIDNEY
DISEASE
ADPKD is the most common form of polycystic
kidneys disease in humans , 1 in 800 live births.
The disease is characterized by the presence of
multiple cysts that develop on the wall of collecting
tubules and nephrons. The cysts are scattered
within the cortex and medulla. These cysts enlarge
progressively and are typically identified in early
adulthood. Cysts may also develop in the liver,
spleen and pancreas in adults.
19. Most commonly detected renal
abnormality
Hydronephrosis refers to abnormal
dilatation of renal pelvis and calyces.
Pyelectasis refers to milder form
with only dilatation of renal pelvis
20. The severity of renal pelvic dilatation can be assessed using
different grading systems. Measuring the maximal antero-
posterior diameter of the renal pelvis (APPD) on a
transverse scan of the fetal abdomen is the generally
accepted method
thresholds vary between 4 and 10 mm in the second
trimester, and between 7 and 10 mm in the third trimester.
Using a cut-off value of 4 mm in the second trimester,
results in a diagnosis of pyelectasis in 2% of pregnancies
(Adra et al., 1995; Corteville et al., 1991). A 7 mm cut-off in
the third trimester has a sensitivity of 100
21.
22.
23. Obstruction at the UPJ is the most common cause of
non-physiologic neonatal hydronephrosis,
It is also one of the most common reasons for postnatal
surgery of the UT.
Most cases of UPJ obstruction are functional (caused by
a muscular abnormality) rather than the result of mixed
anatomic lesions such as fibrous adhesions, kinks,
valves, or aberrant vessels.
On sonography, a dilated renal pelvis with or without
caliectasis is identified. he ureter and the bladder are
not dilated. Severe chronic obstruction leads to
effacement of the calyces and thinning of the renal
cortex (SFU grade 4)
24. More common in males
Primary megaureters- 3 types
25. LOWER URINARY
TRACT
OBSTRUCTION
Fetal megacystis:
10-14 weeks
Longitudinal diameter of bladder- >7mm or
more
2nd- 3rd trimester – enlarged bladder ,fails to
empty over 45 min of observation
If >7-15mm mostly associated with
chromosomal abnormalities.
27. Most common cause
Seen exclusively in males
Infra vesicular pressure generated secondary to obstruction results in persistently
dilated UB with a dilated proximal dilated urethra giving KEY HOLE appearance
Thickening of bladder wall,B/L tortuous hydroureters and hydronephrosis
28. most severe, and earliest detected, form of
obstructive uropathy. he sonographic features
include a greatly distended bladder that may
ill the whole abdomen, and anhydramnios
after the first trimester
. Urethral atresia is almost always fatal,
because of associated renal dysplasia and
pulmonary hypoplasia, and only case reports
of survivors following antenatal treatment
have been described.195,1
29. characterized by a congenital deficiency of the
mesodermal tissues of the phallus, with dilation of the
penile urethra and enlargement of the penis.
this condition has been classified into two types,
fusiform and scaphoid urethra, but it is preferable to
consider it as a spectrum.
Urinary stasis in the dilated penile urethra results in
functional obstruction of the UT.
The prenatal sonographic findings include those of
LUTO, with dilation and elongation of the penile
urethra
. Associated malformations of the UT include urethral
atresia, posterior urethral valves, prune belly syndrome,
and horseshoe kidney. Abnormalities involving the GI
tract and spine and VACTERL association on have been
reported
30. Deficiency of abdominal musculature and cryptorchidism
Rarely in females
Bladder is large thin walled
33. FAILURE OF URINE
PRODUCTION
Bilateral severe renal abnormalities
like renal agenesis, MCDK, ARPKD,
UPJ obstruction.
Severe intrauterine growth restriction
or placental insufficiency
FAILURE TO STORE URINE
Bladder exstrophy
Cloacal exstrophy
Cloacal malformation
Bilateral ectopic ureter with drainage
outside of bladder
34. Incomplete median closure of the inferior part
of the anterior abdominal wall and anterior
wall of urinary bladder
On USG,
AFI and kidneys are normal but bladder is not
identified
Irregular mass may be seen arising from the
anterior abdominal wall inferior to umbilicus
Low umbilical cord insertion
Widening of pubic bones
Rarely reported with OEIS complex
Longitudinal scan of the lower fetal abdomen in a 29-
week fetus shows an irregular mass on the anterior
abdominal wall (arrows), below the umbilical cord
insertion (U). A luid-illed bladder was not identiied.
Note normal amniotic luid volume. (B) Corresponding
photograph shows the exposed bladder (arrows) below
the umbilical cord (U).
35. More than half of all congenital abdominal masses
found in the neonate originate in the kidney.
In the fetus, the most common renal tumor is the
mesoblastic nephroma .
It appears as a solid tumor that is sometimes difficult
to delineate from the adjacent renal parenchyma.
The tumor can appear partially cystic.
In utero, polyhydramnios is typically associated and
hypertension develops after birth.
Cases of fetal renal Wilms’ tumor have been reported
as solid or partially cystic tumors. The prognosis is
good. Bilateral involvement suggests
nephroblastomatosis, which is a condition with
multiple benign nodular lesions.
36. Whenever a mass is detected in the suprarenal
area, a neuroblastoma should be suspected first
regardless of the pattern of the mass
Neuroblastoma may present as a cystic, a solid
or more complex appearance.
Color Doppler imaging may demonstrate
increasing vascularization of the hyperechogenic
regions of the mass.
The differential diagnosis should include adrenal
hemorrhage, associated or not with RVT, and
adrenal cysts.
. Extra-adrenal causes, such as sub-
diaphragmatic pulmonary sequestration, should
also be included in the differential diagnosis
Editor's Notes
he permanent kidney (metanephros) is the third in a series of excretory organs in the human embryo, forming ater the pronephros and mesonephros.3 In the seventh menstrual week, the metanephros begins to develop from two sources: the metanephric diverticulum (ureteric bud) and the metanephric mass of intermediate mesoderm (Fig. 39.1). he ureteric bud is an outgrowth from the mesonephric duct, near its entrance into the cloaca. It elongates and branches in a dichotomous pattern, giving rise to the ureter, renal pelvis, calycescollecting tubules.
hrough interaction with the metanephric mesoderm, the ureteric bud induces the formation of nephrons. In early embryonic life, the kidneys are located in the pelvis, but they “ascend” to their adult position by the 11th menstrual week. At this gestation, the kidneys start to produce urine.By the ninth menstrual week, the cloaca (caudal part of hindgut) is divided by the urorectal septum into the rectum posteriorly and the urogenital sinus anteriorly (see Fig. 39.1). he urinary bladder, the female urethra, and most of the male urethra develop from the urogenital sinus and the surrounding splanchnic mesenchyme. Initially, the bladder is continuous with the allantois, but this structure soon constricts and becomes a ibrous cord, the urachus, which extends from the apex of the bladder to the umbilicus.
heir hyperechogenicity can be compared to that of the liver or spleen)
ITFALLS IN INTERPRETATIONAmniotic luid volume may be normal before 16 weeks’ gestationBowel or adrenal glands can be mistaken for kidneys Urachal diverticulum may mimic the bladderEmpty bladder may be caused by impaired renal function from other causes (e.g., intrauterine growth restriction)
. An ectopic kidney is usually smaller and may be malrotated.
Other ectopic locations include horseshoe, crossed fused ectopia (both kidneys lie on the same side), and intrathoracic ectopia.
Crossed ectopia should be differentiated from duplex kidneys. In crossed (fused) ectopia, there is an angulation between the two kidneys, whereas in duplication, the two renal moieties lie in the same continuous plane
Consists of heterogenous group of disorders with inherited and acquired causes
Pottter classification is based on histology not considered
Kidneys -non functional
So prognosis depends on other kidney
Affects whole kidney but also affects portion of the duplex kidney supplied by attic ureter
The sonographic findings in patients with MDK are usually straightforward:
unilateral involvement with noncommunicating cysts of variable size, variable amount of hyperechogenic stroma, no normal cortex or medulla, irregular renal contours, and no identifiable collecting system
MDK may also develop in the upper part of a duplex system (see Fig. 16-29) or be located in an ectopic position (Fig. 16-41). The size of the cysts may decrease in utero or after birth (see Fig. 16-40). Therefore, the entire MDK may “disappear” and give the appearance of renal agenesis. Unilateral involvement carries a good prognosis, although there may be an anomaly affecting the contralateral kidney (i.e., UPJ obstruction). The condition can be associated with other system’s malformations (Fig. 16-42). When MDK is an isolated finding, there is no increased risk of chromosomal anomaly. Cases with bilateral involvement (1 out of 15 cases) are associated with severe oligohydramnios and pulmonary hypoplasia; they carry a poor progno
This appearance can be observed in the second trimester. The patterns may evolve, and the size of the kidneys may continuously increase during the third trimester. Other findings include oligohydramnios and lung hypoplasia, and therefore, the prognosis is usually poor. There are no other malformations associated with ARPKD. The list of differential diagnoses includes glomerulocystic disease and Bardet-Biedl syndrome (BBS) (see later).79,80 In these two diseases, the parenchyma is more homogenous than in ARPKD. When the kidneys are not as enlarged (+2 → +6 SD), the diagnosis may be more difficult to ascertain. A hypoechoic outer cortical rim that is usually present in the recessive type may help in suggesting the diagnosis (see Fig. 16-30C). Cysts (greater than 3 mm) may be already apparent in the fetus in the third trimester; they may appear unilateral, and their number varies. This finding occurs in one third of diagnosed fetal cases but is not specific.81
Coronal and transverse scans of a 22-week fetus show bilateral large, diffusely hyperechoic kidneys (calipers) with loss of corticomedullary differentiation
These patients have a better prognosis when the amniotic fluid volume is preserved. The differential diagnosis includes metabolic disorders and intrauterine growth restriction. The liver abnormalities, for example, hepatic fibrosis, are not demonstrated in utero
Coronal scan of a 30-week fetus shows markedly enlarged kidneys (calipers), with a hypoechoic peripheral rim surrounding the centrally increased echogenicity. Right kidney measures 7.5 cm in length and left kidney 8 cm. (B) Coronal scan of a different fetus at 31 weeks’ gestation shows markedly enlarged kidneys (calipers), with hyperechoic pyramids (arrowheads), resulting in “reversed corticomedullary differentiation.”
In the fetus, a pattern highly suggestive of the disease has been recently described by Brun et al90 and was encountered in more than 80% of affected patients in the third trimester. They found moderately enlarged kidneys (1-2 SD above the mean) which have hyperechoic cortices and relatively hypoechoic medullae For the authors, the hyperechoic cortex is probably related to the presence of multiple microcysts that predominate at this stage in the cortex. In most cases, the amniotic fluid volume was normal.90 Although the exact sensitivity of the pattern is unknown, its demonstration should prompt a familial inquiry including sonography of the parents and grandparents because 50% of cases with the dominant form are discovered following the sonographic detection. However, it is estimated that an unknown percentage of cases of ADPKD are the result of a new mutation. A list of differential diagnoses exists for this pattern and should be considered (Table 16-7 and Fig. 16-33). For some patients, only long-term follow-up will establish the final diagnosis.
Coronal scan of 30-week fetus shows enlarged kidneys (calipers), measuring 5 cm in length (>3 SD), with increased corticomedullary differentiation due to increased echogenicity of the cortex.
n type I or primary obstructed megaureter, there is proximal dilation due to relative obstruction by a short aperisaltic segment of the ureter near the vesicoureteral junction. he transvesical course and insertion of the ureter are normal. It is thought to be due to muscular derangement with increased connective tissue in the afected segment of the ureter.
Type II or reluxing primary megaureter is usually the result of an abnormality involving or closely associated with the vesicoureteral junction including a short or absent intravesical ureter, a con- genital paraureteric diverticulum, or another abnormality of the vesicoureteral junction.
Type III, or nonreluxing, nonobstructed primary megaureter, is the most common of the three types. As the name suggests, neither relux nor apparent obstruction of the distal ureter is found. he dilation starts just above the bladder, and the cause is unknow
Coronal scan of a 17-week fetus shows a greatly distended bladder (B) that occupies the entire abdomen. The thorax (arrows) is compressed and bell shaped because of pulmonary hypoplasia. There is anhydramnios. P, Placenta.
Longitudinal scan of the lower fetal abdomen in a 29-week fetus shows an irregular mass on the anterior abdominal wall (arrows), below the umbilical cord insertion (U). A luid-illed bladder was not identiied. Note normal amniotic luid volume. (B) Corresponding photograph shows the exposed bladder (arrows) below the umbilical cord (U).
The prognosis of antenatal neuroblastoma is excellent even when hepatic metastases are present. Furthermore, some cases of spontaneous involution have been reported (Fig. 16-66).
Bilateral calcifications are unusual and may suggest Wolman syndrome (Fig. 16-68). Isolated, uncomplicated small cysts may be observed at the level of the adrenals (see Fig. 16-67). Their size is usually small and they disappear spontaneously. Large cysts develop in association with the Beckwith-Wiedemann syndrome. These cysts may bleed, and their appearance becomes more complex