Ultrasound images of fetal abdomen

Echogenic particulate matter in the fetal Gallbladder

Sonography of this 3rd trimester fetus revealed echogenic debris within the gall bladder. These ultrasound images of the fetal gall bladder are diagnostic of biliary sludge. This sonographic finding does not appear to be of any clinical significance, as the sludge usually disappears after birth.Ultrasound images of fetal gall bladder sludge are courtesy of of Dr. Jaydeep Gandhi, Mumbai, India.

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 Sonography of the fetal abdomen (see pictures above), show 2 anechoic lesions (double bubble sign). The first bubble is formed by the fluid filled fetal stomach, the second being formed by the distended fetal duodenum. The obstruction is likely to be at the 2nd part of the duodenum. These ultrasound images (double bubble sign) suggest the likelihood of duodenal atresia. This sign may also be seen in duodenal stenosis or annular pancreas. These ultrasound images were taken using a Toshiba Nemio 30 ultrasound system , by Dr. Prasenjeet Singh, Delhi, India. 

 

Reference: http://radiology.rsnajnls.org/cgi/reprint/220/2/463.pdf (free article and images).

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Case-2:

This 3D ultrasound image with color coding shows the fetal stomach and duodenum seen showing the double bubble sign. The duodenum is the smaller bubble to the left of the image (in blue) whilst the stomach bubble is seen color coded in red (to the right of the image). This is the classic double bubble sign of duodenal obstruction (this 3D image is courtesy of Mayank Chowdhury, MD).

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These ultrasound images of a 32 week old female fetus show a relatively large (3.9 cms.) cystic lesion in the right adnexal region, in close relation to the urinary bladder (UB). The cyst shows anechoic fluid content with echogenic debris that sediments towards the dependent part of the cyst (note the changes with change in posture). This type of appearance in a fetus is typical of ovarian cyst with solid debris which may be blood as in twisted ovarian cyst (torsion of ovarian cyst in fetus) or a fetal dermoid cyst of the ovary. The last ultrasound image (lower right) shows a 3-D image of the cystic lesion. All 4 ultrasound images are courtesy of Ravi Kadasne, MD, UAE. He used a Philips IU 22 ultrasound system for these images.

 

Reference: http://www.thefetus.net/page.php?id=524  

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 Hyperechoic fetal intestine

Sonography of the fetal abdomen done on this 28 week fetus showed markedly hyperechoic bowel and fetal ascites. The normal fetal intestine is isoechoic or hypoechoic with the fetal liver. (Bow = fetal bowel; as= fetal ascites). The bowel echogenicity is compared with that of the fetal liver and graded from frade-0 (isoechoic) to grade-3 (markedly hyperechoic). Hyperechoic bowel in fetus is strongly associated with poor fetal prognosis- fetal growth retardation and anomalies and fetal death. This fetus did not survive. Ultrasound images courtesy of Dr. Vikas Shukla, MD, India.

 

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This 34 week fetus shows a large cystic lesion (4.5 cms.) arising from the pelvis with a solid, echogenic rounded mass within it (see ultrasound images above). This is the typical sonographic appearance of a sebum plug within a mature cystic teratoma or dermoid cyst. In ultrasound images above, ST= stomach, LK= left kidney, BL= fetal urinary bladder, M= mass.

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Ultrasound imaging of fetal mature cystic teratoma or dermoid cyst

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This 34 week old fetus shows dilated loops of small intestine with evidence of peristaltic waves. The diameter of the loops of small intestine is about 24 mm. Any diameter more than 7 mm is considered abnormal and suggests possible dilatation of the small intestine. The common causes of dilatation of the small intestine are meconium ileus, ileal atresia and jejunal atresia, volvulus etc. It can be difficult to distinguish between these various entities. However, the ultrasound images above, show absence of ascites which is usually present in cases of meconium ileus. The most common presentation seen with multiple loops of dilated small intestine as in the ultrasound images above is due to jejunal atresia.

References: http://www.jultrasoundmed.org/content/25/3/337.full.pdf