Fetal Spine

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Fetal Spine
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Fetal Spine

• Always document the cervical, thoracic, lumbar,
  and sacral spine in both transverse and
  longitudinal
• Notice the triangular shape of the three
  vertebrae in transverse, they form a closed
  triangle

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Fetal Spine in Transverse
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FETAL C SPINE AND CLAVICLE
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Fetal Spine
Sag Cervical Spine
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Fetal Spine in Sagittal
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FETAL SPINE
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FETAL SPINE
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Long Spine
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Fetal spine
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Fetal spine
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Fetal spine
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Fetal Neck

• Anomailes of the neck are fairly infrequent but
  often are associated with poor fetal outcome
• Examination of the posterior neck and the base of
  the skull is important to detect abnormalities
  such as cystic hygroma, occipital cephalocele and
  cervical meningomyeloceles

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Fetal Neck

• Both the transverse and sagittal planes through
  the posterior fossa can be used to assess the
  thickness of the skin and soft tissues over the
  neck

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Nuchal Cord

• The fetal umbilical cord may overlie or wrap
  around the fetal neck
• It is more commonly seen in the third trimester
  of pregnancy
• When evaluating the fetal neck for nuchal
  thickening the overlying cord may be mistaken for
  increased skin thickness of the neck
• Use Doppler to determine if this is cord

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Nuchal Cord
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Nuchal Cord
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Nuchal Cord
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Cystic Hygroma

• The most common neck mass
• It is congenital malformation of the lymphatic
  system
• Benign condition
• Caused by a defect in the formation of lymphatic
  vessels

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Cystic Hygroma

• The lymphatic vessels drain into two large sacs
  lateral to the jugular veins, if the lymphatic
  and venous structures fail to connect the jugular
  lymph sacs enlarge resulting in cystic hygromas
  of the posterior neck
• It is a thin membrane multiseptated mass
  typically located on or around the fetal head and
  neck (80)

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Cystic Hygroma
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Cystic Hygroma
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Cystic Hygroma

• Associated with turners syndrome - which is a
  congenital endocrine disorder caused by the
  ovaries failure to respond to hormones,
• Associated with trisomies 13, 18, 21, renal
  abnormalities
• Characteristics webbing of the neck and hands

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Cystic Hygroma

• Webbed neck or excessive nuchal skin
• Polyhydramnios
• Fluid filled mass near the posterior, lateral, or
  anterior portion of the neck, multiseptated,
• Thin walled cystic mass
• Also associated with
• Fetal ascites
• Large placenta
• Fetal edema
• Elevated AFP

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Cystic Hygroma

• Differentials
• Teratoma
• Neural tube defect
• Hemangioma
• The prognosis varies
• If detected with fetal hydrops then it is usually
  fatal, where as isolated cystaic hygroma has a
  good prognosis

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Cystic Hygroma
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Cystic Hygroma
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Cystic Hygroma
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Cephalocele or Encephalocele

• A cephalocele is a protrusion of meninges and/or
  brain substance through a defect in the cranium
• Cephaloceles are either meningoceles or
  meningoencephaloceles
• The incidence is about 1 in 2000 live births
• Classifed as
• Occipital (most common)
• Frontal
• Parietal

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Encephalocele, Meningocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele

• Sonographically they appear as a saclike
  protrusion around the head that is not covered by
  bone
• If brain has herniated the contents of the sac
  have a heterogeneous appearance
• A bony defect in the occipital vault is a
  distinguishing feature between cystic hygroma and
  cephalocele

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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephaloceles

• Impairment of cerebrospinal fluid circulation and
  hydrocephalus are frequently associated
• Cephaloceles may occur either as isolated lesions
  or as a part of a number of genetic and
  nongenetic syndromes
• Associated with
• Hydrocephalus in 80 of occipital lesions
• Spina Bifida in approximately 7-15
• Polyhydramnios

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Cephalocele
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Cephalocele
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Cephalocele
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Cephaloceles

• Recognition of the bonny defect allows a specific
  diagnosis however the bonny defect is too small
  to see, hence it is difficult to differentiate
• Remember cephaloceles are often associated with
  hydrocephalus
• True cephaloceles carry a mortality rate of 40
  and a high incidence of intellectual impairment

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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele
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Cephalocele

• Differential diagnosis
• Cystic hygroma
• Cloverleaf skull
• Scalp edema
• Fetal ear

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Cephalocele

• Ultrasound findings most occur in the head
  region but Meningoceles and Meningomyeloceles can
  also occur anywhere along the spine
• Meningocele cystic
• Meningomyelocele contains brain matter
• Cranial defect is seen
• Cranial cavity appears small if a significant
  portion of the brain is herniated

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Spina Bifida

• Spina Bifida results from a defective closure of
  the neural tube at 5-6 weeks hence there is a
  defect of the vertebra
• Prognosis depends on the severity of lesion and
  is poorest in infants with
• Total paralysis below the lesion
• Hydrocephalus
• Associated congenital defects

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Associated Syndromes

• In general they are frequently seen with
• Meckel's syndrome which demonstrates polydactyly,
  multicystic kidneys (genetic autosomal recessive)
  
• Amniotic band syndrome - non-genetic syndromes

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Spina Bifida

• Closed Spina Bifida
• Covered with skin
• Demonstrates normal AFP levels
• Opened Spina Bifida
• Not covered with skin, this allows for leakage of
  the CSF into the amnion fluid
• Demonstrates an elevated AFP
• Rachischisis completely open spine with
  herniation and/or destruction of spinal cord

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Spina Bifida

• Spina bifida occulta
• Failure of closure of vertebral column with no
  associated external open abnormalities
• Does not produce any clinical signs and AFP is
  normal
• Spina bifida cystica severe form
• Meningocele herniation of meninges
• Meningomyelocele herniation of the meninges and
  spinal cord

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Spina Bifida

• Associated with
• Hydrocephalus
• Encephalocele
• Arnold Chiari
• Sonographic findings
• Protruding sac containing meninges and in some
  cases the spinal cord
• Meningomyelocele is more common and more severe
  than single meningocele
• May occur anywhere along the spine but the lumbar
  region is the most common location
• Splaying of posterior ossification centers

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Spina Bifida

• The skin may or may not cover the cystic area
  (most often the skin does not cover the cyst)
• Both meningoceles and meningomyeloceles are
  characterized by a defect of the soft tissues and
  the vertebral vertebra
• Remember The cisterna magna is often obliterated
  in most cases of spina bifida

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Spina Bifida

• The lumbar and sacrolumbar areas are also
  frequently affected
• Occurrence of spina bifida in north America is
  .5 to 2.0 per every 1,000
• Many spina bifidas detected inutero are
  associated with chromosomal abnormalities

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Spina Bifida

• Defects can be best identified with transverse
  views of the spine
• The sagittal view is helpful in assessing the
  severity of the lesion

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Spina Bifida
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Thoracic Spina Bifida
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Lumbar Spina Bifida
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Thoracic Spina Bifida
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Thoracic Spina Bifida
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Spina Bifida
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Spina Bifida
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TRV Spina Bifida
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Spina Bifida
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Spina Bifida
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Spina Bifida
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Spina Bifida
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Spina bifida
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Spina Bifida
trv view
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Spina Bifida
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SPINA BIFIDA
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Spina Teratoma

• Teratomas are neoplasms derived from pluripotent
  cells and composed of a diversity of tissues
  foreign to the anatomic site in which they arise
• There is an incidence of 1 in 20,000 to 1 in
  40,000 live births
• The neck accounts for about 5 of teratomas

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Cervical Teratoma

• These tumors are typically unilateral with an
  anterolateral location
• They usually appear as cystic masses early in
  gestation becoming larger and more complex as the
  gestation progresses
• Prognosis - more than 90 of these lesions are
  benign and a surgical cure is possible
• Mortality rates are as high as 80 - 100 if
  untreated, usually due to respiratory obstruction

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Sacrococcygeal Teratoma

• A large mass found off the fetal rump
• Usually presents as large for gestational age due
  to the mass size
• Mixed sonographic appearance from solid to cystic

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Sacrococcygeal Teratoma
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Sacrococcygeal Teratoma
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Sacrococcygeal teratoma
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After surgery
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Sacrococcygeal Teratoma (Trish)
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Sacrococcygeal Teratoma
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Sacrococcygeal Teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal teratoma
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Sacrococcygeal Teratoma
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Sacrococcygeal Teratoma