TORCH INFECTIONS AND PRENATAL ULTRASOUND FINDINGS Eran

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TORCH INFECTIONS AND PRENATAL ULTRASOUND FINDINGS
Eran Casiff M.D.
Department of Obstetrics and Gynecology Kaplan
Medical Center Rehovot 76100, Israel
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Limitations

• Most infected fetuses are sonographically normal
• Ultrasound findings may change with time
• no correlation with infant outcome

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Cerebral Ventriculomegaly

• Measured at the posterior aspect of the choroid
  plexus
• Almost always symmetric
• 5 of cases can be attributed to fetal infection

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Intracranial Calcifications

• Intrauterine infection
• Periventricular hyperechoic foci - the hallmark
• May be located in the thalami and basal ganglia
• Small with no acoustic shadowing
• Most frequently seen with CMV and Toxoplasmosis

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hydranencephaly

• Most severe manifestation of the destructive
  process
• Cerebral hemispheres replaced by fluid, brain
  stem preserved, falx present, absent or deviated,
  posterior fossa structures can be identified
• reported in Herpes simplex, Toxoplasmosis and
  CMV

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Microcephaly

• Often associated with other CNS anomalies
• Diagnosed as three SD below the mean for
  gestational age
• Abnormal HC/AC and HC/FL ratios
• Isolated microcephaly documented in CMV, Rubella
  and Herpes simplex

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Cardiac abnormalities

• Cardiomegaly, mostly in CMV
• Cardiothoracic ratio
• VSD, ASD, Pulmonic stenosis and coaractation of
  the aorta in Rubella

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Hepatosplenomegaly

• Documented in all TORCH infection
• Often a transient finding
• Normograms are available

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Intra-abdominal Calcifications

• Typical appearance echgenic foci with acoustic
  shadowing
• Peritoneum, intestinal lumen, organ parenchyma,
  biliary tree and vascular structures
• Echogenic bowel in CMV and Toxoplasmosis

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Hydrops, Placenta and Amniotic fluid

• Hydrops reported in most TORCH but may be
  transient
• Placentomegaly is usually associated with
  intrauterine infection, but small placentae have
  also been reported
• Hydramnios and oligohydramnios have been reported
  with similar frequency

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Fetal growth restriction

• Estimated weight below the 10th percentile
• common feature with CMV, Rubella, Herpes simplex
  and Varicella
• Usually not seen with Toxoplasmosis and Syphylis

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TOXOPLASMOSIS

• Ventriculomegaly is the most frequently
  documented finding
• Intracranial calcifications, placentomegaly,
  liver calcifications and ascites
• hyperechoic bowel have been reported
• microcephaly never been reported in utero

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SYPHILIS

• Hepatomegaly and Placentomegaly are the most
  frequent sonographic manifestations
• Ascites, Hydrops and Hydramnios are less commonly
  reported
• Resolution of sonographic signs have been
  reported with maternal antibiotic therapy

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RUBELLA

• Incidence less than 1100,000 live birth
• Prenatal diagnosis by sonographic findings have
  never been reported
• Potential detected abnormalities include cardiac
  anomalies, microcephaly, hepatosplenomegaly, FGR,
  microphtalmia and cataract

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CMV

• The most common congenital infection affecting 1
  of all live births
• 10 of infected neonates demonstrate clinical
  manifestations that potentially could be
  identified by prenatal sonography
• Ventriculomegaly, FGR, Intracranial
  calcifications and oligohydramnios are the most
  frequently reported findings

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HERPES SIMPLEX

• HSV are usually acquired at birth
• Intrauterine infections resulting in clinical
  signs has been reported in 100 cases worldwide
• Hydranencephaly is the only sonographic sign
  reported antenatally
• Microcephaly, intracranial calcifications and FGR
  are potentially detectable

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VARICELLA ZOSTER

• The most common finding is Hydramnios
• Also reported liver calcifications,
  hepatomegaly, hydrops, limd deformities,
  ventriculomegaly and FGR

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SUMMARY

• Sonography is not a sensetive test for fetal
  infection
• Normal fetal anatomy survey cannot predict a
  favorable outcome
• Multiple organ systems are affected in 50 of
  cases

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THANK YOU FOR YOUR

• ATTENTION