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Contrast material-enhanced computed tomography (CT) was performed in 100 patients. Fifty milliliters of contrast material was intravenously injected by hand and followed by a drip infusion of 100 mL of contrast material. Venous air embolism occurred in 23% of the patients. The amount of embolism was minimal in 20 patients and moderate in three. Although large amounts of embolism have been reported to be associated with considerable morbidity and mortality, none of the patients in this study had immediate or delayed complications as a result of the small degree of embolism. The locations of the emboli were in the subclavian or axillary vein in nine, right or left brachiocephalic vein in three, internal jugular vein in two, superior vena cava in two, right ventricle in two, and main pulmonary artery in 12 patients. In patients at high risk for cerebral air embolism, such as those with intracardiac shunts or pulmonary arteriovenous malformations, extreme caution should be used--even in the routine administration of intravenous fluids or contrast media--to prevent venous air embolism and resultant neurologic deficits.

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The kidneys of 20 asymptomatic pregnant women were examined sequentially from the first trimester through the postpartum period. In 41.5 per cent, progressive dilatation, more marked on the right side, was seen; however, the remainder demonstrated varying, static, or even diminishing ectasia. In all but two dilatation had reverted to normal by six weeks post partum. The finding of minimal dilatation speaks against pathologic obstruction even in the symptomatic patient. Asymptomatic patients can, however, show variable degrees of hydronephrosis with progression or regression through the course of gestation. The finding of dilatation must be interpreted with caution by virtue of these sequential variations. (Key words: hydronephrosis; obstetrics; preg· nancy) Dilatation of the upper urinary tract in pregnancy has been recognized since 1843.1 Ultrasonography is a well-established means of determining the presence or absence of obstruction of the renal collecting systems, and has been widely applied to the study of hydronephrosis. 2 M 1 To our knowledge, sequential studies of maternal kidneys beginning in early pregnancy and covering the postpartum period have not been published. We therefore under· took a prospective study of a group of women from the first trimester through the six-week postpartum period. MATERIALS AND METHODSWe chose a group of 20 asymptomatic women who had no history of previous renal disease. Any potential subject who had a history of symptoms referable to the urinary tract or known renal disease was eliminated from the study. Informed consent was obtained in every case.Ultrasound examination of the kidneys was accomplished with a commercially available digital gray-scale unit using a 3.5-MHz medium internally focused transducer. Sagittal and transverse scans Address correspondence and reprint requests to Dr. Fried.were obtained, preferably with the patient in the prone position; if the patient could not tolerate this position, an oblique modification was used. Patients were asked to void prior to scanning of the kidneys.Examinations of both kidneys were obtained in the first, second, and third trimesters and an additional scan was performed at six weeks postpartum. This was accomplished in the majority of cases; however, several women did not keep appointments in either the third trimester or the postpartum period.Separation of the pelvicalyceal echo complex was measured in millimeters for each kidney in each of the three trimesters and at the six-week-postpartum visit. RESULTSAs can be seen from table 1, the average dilatation of the pelvicalyceal system was always greater on the right than on the left. Dilatation was identified in the first trimester, and the average dilatation of the study population as a whole advanced with advancing gestational age. Figure 1 is a representation of the distribution of individual measurements. Notice that the general pattern is essentially the same for both kidneys except that the magnitude of dilatation is greater on the right than on the left. The average...

Ultrasound has facilitated the antenatal diagnosis of a variety of gastrointestinal abnormalities such as duodenal atresia, choledochal cysts and omphal~cele.l-~ We present a case of midgut volvulus diagnosed prenatally by ultrasound as a further differential diagnostic consideration in the evaluation of cystic abdominal masses in the fetus. CASE REPORTA 22-yr-old prima gravida was referred for determination of gestational age. Her pregnancy had been complicated a t 33 wk by premature onset of labor treated with ritodrine. At 35 wk, labor began again after premature rupture of membranes. At that time, ultrasound exam revealed a single fetus with gestational age between 31.5 to 34.5 wk. A large mass was detected in the fetal abdomen [Figs. 1(A) and 1fB)I. This measured 10.5 cm in maximum diameter and was located anteriorly with its long axis transverse to that of the fetal spine. The mass was separable from both kidneys. Its internal structure was primarily cystic but appeared to contain septations and a fluid-debris level [ Fig. l(C)]. The amount of amniotic fluid was felt to be increased considering the history of rupture of membranes.The patient delivered a live 2500-g female infant the day following the ultrasound exam. Delivery was complicated by meconium-stained fluid with aspiration necessitating resuscitation.The infant presented with an ecchymotic distended abdomen measuring 35 cm in circumference. A 7-cm abdominal mass was palpable. Xray examination of the abdomen showed a large central mass with a long air fluid level (Fig. 2).Because of the possibility of a perforated viscus, exploratory laparotomy was performed revealing a large cystic abdominal mass filled with green fluid. Microscopic examination of its membrane was consistent with that of a pseudocyst with young fibrous tissue infiltrated by acute and chronic inflammatory cells and fragments of amorphous eosinophilic debris with calcifications. The pseudocyst represented the necrotic remnant of the gut from the midduodenum to the midtransverse colon. Despite supportive care, the infant expired on the third day. DISCUSSIONTo our knowledge, this represents the first report of a case of midgut volvulus observed antenatally. Midgut volvulus results from failure of normal midgut rotation in ~t e r o .~ As a result, the gut lacks the broad mesenteric attachment that normally fixes it to the posterior abdominal wall. The gut may then rotate to a greater or lesser degree around the superior mesenteric artery. Ischemia from occlusion of the arterial supply can result in necrosis of the twisted intestine with dissolution of the twisted loops into a pseudocyst.6 The length of bowel affected varies but, as in our patient, it can involve the intestine from the ligament of Treitz to the midtransverse colon. The etiology of failure of midgut rotation is unknown.The pseudocyst in our case presented as a predominantly cystic anterior abdominal mass. Some internal echoes were detected, possibly representing remnants of tissues broken down within the pseudocapsule. T...

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