Color Doppler imaging aids in the prenatal diagnosis of congenital diaphragmatic hernia

Botash, Robert J.; Spirt, Beverly A.

doi:10.7863/jum.1993.12.6.359

Cited by 16 publications

(15 citation statements)

References 3 publications

(5 reference statements)

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“…Case reports and a limited case series previously showed that the position of the umbilical and hepatic veins can be useful for identifying liver herniation 13 – 15 . This feature was shown in a case of a right‐sided hernia described by Botash and Spirt 13 in 1993 in which color Doppler imaging showed a vessel extending from the right lobe of the liver in the right upper abdomen into an echogenic mass in the right chest. This finding suggested the diagnosis of a right‐sided CDH.…”

Section: Discussionmentioning

confidence: 92%

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Fetal Umbilical Vein Deviation in Congenital Diaphragmatic Hernia

Richards

Kays

2013

Journal of Ultrasound in Medicine

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ongenital diaphragmatic hernia (CDH) is a birth defect with a high rate of morbidity and mortality. [1][2][3] To optimize outcomes, it is critical that screening ultrasound examinations detect affected fetuses. When CDH is recognized, preparations for delivery at the proper place and time can be made, allowing immediate optimal care of the neonate. [3][4][5] With prenatal diagnosis, the fetus can be fully evaluated, and parents can be appropriately counseled.Since most birth defects occur in low-risk patients, it is critical that sonographers performing screening examinations be aware of signs indicating serious anomalies such as CDH. The most readily recognizable findings with fetal CDH include deviation of the heart to the side of the chest opposite the hernia and, with left sided hernia, displacement of the stomach into the chest. 6 Since these signs are present in almost all cases, it is somewhat surprising that only half of ORIGINAL RESEARCHObjectives-Deviation of the intra-abdominal umbilical vein has been described as a marker of congenital diaphragmatic hernia (CDH) and has been shown to help identify liver herniation into the fetal chest. The purpose of this study was to quantify the degree of deviation in affected fetuses and to determine the accuracy of measurements for diagnosing liver herniation.Methods-In patients undergoing prenatal sonography for CDH, the midhepatic portion of the umbilical vein was identified, and the distance between the lateral edge of the vein and the inner rib margin was measured. The same was done on the right, and the ratio of the left to right measurement was termed the "umbilical vein ratio." The accuracy of the umbilical vein ratio for predicting the presence and side of the hernia and for diagnosing liver herniation was determined.Results-All but 1 of the cases with right-sided hernias had an umbilical vein ratio above the normal range, and all had liver herniation. Of those with a left-sided hernia, only 2 had a ratio within the normal range. Of those with a left-sided hernia, an umbilical vein ratio less than 0.4 was shown by receiver operating characteristic curve analysis to be the best predictor of liver herniation. This cutoff had sensitivity of 89% for predicting herniation, with a false-positive rate of 14%.Conclusions-Ninety-three percent of right-sided CDH lesions and 98% of left-sided lesions have an umbilical vein ratio outside the normal range. This finding shows that deviation may a useful indicator of CDH in screening ultrasound examinations. An umbilical vein ratio less than 0.4 is predictive of liver herniation.

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Section: Discussionmentioning

confidence: 92%

“…It has previously been reported that the position of the umbilical vein and its branches can aid in the evaluation of fetuses with CDH 13 – 15 . It has been noted that the umbilical vein may bow toward the side of the defect.…”

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confidence: 99%

Fetal Umbilical Vein Deviation in Congenital Diaphragmatic Hernia

Richards

Kays

2013

Journal of Ultrasound in Medicine

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“…The occurrence of left‐sided CDH has been reported to be 5 times more common than right‐sided CDH . A limitation of this study was that right‐sided and bilateral CDH were not analyzed.…”

Section: Discussionmentioning

confidence: 96%

“…Accurate diagnosis of CDH on the basis of sonography may be difficult, as it can be easily confused with other noncardiac thoracic masses, such as a congenital cystic adenomatoid malformation of the lung, bronchopulmonary sequestration, a bronchogenic cyst, and a mediastinal teratoma. In 1993, Botash and Spirt reported a case of CDH at 34 weeks with herniation of the liver. Color Doppler sonography gave a clue to the diagnosis, as there was a vessel extending from the liver parenchyma to the right hemithorax.…”

Section: Discussionmentioning

confidence: 99%

“…Early detection of CDH and omphalocele at the first‐trimester aneuploidy scan has the potential advantages of offering the couple early counseling options and the opportunity for genetic sampling. In the past, Botash and Spirt and Detti et al suggested that color Doppler studies can aid in the diagnosis of CDH. The course of the superior mesenteric artery (SMA) can be used as a valuable predictor to detect left‐sided CDH and also to assess the content of omphalocele in the first trimester, which has been shown in our study.…”

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confidence: 99%

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The Upturned Superior Mesenteric Artery Sign for First‐Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele

Lakshmy

Agnees

Rose

2017

J of Ultrasound Medicine

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Second-trimester sonography for detection of congenital malformations is a standardized protocol, but a careful anatomic survey at the 11- to 14-week scan is often rewarding. When there is a suspicion of an intrathoracic mass or a mediastinal shift, the upturned course of SMA serves as a valuable sign in confirmation of CDH. Chromosomal abnormalities are often reported in cases of omphalocele containing small bowel only, and the upward course of the SMA toward the base of the cord helps in its early prenatal diagnosis, which facilitates early genetic assessment in these fetuses.

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Prenatal sonography of extracorporeal ductus venosus in association with large fetal gastroschisis

Sherer

O'Brien

Zayat

et al. 2020

J of Clinical Ultrasound

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Liver herniation commonly associated with omphalocele occurs in only approximately 2.3% to 16% of fetuses with gastroschisis. Liver herniation in such cases is associated with considerably decreased survival rates (43% vs 97% with or without liver herniation, respectively). Rarely, abnormally positioned fetal hepatic vasculature has been reported mainly in association with congenital diaphragmatic hernia. In these rare cases, intrathoracic depiction of hepatic venous vasculature has assisted in confirming intrathoracic displacement of the fetal liver. We present a case of a large gastroschisis with complete herniation of the fetal liver in which prenatal sonography depicted an extracorporeal ductus venosus.

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Color Doppler imaging aids in the prenatal diagnosis of congenital diaphragmatic hernia

Cited by 16 publications

References 3 publications

Fetal Umbilical Vein Deviation in Congenital Diaphragmatic Hernia

Fetal Umbilical Vein Deviation in Congenital Diaphragmatic Hernia

The Upturned Superior Mesenteric Artery Sign for First‐Trimester Detection of Congenital Diaphragmatic Hernia and Omphalocele

Prenatal sonography of extracorporeal ductus venosus in association with large fetal gastroschisis

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