HDlive imaging of fetal enteric duplication cyst

Abstract

Enteric duplication cysts are rare congenital anomalies, but their antenatal diagnosis is becoming more common because of advances in ultrasonography. With the latest state-of-the-art technology, HDlive facilitates a more realistic anatomical visualization of different fetal organ structures, making diagnosis more precise. We present a case of antenatal HDlive imaging of an enteric duplication cyst. A 26-year-old pregnant Japanese woman was referred to our ultrasound clinic because of a fetal intra-abdominal cyst at 27 weeks of gestation. Two-dimensional (2D) ultrasound revealed a sonolucent, ellipsoid structure in the subhepatic area. Magnetic resonance imaging yielded the same findings. However, irregular internal echoes appeared at 33 weeks of gestation. There was no vascularity on color Doppler. HDlive clearly depicted a more realistic image of the circular mass, which was thick walled, with a large amount of debris inside, and showed no communication with adjacent structures. Careful monitoring was conducted for these unusual findings. A day after delivery, an emergency operation was performed because the infant had sudden signs and symptoms of obstruction. Intra-operative findings were ileus and a necrotic ileal duplication cyst confirmed by histopathologic studies. Complications of enteric duplication cyst can arise at any time of life, and so thorough monitoring may be recommended. The findings of irregular internal echoes and a large amount of debris inside the cyst are relatively characteristic features of a complicated cyst. HDlive gives us additional information on the actual appearance of a complicated cyst that may be difficult to obtain using conventional 2D sonography alone. HDlive can be very useful in the antenatal surveillance of enteric duplication cysts.

HDlive in the Assessment of Fetal Intracranial, Intrathoracic and Intra-abdominal Anomalies

“…It is a rare cystic lesion usually located in the small intestine, particularly in the ileus. 21 2D sonography shows a thick-walled cyst with heterogeneous internal echoes (Fig. 22A).…”

“…22A). 21 HDlive provides a more discernible image of a rounded structure with a thick wall, no communication with other intra-abdominal structures, and presence of large amounts of thick debris inside which can be visualized with conventional 2D sonography (Fig. 22B).…”

“…22B). 21 This collection of thick debris is due to the necrosis of internal mucosa from gradual torsion of the cyst causing intestinal obstruction in utero.…”

How to obtain diagnostic planes of the fetal central nervous system using three-dimensional ultrasound and a context-preserving rendering technology

“…Several Authors have focused on 3D US as a complementary tool in the evaluation of the secondary palate (25)(26)(27)(28)(29)(30)(31)(32) or the fetal mandible (24,33), and recent reports have suggested that the subjective (34)(35)(36)(37)(38)(39)(40) or semiautomated (41) detection of facial dysmorphisms using 3D US can contribute in the identification of highly suggestive features of genetic syndromes. Also skeletal (42)(43)(44), cardiac (45)(46)(47)(48)(49)(50)(51)(52)(53) and thoracoabdominal (54,55) imaging may benefit from 3D US assessment, while more recent advances in 3D imaging have focused on the implementation of intelligent software for the automated data extraction from 3D volume datasets for clinical purposes. Within this scenario, fetal intelligent navigation (56)(57)(58)(59) and the 5D CNS+ (60) software have been designed with the aim to provide the clinicians valuable and reliable tools capable to simplify the ultrasound assessment of the fetal heart and brain, respectively.…”

HDlive Flow Silhouette Mode for Fetal Heart

“…HDlive uses an adjustable light source, creating lighting and shadowing effects, thereby increasing depth perception, to generate realistic images of the normal fetus and fetal anomalies. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Using the HDlive silhouette mode, we can obtain novel information on normal fetal structures, congenital deformities, and placental abnormalities. [18][19][20][21] It can visualize outlines of structures of interest at the same time as visualizing the inner core, meaning that it is more effective for identifying normal anatomy and congenital deformities.…”