Two‐ and three‐dimensional prenatal sonographic diagnosis of prune‐belly syndrome

Abstract

We report the prenatal diagnosis of 6 cases of Prune-belly syndrome in the 2(nd) trimester. The sonographic diagnosis was based on the findings of oligohydramnios, renal anomalies, and a lower abdominal cystic mass representing the abnormal dilatation of the bladder on conventional 2-dimensional sonographic examination. We discuss the role of Doppler imaging and 3-dimensional sonography as complementary methods to conventional sonography. Four of our 6 cases were confirmed with associated defects.

Fetal Megacystis

“…The characteristic sonographic triad of prune belly syndrome includes anterior abdominal wall distention with deficiency or absence of abdominal wall musculature, megacystis, and pulmonary hypoplasia. About 97% of cases occur in male fetuses 3 , 4 . It is reported to occur 4 times more frequently in twin than in singleton gestations 2 , 5 …”

“…Evaluation of the bladder with Doppler imaging, 3D imaging with orthogonal planes, and 4D imaging with virtual organ computer‐aided analysis helps with the diagnosis and suggests the cause of the enlarged bladder 4 , 36 – 39 . Abdominal distention is more evident and thoracic compression can be better observed with these modes.…”

“…The marked attenuation of the abdominal and bladder walls can be appreciated, and the keyhole sign can be seen more clearly. Doppler scanning allows visualization of vascular distortion around the distended structures and permits evaluation of the severity of the renal lesion 4 , 36…”

“…Prune belly syndrome can be confused with megacystis secondary to posterior urethral valves and with urethral atresia, with which it is also associated 4 , 40 . Prune belly syndrome has been identified as “plum belly” syndrome when there is complete urethral obstruction 15 …”

Prune belly syndrome

“…Cases of trans-abdominal ultrasound diagnosis between 11 and 14 weeks of gestation have been reported [23][24][25]. Key elements in the sonographic diagnosis of PBS include bilateral hydroureter and hydronephrosis, a distended, thin-walled bladder and oligohydramnios [26]. Oligohydramnios implies reduced urine output, poor renal function and subsequent lung hypoplasia.…”