Sonography in Budd-Chiari syndrome.

OBJECTIVE: The objective of this presentation is to provide an overview of sonographic manifestations of Budd-Chiari syndrome (BCS). METHODS: Patients were scanned with ultrasound systems using mainly a 2- to 5-MHz curvilinear transducer and in some patients a 5- to 12-MHz linear transducer. The patients were asked to fast from the previous night or for at least 6 hours. Color and spectral Doppler sonography was performed in all patients. RESULTS: Commonly seen findings in BCS include inferior vena cava (IVC) webs and thrombi, IVC narrowing, hepatic venous thrombosis, enlarged caudate lobes, ascites, intrahepatic or extrahepatic collaterals, monophasic to absent flow in the hepatic veins, and high flow velocities in areas of stenosis in the IVC or hepatic veins. Inferior vena cava stents used in the treatment of BCS could also be seen. CONCLUSIONS: Budd-Chiari syndrome is an uncommon disorder; outcome is poor in many cases; and the condition is often misdiagnosed or underdiagnosed. Sonography is a noninvasive and effective modality for diagnosis of BCS.

Sonographic diagnosis of placental teratoma.

Placental teratomas are very rare, and the features that distinguish them on sonography and allow their differentiation from other placental tumors have not been fully described. Prenatal recognition of this tumor is prognostically useful because, unlike other neoplasms, placental teratoma is benign and almost never associated with congenital deformities in the fetus. We describe the case of a 27-year-old pregnant woman in whom prenatal color Doppler sonographic examination performed during early-stage labor revealed a heterogeneous mass at the placental margin. This lesion, which measured 10 x 8 x 5 cm, had an echogenic focus consistent with calcification and hyperechoic foci consistent with fat. Placental teratoma and fetus acardius amorphus were considered in the differential diagnosis, but the segmental organization and umbilical cord-like structures that characterize the latter diagnosis were absent. The sonographic diagnosis, placental teratoma, was confirmed postnatally by histopathologic examination. The neonate, a healthy boy, was delivered vaginally at term. Although the presence of tissues of varied echogenicity, such as calcification, fat, and fluid, and the absence of both polarity and an umbilical cord-like structure support the sonographic diagnosis of placental teratoma, fetus acardius amorphus should be considered in the differential diagnosis. Histopathologic examination may be needed to establish a definitive diagnosis in such cases.

Antenatal detection of idiopathic arterial calcification with hydrops fetalis.

Idiopathic arterial calcification of infancy, or occlusive infantile arterial calcification, is a rare cause of arterial calcification. This condition is inherited as an autosomal recessive pattern, which is almost always fatal. In most of the 100 cases described in the literature, the diagnosis was made at autopsy; a few cases have been reported in which an antemortem diagnosis was made on the basis of radiographic or sonographic demonstration of arterial calcification. The clinical characteristics are extremely variable, and respiratory distress with cardiac failure is the most common finding. Hypertension that is refractory to treatment is present in most cases. Most infants die before the age of 6 months, and very few have survived for more than 1 year. Mortality in this condition is caused by myocardial ischemia due to coronary artery involvement or refractory cardiac failure. The purpose of this report is to describe the prenatal diagnosis of idiopathic arterial calcification. Fewer than 10 cases of antenatal detection of this condition have been reported in the literature. This case is 1 of 2 cases with the earliest diagnosis of this condition so far (Table 1).

Aneurysms of the inferior vena cava.

Two cases of saccular aneurysms of the infrarenal inferior vena cava (IVC) associated with retrohepatic IVC obstruction are described. Ultrasonographic, computerized tomographic and inferior venacavography findings in these cases are presented.

Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.