most common non-ob surgical condition fetal loss >30% if ruptured,
DESCRIPTION
APPENDICITIS. Most common non-OB surgical condition Fetal loss >30% if ruptured,TRANSCRIPT
• Most common non-OB surgical condition
• Fetal loss >30% if ruptured, <2% if not
• Difficult clinical diagnosis:• Majority of cases afebrile
• Physiologic increase WBC6-16,000 & up to 30,000 in labor
• N/V common in pregnancy
• Site of pain may be unusual
APPENDICITIS
Ax T1w: normal appendix
MR SAFETYRECOMMENDATIONS
• No known adverse fetal effects• Safety concern: energy deposition• MR only if US not adequate • Depending on risk/benefit:
• Avoid MR in first trimester• Avoid Gadolinium
(FDA pregnancy category C)
Preparation & Positioning
• NPO x 4 hours
• Supine or decubitus position• LLD: better for IVC compression
• Phased array coil• Large patient: 2 phased array or body coil
Maternal MR: Technique
• 3 plane 6mm T2w HASTE (Seimens) or SSFSE (GE)
• Coronal, axial T2/T1w True-FISP
• Review to determine need for additional sequences or gadolinium
Additional Noncontrast Sequences
• Fat-suppressed T2w• Inflammation, especially if no gad
• T1w or fat-suppressed T1w• Blood products, fat vs. blood, endometriosis
• Thick slab T2w echo train spin echo• MRCP, MR Urography
• Phase contrast/time of flight: vascular
• Dynamic imaging if neededVascular tumor, accreta
• Delayed fat-suppressed T1WInfection, inflammation
Gadolinium
APPENDIX ON MR
Appendix seen in 10/12 pregnant patients with suspected appendicitis(AJR 2004;183:671-5)
Thin slices and cross-referencing tool helpful
APPENDICITIS
Pregnant with abdominal pain
T2w
T2w FS
34 yo RLQ pain
DEGENERATING FIBROID
Courtesy of Aytekin Oto, M.D.
RUPTURED APPENDICITS
Courtesy of Aytekin Oto, M.D.
RUPTURED APPENDICITIS
33 yo at 31 weeks, right-sided pain
10 weeks pregnant, abdominal pain and fever
COLITIS
Courtesy of Aytekin Oto, M.D.
Courtesy of Aytekin Oto, M.D.
PELVIC ABSCESS
DIVERTICULAR ABSCESS
ULCERATIVE COLITIS
PERITONITIS
Pregnant, history of Crohn dz now with pain and fever
DEGENERATING FIBROID
Fibroids & Pregnancy
• Pain during pregnancy can be severe• Rapid growth
• Degeneration
• Torsion
• Degeneration may lead to premature labor
DEGENERATING FIBROID
35 yo 19 weeks pregnant with severe RLQ pain
DEGENERATING FIBROID
SHORT CERVIX
18 yo 17 weeks pregnant, RLQ pain x 2 mos, now acutely worse
TORSED FIBROID
Surgery: pedunculated fibroid, stalk twisted 360 degrees
SMALL BOWEL OBSTRUCTION
• Adhesions > volvulus >> other causes
• High incidence of necrotic bowel
• Fetal mortality 20-26%• Only 1/3 complete to term after surgery
• Most significant contributor to mortality: delayed diagnosis and treatment
• MR: Ultra-fast sequences (HASTE, FISP) helpful due to minimal motion artifact
30 yo at 36 weeks with abdominal & pelvic pain
SMALL BOWEL OBSTRUCTION
Surgery: sbo, multiple adhesions
INTUSSUSCEPTION
Pregnant with abdominal and pelvic pain, nausea and vomiting
CHOLECYSTITIS
• Pregnant women predisposed to torsion
• Ultrasound diagnostic unless ovaries poorly visualized due to pregnancy
• MR appearance: enlarged ovary with increased stromal SI on T2w
• Increased SI on T1w suggests hemorrhage or vascular congestion
• Gadolinium may be diagnostic
OVARIAN TORSION
OVARIAN TORSION
Courtesy of David McFadden, MD
25 yo 15 weeks pregnant with RLQ pain
OVARIAN TORSION
T2w
OVARIAN TORSION
25 yo 15 weeks pregnant with RLQ pain and adnexal mass on ultrasound
PYELONEPHRITIS
19 yo pregnant woman with right-sided pain and fever
Sickle Beta Thalassemia