us fetal abdomen

8/10/2019 US fetal abdomen

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Ultrasound EvaluationUltrasound Evaluation

Fetal Abdomen

Director of Ultrasound Research & Education

Geisinger Medical Center

Danville, Pennsylvania

Mani Montazemi, RDMS

Current Official Practice GuidelineCurrent Official Practice Guideline

Abdomen

Anterior abdominal wall

Cord insertion

Abdomen

Anterior abdominal wall

Cord insertion

Fetal Abdomen

Presence, size, situs

Kidneys

Bladder

Number of umbilical cord vessels

Presence, size, situs

Kidneys

Bladder

Number of umbilical cord vessels

Scanning TipsScanning Tips

Fetal Abdomen


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Fetal StomachFetal Stomach

Wide range of shapes

Round to oval to kidney-shaped

Wide range of sizes

4mm to 4cm

Wide range of shapes

Round to oval to kidney-shaped

Wide range of sizes

4mm to 4cm

Fetal Abdomen

Variable filling and emptying

Based on fetal swallowing and peristalsis

Variable filling and emptying

Based on fetal swallowing and peristalsis

Non-visualization of the StomachNon-visualization of the Stomach

< 19 wks, 50% ABNL

> 19 wks, 100% ABNL

< 19 wks, 50% ABNL

> 19 wks, 100% ABNL

Fetal Abdomen

Esophageal AtresiaEsophageal Atresia

Fetal Abdomen


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Incidence 1 in 2500 to 4000 live births

Overall detection rate only 50%Most of the polyhydramnios occur after 24 weeks

Incidence 1 in 2500 to 4000 live births

Overall detection rate only 50%Most of the polyhydramnios occur after 24 weeks

Fetal Abdomen

ma stomac u e cou e sm sse as e ng

normal

ma stomac u e cou e sm sse as e ng

normal


Small stomach depend on the type of

esophageal atresia

5 types - most common with

Small stomach depend on the type of

esophageal atresia

5 types - most common with

Fetal Abdomen

tracheoesophageal fistula

Fluid may cross the fistula

Gastric secretions may accumulate

tracheoesophageal fistula

Fluid may cross the fistula

Gastric secretions may accumulate


High incidence of additional

anomalies > 50%

Cardiac, other GI, GU track,

CNS, Facial, skeletal, T18/21

40 % have IUGR

High incidence of additional

anomalies > 50%

Cardiac, other GI, GU track,

CNS, Facial, skeletal, T18/21

40 % have IUGR

Fetal Abdomen

Incidence three times higher

in twins

Classic findings

Polyhydramnios

Absent or small stomach

bubble

Incidence three times higher

in twins

Classic findings

Polyhydramnios

Absent or small stomach

bubble


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Non-visualization or

Always Small Stomach (< 1cm)

Non-visualization or

Always Small Stomach (< 1cm)

Causes:

High Gastrointestinal obstructionMouth to esophagus

Causes:

High Gastrointestinal obstructionMouth to esophagus

Fetal Abdomen

Thoracic or neck mass

Swallowing disorders

Defect or mass in the fetal mouth (clefts)

Severe neurologic or muscular abnormalities

Thoracic or neck mass

Swallowing disorders

Defect or mass in the fetal mouth (clefts)

Severe neurologic or muscular abnormalities

What do you see?What do you see?

Fetal Abdomen

Duodenal ObstructionDuodenal Obstruction

Fetal Abdomen

Large, obstructed stomach and a distended proximal duodenumLarge, obstructed stomach and a distended proximal duodenum


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Two cystic structures in the abdomen that

communicate with each otherClassic double bubble

Two cystic structures in the abdomen that

communicate with each otherClassic double bubble

Fetal Abdomen


Can be seen as early as 22 weeks, usually itsnot apparent up until 29-32 weeks

Polyhydramnios after 24 weeks

Can be seen as early as 22 weeks, usually itsnot apparent up until 29-32 weeks

Polyhydramnios after 24 weeks

Fetal Abdomen

e ec on ra e = on y

Associated with a 30% incidence of trisomy 21

Associated with VACTERL complex

e ec on ra e = on y

Associated with a 30% incidence of trisomy 21

Associated with VACTERL complex

VACTERL ComplexVACTERL Complex

Vertebral defects

Anal atresia

Cardiac defects

Vertebral defects

Anal atresia

Cardiac defects

Fetal Abdomen

Tracheoesophageal fistula

Esophageal atresia

Renal anomalies

Limb defects

Tracheoesophageal fistula

Esophageal atresia

Renal anomalies

Limb defects


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Duodenal ObstructionMajority of cases are due to mechanical problems

Duodenal ObstructionMajority of cases are due to mechanical problems

Intrinsic causes structural abnormalities

Atresia (42%) half of all duodenal atresias occur with Down syndrome, although

conversely, few cases of Down syndrome have duodenal atresia

Intrinsic causes structural abnormalities

Atresia (42%) half of all duodenal atresias occur with Down syndrome, although

conversely, few cases of Down syndrome have duodenal atresia

Fetal Abdomen

Stenosis (38%)

Extrinsic causes external cause

Annular pancreas

Malrotation

Ladds bands

Stenosis (38%)

Extrinsic causes external cause

Annular pancreas

Malrotation

Ladds bands


Prognosis is dependent

upon whether other

anomalies are present

and their severity

Prognosis is dependent

upon whether other

anomalies are present

and their severity

Fetal Abdomen

Polyhydramnios is a constant

feature in all intestinal atresia

Polyhydramnios is a constant

feature in all intestinal atresia

Fetal Abdomen


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Ventral Wall DefectsVentral Wall Defects

Omphalocele

Central defect

Associated anomalies are common

High risk of aneuploidy

Omphalocele

Central defect

Associated anomalies are common

High risk of aneuploidy

Gastroschisis

Periumbilical defect

Associated anomalies are uncommon

Little to no risk of aneuploidy

High rate of bowel related

Gastroschisis

Periumbilical defect

Associated anomalies are uncommon

Little to no risk of aneuploidy

High rate of bowel related

Fetal Abdomen

comp ca ons

Associated with substance abuse &medications

comp ca ons

Associated with substance abuse &medications

OmphaloceleOmphalocele

Fetal Abdomen

Herniation of intraabdominal contentsinto the base of the cord

ALWAYS covered by a membrane


Umbilical cord inserts onto membrane In large defects may be displaced eccentrically

The herniated bowel isNOT directly exposed to

amniotic fluid

Umbilical cord inserts onto membrane In large defects may be displaced eccentrically

The herniated bowel isNOT directly exposed to

amniotic fluid

Fetal Abdomen

Bowel usually does not thicken or dilate Bowel usually does not thicken or dilate


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Is This an Omphalocele?Is This an Omphalocele?

Fetal Abdomen

Pseudo-OmphalocelePseudo-Omphalocele

Fetal Abdomen

Caused by scanning oblique or

by excessive transducer pressure

Caused by scanning oblique or

by excessive transducer pressure

OmphaloceleCan be a small or large wall defect

OmphaloceleCan be a small or large wall defect

Fetal Abdomen


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Small

Failure of normal midgut rotationCord midpositioned

Small

Failure of normal midgut rotationCord midpositioned

Fetal Abdomen

sua y con a ns on y owe

Associated with chromosomal

anomalies

sua y con a ns on y owe

Associated with chromosomal

anomalies


Large

Failure of anterior abdominal

wall closure

Large

Failure of anterior abdominal

wall closure

Fetal Abdomen

May contain organs

Scoliosis

Associated with structural

anomalies

May contain organs

Scoliosis

Associated with structural

anomalies


Measurements of AC

Fetal Abdomen

be excluded from

biometric calculations


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IUGR has been reported in 20% of patients

50% have associated anomalies (20% cardiac)

30% are associated with trisomy 13 & 18

IUGR has been reported in 20% of patients

50% have associated anomalies (20% cardiac)

30% are associated with trisomy 13 & 18

Fetal Abdomen

Elevated maternal serum alpha-fetoprotein (70%) Elevated maternal serum alpha-fetoprotein (70%)


Omphalocele and cord cyst may co-exist

Whartons jelly cyst mucoid degeneration of Wharton Jelly

Allantoic cyst always near insertion site

Omphalomesenteric duct cyst associated with intraabdominal

Omphalocele and cord cyst may co-exist

Whartons jelly cyst mucoid degeneration of Wharton Jelly

Allantoic cyst always near insertion site

Omphalomesenteric duct cyst associated with intraabdominal

Fetal AbdomenJane J.K. Burns, RDMS

mesenteric cystsmesenteric cysts

Diagnostic ChallengeDiagnostic Challenge

Separate from but contiguous with the bladder

Fetal Abdomen


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Patent Urachus With Allantoic CystPatent Urachus With Allantoic Cyst

Urachus is an embryological remnant of the

allantois which runs from the apex of the bladder

through the umbilical ring to terminate in the

proximal umbilical cord

Fetal Abdomen

Umbilical Cord

Allantoic Stalk

Yolk Stalk

Cloaca

A Ruptured Omphalocele

Can Resemble Gastroschisis

A Ruptured Omphalocele

Can Resemble Gastroschisis

Fetal Abdomen

Omphalocele @11 Weeks ?Omphalocele @11 Weeks ?

Fetal Abdomen

Potential PitfallPotential Pitfall


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Normal Midgut HerniationNormal Midgut Herniation

Fetal bowel normally herniates into the base

of the umbilical cord at approx. the 7-8 weeksMA

Fetal bowel normally herniates into the base

of the umbilical cord at approx. the 7-8 weeksMA

Fetal Abdomen

-

Should not be visible by 12 week

-

Should not be visible by 12 week

Possible Anomaly

CRL > 44mm with persistent herniation

Maximum dimension of abdominal mass > 7mm

Normal Midgut HerniationNormal Midgut Herniation

This appearance should not be mistaken for a

ventral wall defect

This appearance should not be mistaken for a

ventral wall defect

Fetal Abdomen

Midgut (umbilical) herniation

beyond the 12th week of gestation

has to be considered pathological

Fetal Abdomen


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GastroschisisGastroschisis

Fetal Abdomen

Small defect to right of cord insertion

No membrane over bowel


Incidence is 1 in 3000 births

Varies considerably with

maternal age

Strong association reported

among younger patients

Incidence is 1 in 3000 births

Varies considerably with

maternal age

Strong association reported

among younger patients

Fetal Abdomen

Less likely for organ

herniation

Variable amounts of bowel

herniated

Bowel floats within

amniotic fluid

Less likely for organ

herniation

Variable amounts of bowel

herniated

Bowel floats within

amniotic fluid


Hepatic herniation is less frequent with

gastroschisis than with omphaloceles

Hepatic herniation is less frequent with

gastroschisis than with omphaloceles

Fetal Abdomen


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Small defect (2-4cm) Small defect (2-4cm)

Fetal Abdomen


Associated anomalies in about < 10% of fetuses

IUGR in up to 50%

No chromosomal abnormalities

Associated anomalies in about < 10% of fetuses

IUGR in up to 50%

No chromosomal abnormalities

Fetal Abdomen

--


Oligohydramnios

More common than polyhydramnios

Suggest fetal distress

Oligohydramnios

More common than polyhydramnios

Suggest fetal distress

Fetal Abdomen

Polyhydramnios

Suggest bowel obstruction or atresia

Polyhydramnios

Suggest bowel obstruction or atresia


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Marked bowel dilatation, which may be either

external or internal to the abdominal cavity, suggestsbowel obstruction and/or ischemia

Marked bowel dilatation, which may be either

external or internal to the abdominal cavity, suggestsbowel obstruction and/or ischemia

Fetal Abdomen


Bowel can twist and cut off blood supply Bowel can twist and cut off blood supply

Fetal Abdomen


Fetal Abdomen


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Fetal Abdomen


Fetal Abdomen

Ectopic CordisLarge omphalocele coming all the way to heart

Ectopic CordisLarge omphalocele coming all the way to heart

Rare malformation

Protrusion of heart through chest wall

Association - Pentalogy of Cantrell

Rare malformation

Protrusion of heart through chest wall

Association - Pentalogy of Cantrell

Fetal Abdomen


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Pentalogy of CantrellPentalogy of Cantrell

A term used to describe the association of 5 anomalies:

1. Midline supraumbilical abdominal defect2. Defect of the lower sternum

A term used to describe the association of 5 anomalies:

1. Midline supraumbilical abdominal defect2. Defect of the lower sternum

Fetal Abdomen

.

4. Anterior diaphragmatic hernia

5. Intracardiac abnormalities

.

4. Anterior diaphragmatic hernia

5. Intracardiac abnormalities

Pentalogy of Cantrell US FindingsPentalogy of Cantrell US Findings

Midline anterior wall defectusually upper abdomen

Ectopic heart

Pericardial or pleural effusion

Midline anterior wall defectusually upper abdomen

Ectopic heart

Pericardial or pleural effusion

Fetal Abdomen

Craniofacial anomalies

Ascites

Two vessel cord

Craniofacial anomalies

Ascites

Two vessel cord

Limb-Body Wall ComplexLimb-Body Wall Complex

Also known as body stalk anomaly

Failure of ventral abdominal wall to close

Often left sided

Also known as body stalk anomaly

Failure of ventral abdominal wall to close

Often left sided



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Abdominal organs lie in a sac outside the abdominal cavity

Short or absent umbilical cord

Fetus lies directly on placenta*

Universally fatal

Abdominal organs lie in a sac outside the abdominal cavity

Short or absent umbilical cord

Fetus lies directly on placenta*

Universally fatal

Fetal Abdomen


Amniotic bands attached broadly to the fetus &

placenta

Large thoraco-abdominal wall defect

no coverin membrane

Amniotic bands attached broadly to the fetus &

placenta

Large thoraco-abdominal wall defect

no coverin membrane


Distorted body axis

Distorted body axis


Severe scoliosis prominent feature

Limb defects common

Complex array of multiple malformations

Severe scoliosis prominent feature

Limb defects common

Complex array of multiple malformations

Fetal Abdomen

Craniofacial & Internal organ anomaliesCraniofacial & Internal organ anomalies


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Bladder & Cloacal ExstrophyBladder & Cloacal Exstrophy

Failure of closure of lowerabdominal wall resulting in

exposed bladder Omphalocele

Absent bladder

Failure of closure of lowerabdominal wall resulting in

exposed bladder Omphalocele

Absent bladder

Fetal Abdomen

Imperforate anus

Spinal abnormalities

Malformation of thegenitalia

Single umbilical artery

Imperforate anus

Spinal abnormalities

Malformation of thegenitalia

Single umbilical artery

Bladder ExstrophyBladder Exstrophy

2o to abnormal development of

the cloacal membrane

Incidence is 1:30,000 births

Eversion & exteriorization of

2o to abnormal development of

the cloacal membrane

Incidence is 1:30,000 births

Eversion & exteriorization of

Fetal Abdomen

abdominal surface

Inferiorly displaced umbilicus

Widely separared pubic bones

abdominal surface

Inferiorly displaced umbilicus

Widely separared pubic bones

Reports of T21 & 13

Bladder Exstrophy US FindingsBladder Exstrophy US Findings

Non-visible bladder

Normal kidneys

Normal amniotic fluid

volume

Non-visible bladder

Normal kidneys

Normal amniotic fluid

volume

Fetal Abdomen

Low CI

Bulging massprotruding from thelower abdominal wall

Small penis

Splayed iliac bones

Low CI

Bulging massprotruding from thelower abdominal wall

Small penis

Splayed iliac bones


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2

Cloacal ExstrophyCloacal Exstrophy

Omphalocele & bladder extrophy with prolapsed ileum between the two bladder halves

Fetal Abdomen

Ventral Wall Defects

Relation to Umbilicus

Ventral Wall Defects

Relation to Umbilicus

Above umbilicus

Consider pentalogy of cantrell

At umbilicus

Above umbilicus

Consider pentalogy of cantrell

At umbilicus

Fetal Abdomen

ons er gastrosc s s or omp a oce e

Below umbilicus

Consider exstrophy of bladder or cloaca

Difficult to tell because of size

Consider body stalk anomaly

ons er gastrosc s s or omp a oce e

Below umbilicus

Consider exstrophy of bladder or cloaca

Difficult to tell because of size

Consider body stalk anomaly

Normal Appearance of BowelNormal Appearance of Bowel

Amniotic fluid is swallowed & as it gets to the small

bowel it mixes with bowel mucopolysaccharide

Moves to the large bowel water is resorbed, leaving

meconium

Amniotic fluid is swallowed & as it gets to the small

bowel it mixes with bowel mucopolysaccharide

Moves to the large bowel water is resorbed, leaving

meconium

Fetal Abdomen

Meconium is expelled at birth

If there is obstruction or if meconium is abnormally

thick that wouldnt pass it causes obstruction in the

bowel meconium ileus

Meconium is expelled at birth

If there is obstruction or if meconium is abnormally

thick that wouldnt pass it causes obstruction in the

bowel meconium ileus


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Normal Appearance of BowelNormal Appearance of Bowel

Meconium

Variable in echogenicity (hypo to hyperechoic), can beseen throughout the later part of pregnancy, particularly in

late 3rdtrimester

Meconium

Variable in echogenicity (hypo to hyperechoic), can beseen throughout the later part of pregnancy, particularly in

late 3rdtrimester

Fetal Abdomen

Hyperechoic BowelHyperechoic Bowel

Fetal Abdomen

That Mean?

That Mean?


Increased echogenicity of the mesentery and small

bowel walls

Increased echogenicity of the mesentery and small

bowel walls

Fetal Abdomen

The bowel itself is not echogenic


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Often normal variant

Related to higherfrequency transducers

and to images with

Often normal variant

Related to higherfrequency transducers

and to images with

Fetal Abdomen

Fetal Abdomen

Echogenic Fetal BowelEchogenic Fetal Bowel

Abnormal if

> 4 cm in size

May have mass effect

Abnormal if

> 4 cm in size

May have mass effect

Fetal Abdomen

omogeneous or e erogeneous

Brightness > bone (femur, spine, iliacs)

omogeneous or e erogeneous

Brightness > bone (femur, spine, iliacs)


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Echogenic Fetal BowelEchogenic Fetal Bowel

Seen in association with:

Cystic fibrosis, trisomy 21, cytomegalovirus(CMV), parvo virus (5th disease), GI obstruction

and IUGR

Seen in association with:

Cystic fibrosis, trisomy 21, cytomegalovirus(CMV), parvo virus (5th disease), GI obstruction

and IUGR

Fetal Abdomen

Echogenic BowelEchogenic Bowel

Swallowed blood (intra-amniotic hemorrhage) Swallowed blood (intra-amniotic hemorrhage)

Fetal Abdomen

4 days post-amniocentesis4 days post-amniocentesis

Meconium PeritonitisMeconium Peritonitis

Leaking of bowel contents leading to an

intense peritoneal reaction

Leaking of bowel contents leading to an

intense peritoneal reaction

Fetal Abdomen


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50% have underlying bowel pathology 50% have underlying bowel pathology

Fetal Abdomen


Calcifications 85%

Usually punctate, linear or clumped foci

Calcifications 85%


Fetal Abdomen


Calcifications 85%


Ascities 54%

Calcifications 85%


Ascities 54%

Fetal Abdomen

Usually complexUsually complex


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Calcifications 85%


Ascities 54%

Calcifications 85%


Ascities 54%

Fetal Abdomen

sua y comp ex

Bowel dilatations 27%

sua y comp ex



Calcifications 85%


Ascities 54%

Calcifications 85%


Ascities 54%

Fetal Abdomen

sua y comp ex


Pseudocysts 14%

Polyhydramnios 65%

sua y comp ex


Pseudocysts 14%

Polyhydramnios 65%


Calcifications can extend to thorax Calcifications can extend to thorax

Fetal Abdomen


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Calcifications can extend to scrotal sac Calcifications can extend to scrotal sac

Fetal Abdomen

Abdominal CalcificationsAbdominal Calcifications

Infections: herpes, toxoplasmosis, cytomegalovirus

Tumors: teratoma, hepatoblastoma, neuroblastoma

Peritonitis: meconium leak

Infections: herpes, toxoplasmosis, cytomegalovirus

Tumors: teratoma, hepatoblastoma, neuroblastoma

Peritonitis: meconium leak

Fetal Abdomen

Gallstones

Idiopathic

Gallstones

Idiopathic

Small & Large

Fetal Abdomen

Bowel ObstructionObstructions below the duodenum are even harder to diagnose


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Small Bowel ObstructionSmall Bowel Obstruction

Jejunal & ileal obstruction is more common

than duodenal obstruction!Vascular injury

Jejunal & ileal obstruction is more common

than duodenal obstruction!Vascular injury

Fetal Abdomen

Small bowel loops can be seen specially in 3rd

trimester

Small bowel loops can be seen specially in 3rd

trimester


They peristalsis and changein configuration

Do not persist, and shouldnotbe >15 mm in length and

They peristalsis and changein configuration

Do not persist, and shouldnotbe >15 mm in length and

Fetal Abdomen

Can rarely present as cystlike mass

Polyhydramnios

Timing & severity dependenton site of atresia

Can rarely present as cystlike mass

Polyhydramnios

Timing & severity dependenton site of atresia

Small bowels are

centrally located

Small bowels are

centrally located


Causes:

Intestinal atresia

Related to an in utero vascular accident

Causes:

Intestinal atresia

Related to an in utero vascular accident

Fetal Abdomen

Stenosis

Volvulus

Meconium ileus

In fetuses with cystic fibrosis

Stenosis

Volvulus

Meconium ileus

In fetuses with cystic fibrosis


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PitfallsPitfalls

Different processes can be mistaken for dilated

small bowelCysts in an enlarged multicystic displastic kidney

Different processes can be mistaken for dilated

small bowelCysts in an enlarged multicystic displastic kidney

Fetal Abdomen

Large Bowel ObstructionLarge Bowel Obstruction

Normal large bowel < 20 mmdiameter

Rare - It occurs at the anal-rectalregion

Additional structural &

Normal large bowel < 20 mmdiameter

Rare - It occurs at the anal-rectalregion

Additional structural &

Fetal Abdomen

chromosomal anomalies are verycommon (75%) VACTERL & caudal regression

syndrome

Causes:

Atresia

Stenosis

chromosomal anomalies are verycommon (75%) VACTERL & caudal regression

syndrome

Causes:

Atresia

Stenosis

Solid Abdominal MassesSolid Abdominal Masses

Mesoblastic nephromaNeuroblastoma

Hepatoblastoma

Fetal AbdomenSubdiaphragmatic extralobar

pulmonary sequestration


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Fetal Abdomen

Abdominal Cysts

Differential Diagnosis

Abdominal Cysts

Differential Diagnosis

RUQ Hepatic/choledochal cyst

LUQ Splenic cyst

Posterior

RUQ Hepatic/choledochal cyst

LUQ Splenic cyst

Posterior

Fetal Abdomen

ena cys , y ronep ros s

Anterior/mid-abdomen Mesenteric cyst, umbilical vein varix

Lower abdomen Ovarian cyst (but may migrate to mid-abdomen)

Ureterocele

Urachal cyst

Hydrometrocolpos

ena cys , y ronep ros s

Anterior/mid-abdomen Mesenteric cyst, umbilical vein varix

Lower abdomen Ovarian cyst (but may migrate to mid-abdomen)

Ureterocele

Urachal cyst

Hydrometrocolpos


Fetal Abdomen


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Fetal Abdomen

There is Flow! Is it venous or arterial?There is Flow! Is it venous or arterial?

Fetal Abdomen

Umbilical Vein VarixUmbilical Vein Varix

Focal dilatation of umbilical vein

Usually intraabdominal but extrahepatic may

occur in association with persistent right

Focal dilatation of umbilical vein

Usually intraabdominal but extrahepatic may

occur in association with persistent right

Fetal Abdomen

It may also occur in free floating loops of cord

Umbilical vein varix of intra-amniotic segment

is rarer than intra-abdominal

It may also occur in free floating loops of cord

Umbilical vein varix of intra-amniotic segment

is rarer than intra-abdominal


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Focal dilatation of intra-abdominal portion

Usually near cord insertion

Abnormal if internal diameter > 9 mm or twice size of

intrahepatic portion of vein

Focal dilatation of intra-abdominal portion

Usually near cord insertion

Abnormal if internal diameter > 9 mm or twice size of

intrahepatic portion of vein

Fetal Abdomen

-

to 8 mm at term

-

to 8 mm at term


Fetal Abdomen


Can be associated with:

Chromosome abnl (T-21, 18, 9)

Congenital malformations

Decreased growth

Can be associated with:

Chromosome abnl (T-21, 18, 9)

Congenital malformations

Decreased growth

Fetal Abdomen

y rops

Thrombosis

May be first manifestation of elevated venouspressure therefore may signify increased risk ofcardiac decompensation

As isolated finding: normal outcome

y rops

Thrombosis

May be first manifestation of elevated venouspressure therefore may signify increased risk ofcardiac decompensation

As isolated finding: normal outcome


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3

Choledochal CystCholedochal Cyst

Cystic dilatation of the CBD

Separate from gallbladder No communication with stomach

Cystic dilatation of the CBD

Separate from gallbladder No communication with stomach

Fetal Abdomen

Abdominal CystsAbdominal Cysts

Fetal Abdomen

Abdominal CystsAbdominal Cysts

Lower abdomen

Female: think ovarian: may migrate/auto-amputate

Torsion in ~ 40 % if > 5 cm

Lower abdomen

Female: think ovarian: may migrate/auto-amputate

Torsion in ~ 40 % if > 5 cm

Fetal Abdomen


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Fetal Abdomen

us fetal abdomen

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