A 23-year-old gravida 4, para 0 pregnant patient presented for her follow up antenatal ultrasound at 33 weeks. Prior imaging showed a dichorionic diamniotic twin pregnancy with normal anatomy for both fetuses. Ultrasound at follow up showed an enlarged abdominal aorta (image 1 and 2) seen in twin B along with right ventricular hypertrophy and small pericardial effusion. The aneurysm extended from the diaphragm to the aortic bifurcation. A small intraluminal membrane was seen at the level of the aortic bifurcation suggesting possible dissection (image 3). The twins were delivered by Caesarean section due to patient's morbid obesity and other risk factors. A postnatal ultrasound confirmed the abdominal aortic aneurysm with dissection which extended into the mesenteric vessels and renal arteries (image 4 and 5). CT angiogram was performed for planning for repair of the abdominal aortic aneurysm (image 6). The baby expired after 3 weeks in the hospital and genetic consult was obtained in the interim which suggested the possibility of Loey Dietz syndrome. Aneurysms detected in fetal life most commonly affect the vein of Galen, the ductus arteriosus and, rarely, the vessels of the umbilical cord. Congenital aneurysms of the aorta are a rare and can affect the abdominal as well as the ascending aorta. Supporting information can be found in the online version of this abstract Supporting Information Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Objective To assess the feasibility and accuracy of point-of-care ultrasound (POCUS) in monitoring peripherally inserted central catheter (PICC) location in neonates by non-radiologist physicians. Methods A prospective cohort study compared PICC localization by ultrasound in neonates with a recent radiograph. The ultrasound exam was performed using a standardized protocol with 13-6 MHz linear and 8-4 MHz phased array transducers by a neonatal-perinatal fellow who was blinded to PICC location on the radiograph. Results Of the 30 neonates included, 96.6% (n = 29) were preterm, with 63.3% (n = 19) weighing <1500 g. Nighty-four percent (n = 94) of ultrasound scans matched the radiograph report. The protocol had a sensitivity of 0.97, specificity of 0.66 and positive predictive value of 0.98. Conclusion Limited ultrasound exams to monitor PICC position in neonates using a standardized protocol by non-radiologist physicians are feasible and accurate in a single ultrasound user. Further study in multiple providers is needed before widespread use.
*University of Washington; and †University of Washington, Harborview Medical Center, Seattle Cancer Center Alliance, Seattle, WA. Received for publication June 16, 2014; accepted June 21, 2014. The authors declare no conflict of interest. Reprints: Manjiri Dighe, MD, FSRU, FSAR, 1959 NE Pacific Street, Box 357115, University of Washington Medical Center, Department of Radiology, Seattle, WA 98195 (e-mail: [email protected]).
Techniques for iterative reconstruction of magnetic resonance diffusion images from motion corrected multi-planar acquisitions are beginning to allow the use of more complex diffusion models and tractography techniques to study early brain connectivity. Many techniques have been developed for adult and neonatal brain tractography from diffusion images. However, fundamental differences in the underlying tissues, signal levels and relative spatial resolution that are available in fetal studies mean these techniques may need to be significantly adapted to deal with the different challenges. Here we evaluate and compare the use of diffusion tensor and spherical harmonic models in extracting known fetal white matter connective anatomy from multi-planar, motion corrected, variable data density studies of normally developing human fetal brains. Visual evaluation of known tracts indicates that, although there are significant differences in the diffusion properties of fetal brain tracts and also image signal strength in fetal brain studies, when compared to adult brain imaging and tractography, high order models such as spherical harmonic techniques still offer advantages in appropriately delineating known anatomy from in utero data.
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