Horizontal stomach: a new sonographic clue to the antenatal diagnosis of right-sided congenital diaphragmatic hernia.

We report on two cases of isolated right-sided congenital diaphragmatic hernia (CDH) in which the condition was first suspected due to ultrasound visualization of a horizontal orientation of the fetal stomach in the abdomen. In the first case, a 38-year-old woman, gravida 2 para 1, attended the ultrasound department of Valduce Hospital, Como at 13 weeks\u2019 gestation for a first-trimester scan. Fetal nuchal translucency thickness and anatomy appeared normal; however, an abnormal horizontal orientation of the fetal stomach was noted (Figure 1). At 20 weeks\u2019 gestation, a massive protrusion of the liver into the fetal chest was documented, leading to the diagnosis of isolated right-sided CDH. Moderate lung hypoplasia was demonstrated (observed to expected lungto- head ratio was 41%, according to the longest diameter method)1. Antenatal findings were confirmed after birth and neonatal death occurred soon after delivery

Demonstration of the Pericallosal Artery at 11-13 Weeks of Gestation Using 3D Ultrasound.

Objective: To assess the sonographic visualization of the pericallosal arteries in normal fetuses at 11-13 weeks of gestation using 3D ultrasound. Methods: We prospectively enrolled women with a singleton pregnancy undergoing ultrasound at 11-13 weeks of gestation. A 3D volume with high-definition power Doppler was acquired starting from the sagittal view of the fetal head and stored in the spatiotemporal image correlation mode. The images of the pericallosal arteries were assigned a score of 0 (no visualization), 1 (visualization of the origin) or 2 (visualization of the whole course). A follow-up scan was performed in all cases at 20 weeks of gestation to assess the presence of the corpus callosum. Results: 70 patients were included and the pericallosal arteries were sonographically detectable in all cases. Image scores of 1 and 2 were obtained in 8 and 62 cases, respectively. The whole length of the vessel was between 3.5 and 4.5 mm. The vast majority of those with a score of 2 were beyond 12 completed weeks of gestation. All fetuses showed a normal corpus callosum at midtrimester and no abnormal brain findings after birth. Conclusions: The pericallosal arteries are sonographically visible since the first trimester in 3D ultrasound scans of fetuses found to have a normal corpus callosum at follow-up. \ua9 2014 S. Karger AG, Basel

Normal morphometry of fetal posterior fossa at midtrimester: brainstem-tentorium angle and brainstem-vermis angle.

Objective: To standardize the evaluation of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem, using two novel measurements: the brainstem-tentorium angle (BT angle) and the brainstem-vermis angle (BV angle). We also aimed to test the reproducibility of these measurements. Methods: Prospective observational study including normal fetuses at routine anomaly scan with confirmed normal follow-up. Three-dimensional volumes of the fetal head were acquired starting from standard trans-cerebellar views. In the sagittal plane, obtained by multiplanar reconstruction, the angle between the brainstem and the tentorium insertion in the fetal skull, and between the brainstem and the lower edge of the vermis were measured twice by two independent operators. Intraobserver and interobserver variations were calculated. Results: Eighty cases were included. The estimated BT and BV angles lie in a wide interval among normal midtrimester fetuses with a median value (min-max) of 25.65 (20.13-47.39) and 9.29 (3.87-19.36) respectively. Intraobserver and interobserver variation were good for both measurements. Conclusion: The BT and BV angle may be of help in assessing the fetal posterior fossa at midgestation and gives a standardized and reproducible measurement of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem. \ua9 2012 John Wiley & Sons, Ltd