HDlive imaging of intra-amniotic umbilical vein varix with thrombosis

Effect of Extra-abdominal Vein Varix on the Stress Distribution in Umbilical Cord: A Simulation Study

The umbilical cord is a critical structure linking the fetus to the placenta and is surrounded by the amniotic fluid. It is composed of a vein, two arteries coiled around the vein, and Wharton's jelly surrounding the blood vessels. In this study, the stress distribution of the arteries, vein, and Wharton's jelly of an umbilical cord with extra-abdominal umbilical vein varix is analyzed for varying amniotic pressure using finite element analysis. Four diameters are considered for the umbilical vein, 6.5 mm, 11 mm, 15.5 mm, and 20 mm, with 6.5 mm corresponding to the normal vein diameter. The amniotic pressure is varied from 15-105 mmHg in steps of 15 mmHg, to simulate contractions during labour. Stress distribution is obtained and the peak stresses are analyzed. According to the results, the peak stress in the Wharton's jelly and the umbilical vein increases nonlinearly with increasing amniotic pressure. The peak stress in umbilical arteries initially decreases till the amniotic pressure reaches 45 mmHg and thereafter increases. This might be due to asymmetric deformation of the Wharton's jelly at the pressure range below arterial pressure.Clinical Relevance- This study could be useful in understanding the fundamental mechanics of extra-abdominal umbilical vein varix and help in development of better treatment protocols.

A Case of Intra-Amniotic Umbilical Vein Varices Misdiagnosed as an Omphalocele

Background: Intra-amniotic umbilical vein varices are characterized by a focal dilatation of the extra abdominal umbilical vein. Case report: We report a full-term baby female with extra-abdominal umbilical vein varices misdiagnosed clinically as an omphalocele. The umbilical vein was ligated and excised near the level of the liver. The infant died one day after surgery due to extrinsic compression of the renal pedicle by a massive thrombus, resulting in severe renal failure and life-threatening hyperkalemia despite intensive resuscitation. Conclusion: Large intra-amniotic umbilical vein varices can be clinically misdiagnosed as an omphalocele. Their resection near the level of the fascia, as with normal umbilical veins, could be a better management with a better prognosis.

Foetal death due to extensive extra-abdominal umbilical vein Varix with umbilical vein thrombosis: a case report

BACKGROUND

Foetal anaemia and umbilical vein thrombosis are rare pregnancy complications that can increase the risk of perinatal adverse events, which, in severe cases, can lead to foetal death. During pregnancy, umbilical vein varix (UVV) commonly occurs in the intra-abdominal part of the umbilical vein and is associated with an increased risk of foetal anaemia and umbilical vein thrombosis. However, UVV occurring in the extra-abdominal part of the umbilical vein is rare, especially when accompanied by thrombosis. In this case report, we describe a rare case of an extensive extra-abdominal umbilical vein varix (EAUVV), which ultimately resulted in foetal death due to umbilical vein thrombosis.

CASE PRESENTATION

In this report, we describe a rare case of an extensive EAUVV that was discovered at 25 weeks and 3 days of gestation. During the examination, there were no abnormalities in foetal haemodynamics. The estimated weight of the foetus was only 709 g. In addition to refusing to be hospitalized, the patient refused close monitoring of the foetus. As a result, we were limited to choosing an expectant therapy. The foetus died 2 weeks after diagnosis and was confirmed to have EAUVV with thrombosis after the induction of labour.

CONCLUSION

In the case of EAUVV, lesions are extremely rare, and it is very easy for thrombosis to form, which may result in the death of the child. When determining the next step in the treatment of the condition, the degree of UVV, possible complications, gestational age, foetal haemodynamics, and other relevant factors are strongly connected to the clinical therapy decision, and these factors should be considered comprehensively when making a clinical decision. We recommend close monitoring with hospital admission (to facilities capable of handling extremely preterm foetuses) after variability in delivery for worsening haemodynamic status.

Massive Extra-Abdominal Umbilical Vein Varix: A Case Report

Umbilical vein varices are rare umbilical cord anomalies that typically occur intra-abdominally. Extra-abdominal umbilical vein varices are exceedingly rare and usually diagnosed postnatally on gross pathologic examination. Umbilical vein varices have been associated with increased risk of fetal anemia, cardiac abnormalities, and intrauterine fetal demise. This case report discusses a patient who presented with a massive extra-abdominal umbilical vein varix, whose infant was ultimately delivered due to fetal distress and died in the neonatal period. This report also discusses associated fetal conditions and guidelines for antenatal testing and surveillance of known umbilical vein varices.

Severe fetal anemia as a consequence of extra-abdominal umbilical vein varix: A case report and review of the literature

Umbilical vein varix is associated with a high incidence of fetal anomalies and perinatal complications. There are two types of umbilical vein varix: fetal intra-abdominal and extra-abdominal. Herein, a case is reported of severe fetal anemia with extra-abdominal umbilical vein varix. A 33-year-old primigravida was referred to our hospital for fetal growth restriction, fetal cardiomegaly, and decreased fetal movements at 26 weeks' gestation. A Doppler assessment showed an elevated middle cerebral artery peak systolic velocity at 2.2 MoM, suggesting fetal anemia. Umbilical vein varix had caused intermittent turbulent flow, provoking hemolytic anemia. Intrauterine transfusion improved fetal circulatory failure and anemia and prolonged gestational period. At 33 weeks' gestation, the patient underwent cesarean delivery due to nonreassuring fetal status. Pathological analysis revealed focal loss of vascular smooth muscle of the umbilical vein. Extra-abdominal umbilical vein varix has been reported in 14 cases including this case. The antenatal diagnosis rate is reported to be 79%; fetal heartbeat abnormalities and fetal deaths were reported as 50% and 14%, respectively. Eighty-six percent of patients had intra-umbilical cord thrombosis, but currently this is the only case of hemolytic anemia. Furthermore, extra-abdominal umbilical vein varix may present as fetal hydrops with anemia. During ultrasound examination of fetal anemia, umbilical cord screening should be performed with caution.

Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester

Objectives

Umbilical cord varix is an abnormal dilatation of the umbilical vein. There are two types of umbilical venous varix, of which the free-loop type is extremely rare, and the prognosis and etiology are unclear. In this report, we present a case of a significantly enlarged varix in the free loop of the umbilical cord found in the second trimester.

Case presentation

Cesarean section was performed at 28 weeks’ gestation due to enlargement of the varix and rapidly increased umbilical venous velocity at the outlet of the varix. Neonatal blood tests revealed anemia and high concentrations of D-dimer, and they were considered to be due to clot formation inside the umbilical cord venous varix. The neonate received blood transfusion but other neonatal course was generally favorable. Thrombus formation in the enlarged varix was due to the constriction of the umbilical cord.

Conclusions

This case showed that the assessment of umbilical venous flow velocity can be used for estimating the constriction of the umbilical vein and for determining the timing of delivery.

A Case Report of Umbilical Vein Varix with Thrombosis: Prenatal Ultrasonographic Diagnosis and Management

Umbilical vein varix (UVV) is a very rare cord anomaly associated with intrauterine fetal death and fetal anomaly. We describe a case of extra-abdominal UVV with thrombosis. UVV was diagnosed at 23 weeks of gestation for the first time by ultrasonographic screening. Peak systolic velocity (PSV) near the UVV was partially increased up to about 100 cm/s, and blood flow was not detected in one of the umbilical arteries at 28 weeks of gestation. Therefore, the mother was hospitalized to monitor alterations of the PSV of the UVV frequently. Because the PSV of the UVV showed a sudden rapid increase up to about 150 cm/s at 32 weeks of gestation, she underwent emergent cesarean section on the same day to avoid sudden umbilical cord occlusion. The infant's birth weight was 1,744 g, and the Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The pathological examination showed UVV with thrombosis and an occlusion in one of the umbilical arteries. The neonatal laboratory data showed no coagulopathy. Based on our experience with this case, frequent ultrasonographic examination should be performed to detect the acute thrombosis in the case of extra-abdominal UVV, especially during the preterm period.

Case 253: Thrombosed Umbilical Venous Varix in an Infant

History A 3-month-old previously healthy girl presented to an outside institution with a 4-day history of low-grade fever, irritability, and a tender "knot" in the upper abdomen. Ultrasonography (US) was performed at an outside hospital. US images were not available for review; however, they showed a mass in the left hepatic lobe, per the outside report, and the patient was referred to our institution for further evaluation. Her parents reported a normal full-term pregnancy, with regular prenatal care and normal prenatal US findings. The baby was born after an uncomplicated gestation. She was delivered at term via an uncomplicated cesarean section due to a maternal history of cesarean section. The perinatal course was uncomplicated, and there was no history of umbilical catheterization, per the parents. On arrival at our institution, the patient had a temperature of 38.2°C. All other vital signs were normal. Palpation revealed a tender and firm mass in the periumbilical region; otherwise, physical examination findings were normal. Results of laboratory work-up were normal, except for elevated white blood cell count (26 600/mm³ [26.6 × 10⁹/L]; normal, 6000-17 500/mm³ [6-17.5 × 10⁹/L]). The patient underwent US followed by intravenous contrast material-enhanced (10 mL ioversol, Optiray 320; Medtronic, Santa Rosa, Calif) computed tomography (CT) on the same day.

Three-dimensional HDlive imaging of an umbilical cord cyst

Umbilical cord cysts (UCC) are a rare congenital malformation. Previous reports have suggested that the second- and third-trimester UCC may be associated with other structural anomalies or chromosomal abnormalities. Therefore, high-quality imaging is clinically important for the antenatal diagnosis of UCC and to conduct a precise anatomical survey of intrauterine abnormalities. There have been few reports of antenatal diagnosis of UCC with the conventional two- and three-dimensional ultrasonography. In this report, we demonstrate the novel visual depiction of UCC in utero with three-dimensional HDlive imaging, which helps substantially with prenatal diagnosis. A case with an abnormal placental mass at 16 weeks and 5 days of gestation was observed in detail using HDlive. HDlive revealed very realistic images of the intrauterine abnormality: the oval lesion was smooth with regular contours and a homogenous wall at the site of cord insertion on the placenta. In addition, we confirmed the absent of umbilical cord, placental, and fetal structural anomalies. Here, we report a case wherein HDlive may have provided clinically valuable information for prenatal diagnosis of UCC and offered a potential advantage relative to the conventional US.

Three-dimensional ultrasonography by means of HDlive rendering in the first trimester of pregnancy: A pictorial review

Our objective was to describe early embryo/fetus anatomy and abnormalities provided by three and four-dimensional (3D/4D) ultrasound using HDlive rendering technology in the first trimester of pregnancy. Normal and pathologic embryonic and fetal volume data set with postprocessing using HDlive rendering mode. Virtual fetoscopic imaging of the normal and pathologic fetus even at early stage of development with increasing maternal-fetal bonding process. HDlive represents a novel and valuable lightening system for 3D/4D ultrasound application that may aid the prenatal interpretation of early congenital malformations although limitations and cautions are still needed for inclusion in obstetric clinical practice.

HDlive rendering images of the fetal stomach: a preliminary report

PURPOSE

This study aimed to show reconstruction of the fetal stomach using the HDlive rendering mode in ultrasound.

METHODS

Seventeen healthy singleton fetuses at 18-34 weeks' gestational age were observed using the HDlive rendering mode of ultrasound in utero.

RESULTS

In all of the fetuses, we identified specific spatial structures, including macroscopic anatomical features (e.g., the pyrous, cardia, fundus, and great curvature) of the fetal stomach, using the HDlive rendering mode. In particular, HDlive rendering images showed remarkably fine details that appeared as if they were being viewed under an endoscope, with visible rugal folds after 27 weeks' gestational age.

CONCLUSION

Our study suggests that the HDlive rendering mode can be used as an additional method for evaluating the fetal stomach. The HDlive rendering mode shows detailed 3D structural images and anatomically realistic images of the fetal stomach. This technique may be effective in prenatal diagnosis for examining detailed information of fetal organs.

Umbilical vein thrombosis: to deliver or not to deliver at the time of diagnosis?

Key Clinical Message

Umbilical vein thrombosis is a rare anomaly with high mortality that frequently occurs in association with fetomaternal conditions. The unfavorable outcome of our case highlights the need for consensus on severity criteria, including the percentage of vascular occlusion determined by power Doppler, in order to improve outcome.

HDlive imaging of vertical, bridging uterine synechia during pregnancy

We present a case of vertical, bridging uterine synechia in the central part of the uterine cavity diagnosed by conventional two-dimensional (2D) sonography and HDlive at 29 weeks and 5 days of gestation. 2D sonography showed a uterine synechia located vertically in the central part of the uterine cavity, dividing the lower uterine cavity into two parts. HDlive clearly revealed triangular, vertical, and bridging uterine synechia with foot protrusion and umbilical cord prolapse in the lower uterine cavity. The low, liquor-filled amniotic cavity was divided by a thin membrane. MRI confirmed the vertical structure dividing the uterus with umbilical cord prolapse. Emergency cesarean section was performed at 37 weeks and 1 day of gestation because of onset of labor, and a female infant weighing 2,380 g was delivered with an umbilical artery pH of 7.25, and Apgar score of 6/9 at 1 and 5 min, respectively. The vertical, bridging synechia in the central part of uterine cavity was confirmed during the operation.

Three-dimensional high-definition flow in the diagnosis of placental lakes

Placental lakes are sonolucent areas often found in the normal placenta. Most of them are asymptomatic. They are sometimes related to placenta accreta or intrauterine fetal growth restriction, among other conditions. Although Doppler sonography is useful for evaluating noxious placental lakes, it is not easy to adapt Doppler studies to conventional two-dimensional color Doppler sonography because of the low-velocity blood flow and high vascularity in the placenta. Here, we demonstrate how three-dimensional high-definition imaging of flow provides a novel visual depiction of placental lakes, which helps substantially with the differential diagnosis. As far as we know, there have been no previous reports of observation of placental lakes using three-dimensional high-definition imaging of flow.

HDlive 3D ultrasound and follicular development

Two-dimensional (2D) ultrasonography is the fundamental technology on which diagnosis, management, and control in reproductive medicine depends. Over the years there have been efforts to improve 2D ultrasound image quality. In recent years, a series of software has appeared that has generated enormous interest. The goal of these modes has been to improve image quality and diagnostic accuracy. HDlive incorporates a movable virtual adjustable light source which, as it penetrates, produces selective illumination with respective shadows that result from the structures where light is reflected. This combination of light and shadow results in spectacular images which appear much more real than those obtained with conventional 3D ultrasonography.