A large meconium pseudocyst that developed into the generalized type during the antepartum period

A fetal intraabdominal cystic mass, measuring 6 cm, was detected at 30 weeks of gestation in a 27-year-old gravida 2 para 1 woman. At 33 weeks of gestation, the cyst disappeared. Ultrasonography showed fetal bowel dilatation, polyhydramnios, and intraabdominal calcifications. Fetal meconium peritonitis was diagnosed prenatally. Because the fetal ileus became worse, a cesarean section was performed at 35 weeks of gestation; a female infant weighing 2,131 g with an Apgar score of 8 was delivered. Six hours after birth, the neonate received an ileostomy. The bowel was reanastomosed 42 days after the initial operation. On postoperative pathology, a meconium pseudocyst was diagnosed. To our knowledge, this is the first report of a large fetal meconium pseudocyst that developed into the generalized type in the uterus during the preterm antepartum period.     

Unusual leiomyoblastoma of the stomach

Only about 250 cases of benign gastric leiomyoblastoma of the stomach have been reported. Most occur in the smooth muscle of the antrum, and may be intramural, intraluminal, or exogastric in position. A pedunculated gastric leiomyoblastoma occurs less frequently, and those containing radiographically identifiable calcifications are extremely rare.     

Fetal bowel calcifications: A sign of anal atresia with rectourethral fistula

Fetal bowel calcifications were observed at 24 weeks of gestation in a male fetus, suggesting an anorectal malformation (ARM) with rectourethral fistula. At birth, the newborn presented with complex ARM including anal atresia, rectourethral fistula, and esophageal atresia. The prenatal sonographic visualization of calcifications within distended bowel should raise the suspicion of ARM including anal atresia and rectourethral fistula, the presence of such calcification depending on the timing of onset of fistula formation. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010     

Is the preliminary film necessary prior to the micturating cystourethrogram in children?

The aim of the study was to determine the value of the preliminary film in children undergoing a micturating cystourethrogram (MCU). The coded computer reports of 806 children undergoing MCUs in a 12-month period were retrospectively reviewed for abnormalities of the lumbar spine, hips, or for calcifications. Vesicoureteric reflux was present in 185 patients (23%). Four patients had renal calculi (0.5%), and in all cases the abnormality was evident on preceding imaging of the upper urinary tract. Spinal anomalies (other than known meningomyelocele) were present in four patients. The clinically obvious abnormalities present in these were a sacral teratoma, a sacral lipoma, scoliosis with tracheo-oesophageal fistula, and a cutaneous angioma with a sacral pit. No patients (other than those with known meningomyelocele) had dislocated hips diagnosed. If the preliminary film had not been performed in 806 patients, neither spinal anomaly, renal calculus, nor congenital dislocated hip would have been missed. The low incidence of plain film anomalies indicates that in our population a plain film is not justified routinely.     

64层螺旋CT冠状动脉血管成像诊断冠状动脉变异的价值

目的：评价64层螺旋CT冠状动脉血管成像（CTA）在诊断各种类型冠状动脉变异中的价值和临床应用。方法：回顾性分析617例行冠状动脉CTA检测患者的冠状动脉变异检出率，并根据CT结果对冠状动脉变异进行分类。结果：617例冠状动脉CTA受检者中，共检出冠状动脉变异78例（12．64％，78／617），其中右冠状动脉起自主动脉左冠状窦者9例，左冠状动脉起自主动脉右冠状窦者2例，右冠状动脉开口高位者2例，多开口变异者2例（并行左主干），心肌桥者59例．前降支．肺动脉瘘者2例，左右冠状动脉一肺动脉瘘者l例，右冠状动脉一左室瘘合并右冠状动脉瘤者1例。结论：冠状动脉CTA能准确评估冠状动脉变异，并可清晰显示各类病变细节，可作为无创性诊断冠状动脉变异的首选方法。     

儿童交通性支气管肺前肠畸形影像学表现

目的分析儿童交通性支气管肺前肠畸形(CBPFM)的影像学特征。方法回顾性分析5例CBPFM患儿的临床及影像学资料。患儿均接受X线、消化道造影(GI)及CT检查,其中2例接受CT增强扫描。结果所有患者均发生在右肺,其中右肺发育不良2例,肺叶内型隔离肺2例,右肺上叶支气管闭锁1例。5例均合并食管-气管瘘,瘘口位于T6水平1例,T8、T9水平各2例。X线表现为白肺2例,软组织肿块影2例,肺炎1例。GI可清晰显示瘘口位置、大小及走向。CT检查可显示CBPFM的各种表现及其合并畸形。结论 CBPFM应包含一种或多种气道、肺组织及血管的异常,且合并食管-气管瘘。GI可直接、清晰显示食管-气管瘘。CT检查可显示肺、气道和血管及前肠发育异常情况。CT和GI相结合是诊断本病的最佳检查方法。     

Congenital absence of scaphoid and flexor pollicis longus. A case report

Congenital absence of scaphoid with or without other anomalies like hypoplastic thenar muscle, hypoplastic thumb, carpal anomalies, radial ray defects and VATER (Vertebral defects, Anal atresia, Tracheo oesophageal fistula, Renal dysplasia) anomalies are rare and has been reported [1,2,3,4,5,6]. We are reporting this rare combined defect of absent scaphoid, hypolastic thumb with thenar muscles and absent flexor pollicis longus. We are not aware of any similar case report in English literarure.     

Gallstone duodenum: Unusual complication of an obstructing intraluminal duodenal diverticulum

An unusual case of gallstones within the duodenum, secondary to obstruction by an intraluminal diverticulum, is reported. The gallbladder appeared normal an oral cholecystogram, excluding internal biliary fistula as the source of duodenal gallstones.     

Prenatal diagnosis of ventriculocoronary fistula.

BACKGROUND: Cardiac anomalies may be associated with abnormal coronary vascular connections. We report the prenatal diagnosis of ventriculocoronary fistula in three fetuses with associated cardiac anomalies. MATERIALS AND METHODS: Fetal echocardiography was performed in three patients referred for suspected cardiac anomaly. Two-dimensional fetal echocardiography was complemented by color Doppler flow imaging and spectral Doppler in all cases. RESULTS: A ventriculocoronary fistula was diagnosed in three patients referred at 22, 23 and 32 weeks. The first patient had hypoplastic left heart associated with transposition of the great arteries and pulmonary atresia with an intact interventricular septum. The coronary fistula arose from the transposed aorta to the left ventricle. In two patients ventriculocoronary fistula was found in association with pulmonary atresia and an intact interventricular septum. In all cases there was bidirectional flow within the fistula (diastolic blood flow towards the ventricle with reversal during ventricular systole). The pregnancy with hypoplastic left heart with transposition, and one of those with pulmonary atresia resulted in neonatal death and stillbirth, respectively. In the third instance the ventriculocoronary fistula was verified by postpartum cardiac angiography. The infant initially received a Blalock-Taussig shunt, subsequently replaced by a bidirectional Glenn shunt, and was doing well at the time of writing. CONCLUSION: A ventriculocoronary fistula can be identified prenatally by color and spectral Doppler. This anomaly should be sought in fetuses with outflow tract obstructive cardiac lesions and an intact interventricular septum. Prenatal diagnosis allows early angiography postnatally. Delineation of coronary vascular regions may therefore facilitate preoperative planning.     

Fetal magnetic resonance imaging in the antenatal diagnosis and management of hydrocolpos.

Hydrocolpos should be considered systematically when an abdominopelvic cystic mass is diagnosed in a female fetus. Because the prognosis and neonatal management of isolated hydrocolpos with spontaneous resolution differs greatly from that of hydrocolpos associated with a cloacal malformation, it is important to ascertain prenatally whether there are associated anomalies. We report the prenatal characteristics of three fetuses with hydrocolpos; in two cases there was spontaneous resolution and one infant was born with digestive tract atresia. The principal ultrasound findings were an oblong anechoic pelvic mass with or without a sagittal septum, located behind a normal bladder. On magnetic resonance imaging (MRI), the cervical imprint on the vagina confirmed the diagnosis of hydrocolpos and helped to diagnose cloacal malformation by demonstrating the absence of meconium beside the bladder on T1 sequences. Our cases show that MRI is useful for differentiating isolated hydrocolpos from hydrocolpos associated with cloacal malformation.     

Hyperechoic meconium in the third trimester fetus: an uncommon normal variant.

Fetal meconium is usually hypoechoic or isoechoic to adjacent abdominal structures on antenatal sonography. Hyperechoic meconium is associated with pathologic conditions, such as meconium ileus, meconium peritonitis, and anorectal malformations. The authors describe three third trimester fetuses with hyperechoic meconium and a normal outcome. Although a prospective study revealed that this finding is very uncommon, hyperechoic meconium can be a normal variant, particularly when it is seen as an isolated finding late in the third trimester.     

Ultrasound findings in gestations destined for unanticipated fetal demise.

There are few reports of ultrasound findings in the second and third trimesters preceding intrauterine fetal demise. To describe these findings, the ultrasound assessments of 36 structurally normal singleton fetuses with subsequent intrauterine fetal demise were compared to gestational age-matched controls. Compared to controls, it was found that biparietal diameter, head circumference, femur length and estimated fetal weight were all decreased, abnormalities of amniotic fluid volume were more frequent, but the cephalic index was not different. Upon delivery, the group with subsequent intrauterine fetal demise was not found to have any major anomalies, but had a high incidence of abnormal umbilical cord position, abruptio placentae, chorioamnionitis and meconium aspiration.     

Gender differences in the types and frequency of coronary artery anomalies

Coronary artery anomalies are rarely encountered in general population. Gender may play a role in the types and incidence of coronary artery anomalies, although the effect of gender is not well established. In the present study, we therefore aimed to investigate the frequency and location of various types of coronary artery anomalies and their correlation with gender. We assessed retrospectively the coronary angiography movies of 7,810 patients (2,214 females and 5,596 males), the method of which is distinct from the earlier studies with angiographic archive records. We defined and classified the coronary artery anomalies according to their origin, course (myocardial bridge), and termination (fistula). The incidence of coronary artery anomalies was 3.35% (262 of 7,810): 130 individuals with anomalous origin (1.66%), 105 individuals with myocardial bridges (1.34%), and 27 with fistulas (0.35%). The frequency of the coronary artery anomalies was significantly higher in the females than the males (p = 0.001). Of the coronary artery origin anomalies, the circumflex and the left anterior descending artery originating from separate ostia in the left aortic sinus were higher in the females compared to the males (P < 0.001). In contrast, the frequency of myocardial bridges was higher in the males (P = 0.01). No gender difference was detected in fistulas. Thus, gender affects the types of coronary artery anomalies, except for fistulas. The determination of the presence of the coronary artery anomalies during the coronary angiography is critical for the planning of the treatment and for the proper clinical follow-up of patients.     

A case of coronary artery fistula with mitral stenosis

Coronary artery fistulae, being a rare form of congenital anomalies of the coronary arteries, are usually discovered by chance during coronary arteriography. However, these fistulae can cause an important coronary morbidity and mortality leading to angina, syncope, congestive heart failure, myocardial infarction and sudden death. The coincidence of mitral stenosis and congenital artery fistula is rare in the literature. In our case report, a patient with a coronary artery fistula originating from the circumflex, draining to the main pulmonary artery, discovered at cardiac catheterization and coronary angiography done with a prediagnosis of mitral stenosis is presented in the light of the literature.     

内支架治疗消化道恶性梗阻的探讨

目的探讨内支架治疗消化道恶性梗阻和食管-支气管瘘的有效性和安全性。方法71例消化道恶性梗阻和食管-支气管瘘患者采用永久性部分覆膜镍钛合金内支架治疗,全部病例均在DSA监视下经口或肛门将支架置放于梗阻或瘘口部位,术前术后均做造影对照,根据进食进水和排便情况评价疗效。结果上消化道支架置入后恢复饮食,饮水后无呛咳62例(96.9%);乙状结肠和直肠支架置入后肠梗阻症状均即刻解除;术后支架移位2例(2.8%);再狭窄2例(2.8%);声音嘶哑1例(1.4%);胸部剧烈疼痛2例(2.8%),轻度疼痛12例(16.9%);大出血1例(1.4%),经相应处理后全部好转。结论永久性部分覆膜镍钛合金内支架置入术是消化道恶性梗阻和食管-支气管瘘的有效治疗方法,操作简便,安全性高。     

小儿脐尿管疾病的诊治（附13例报告）

[目的]探讨小儿脐尿管疾病的诊断与治疗方法.[方法]根据病史并结合脐孔美蓝注射试验或造影、B超、CT、MRI和膀胱镜检等辅助检查方法诊断脐尿管疾病13例,并予以手术治疗.[结果]脐尿管瘘并感染4例,脐尿管囊肿并感染6例,脐尿管窦道并感染1例,脐尿管鳞状细胞癌1例,脐尿管瘘致粘连性肠梗阻1例.术后7～20 d痊愈出院,随访至今无复发及癌变.[结论]早期诊治是提高疗效、减少并发症的关键,手术应彻底切除脐尿管及其异常组织,可避免复发.     

多层螺旋CT血管成像对冠状动脉畸形的诊断价值

目的探讨多层螺旋CT冠状动脉成像在分析诊断先天性冠状动脉畸形中的价值。方法回顾性分析2051例行多层螺旋CT冠状动脉成像影像资料,统计冠状动脉畸形的发生率,并分析冠状动脉畸形的CT影像表现。结果2051例行多层螺旋CT冠状动脉成像的人群中,发现冠状动脉畸形57例,检出率为2.8%,其中51例为冠状动脉起源和走行异常,3例为冠状动脉瘤,3例为冠状动脉瘘。结论多层螺旋CT成像在冠状动脉畸形的诊断和预后判断中有应用价值。     

先天性冠状动脉畸形的超声心动图诊断

目的探讨超声心动图诊断小儿先天性冠状动脉畸形的意义。方法对本院诊治的30例先天性冠状动脉畸形的超声心动图结果与心血管造影、手术结果进行分析比较。结果冠状动脉异位开口于肺动脉4例,占13%;单支冠状动脉畸形3例,占10%;冠状动脉瘘23例,占77%,累及右冠状动脉12例（52%）,其中多个瘘口1例,左冠状动脉11例（48%）,瘘入右侧心腔11例（48%）,瘘入肺动脉11例（48%）,瘘入左侧心腔1例（4%）。冠状动脉畸形中伴有其他先天性畸形6例（26%）。超声心动图诊断敏感性93%,特异性100%。其中对冠状动脉瘘及瘘口的形态、数目、瘘入的部位准确性达100%,对冠状动脉异位开口于肺动脉及单支冠状动脉畸形各有1例误诊为弹力纤维增生症。结论超声心动图对先天性冠状动脉畸形有较高的诊断价值,可作为首选诊断方法。对心脏扩大、心内膜增厚、心功能弥漫性降低的弹力纤维增生症样超声心动图改变必须保持对冠状动脉畸形的警惕性,应仔细探测左右冠状动脉及分支,并结合心电图等临床资料进行分析。     

Second trimester prenatal findings in duodenal and esophageal atresia without tracheoesophageal fistula.

The combination of duodenal atresia and esophageal atresia without tracheoesophageal fistula leads to a closed loop of bowel involving the distal esophagus, stomach, and duodenum. Prenatally, this association of anomalies is visualized as a characteristic dilated C-shaped fluid collection in the fetal abdomen. We report three cases of the association of duodenal and esophageal atresia without tracheoesophageal fistula, identified sonographically in the second trimester of pregnancy.     

双源CT诊断先天性冠状动脉瘘

目的 观察双源CT在先天性冠状动脉瘘诊断中的应用价值. 方法 使用双源CT机对9例先天性冠状动脉瘘患者进行增强扫描,将获得的数据进行容积再现、多平面重建、最大密度投影、曲面重建,分析冠状动脉走行及心内外结构. 结果 左冠状动脉主干右心室瘘2例;左冠状动脉主干和(或)前降支主肺动脉瘘7例,其中5例合并右冠状动脉主肺动脉瘘. 结论 双源CT冠状动脉造影方便、快捷、无创,可以作为诊断先天性冠状动脉瘘的首选方法.