胎儿成骨不全二例

例1,女,33岁,孕21周,因腹胀就诊.彩色多普勒超声检查所见:胎头颅骨光环完整,胎儿双顶径(biparietal diameter,BPD)5.9 cm,侧脑室不宽,脊柱排列规则连续,胎心搏动规律,四肢短小,股骨长2.7 cm,胫骨长2.2 cm,双侧股骨、肱骨、胫腓骨可见数处骨质高回声中断及错位,略弯曲(图1);胎盘附于宫底壁无异常,羊水暗区深处9.5 cm.超声诊断:(1)单胎妊娠;(2)胎儿成骨不全;(3)羊水过多.住院引产一死女婴.X线检查结果:四肢长骨骨皮质薄,密度低,骨小梁稀少,有多处骨折及少许骨痂.经病理证实为成骨不全.     

连续顺序追踪超声法在诊断人体鱼序列征中的价值

目的 探讨人体鱼序列征的产前超声影像特征及连续顺序追踪超声法在产前诊断人体鱼序列征中的应用价值.方法 对2004年1月至2010年12月来我院行胎儿系统超声检查及11～13+6周颈项透明层(NT)检查的孕妇运用连续顺序追踪超声法检查胎儿四肢,对疑有人体鱼序列征的胎儿使用高频探头对四肢进行详细扫查,根据胎儿下肢发育不良程度和并腿严重程度进行超声分型(Ⅰ～Ⅶ型).产前超声诊断结果与引产胎儿X线及尸检诊断结果进行对比分析.结果 运用连续顺序追踪超声法产前诊断胎儿人体鱼序列征8例4个类型:双足并腿畸形7例(Ⅰ型2例,Ⅱ型3例,Ⅲ例2例),无足并腿畸形1例(Ⅵ型),未发现Ⅳ型、Ⅴ型(单足并腿畸形)和Ⅶ型(无足并腿畸形)胎儿;8例均合并肾脏畸形,均伴发单脐动脉起源于高位腹主动脉;其中6例无羊水,1例羊水过少,1例羊水正常.8例引产后X线及胎儿标本外观检查(尸检6例)结果与产前超声诊断结果均符合.结论 中、晚孕期发现胎儿双肾缺如或双肾囊性发育不良导致无羊水时应高度警惕该畸形的发生.单脐动脉起源于高位腹主动脉为该畸形的特异性表现.11～13+6周因羊水量正常为该畸形检出的最佳时机.产前连续顺序追踪超声法是诊断人体鱼序列征准确、可靠的检查方法.     

超声与X线诊断儿童先天性胆总管囊肿的对照及评价

本义报告了31例经手术及病理证实的儿童先天性胆总管囊肿.其中男11例,女20例,平均年龄2.9岁(3天至11岁),全部病例均于手术前进行了超声及X线胃肠钡餐造影检查.结果:诊断符合率超声为935%(29/31),X线为58.1%(18/31).二者对比显示,超声检查诊断儿童先天性胆总管囊肿优于X线胃肠钡餐造影,尤其囊肿较小时.因此,超声应作为儿童先天性胆总管囊肿影像学检查中的首选方法.     

胎儿胸腔先天性占位性病变的产前超声诊断与预后分析

目的:探讨超声诊断胎儿胸腔先天性占位性病灶的超声表现及预后评估.方法:2012年12月—2020年3月于我院进行产前超声检查的孕产妇36517例次,从其中检出24例胎儿存在胸腔先天性占位性病变,回顾性分析此24例胎儿的超声图像与随访结果.结果:产前24例胎儿胸腔先天性占位病变中,19例胎儿为先天性囊腺瘤畸形,超声表现为...     

超声在汶川地震骨折诊断中的应用

目的探讨超声影像技术在地震灾害时对骨折伤员现场检查中的应用价值。方法2008年5月14日解放军总医院医疗队在四川省都江堰市汶川水磨镇和映秀镇地震现场使用便携式超声仪对260例地震中四肢或躯干等部位受伤，因疼痛活动受限的患者进行超声检查及救治，其中55例后期行X线检查（野战X线诊断车）。将超声诊断为骨折患者的声像图与X线检查结果进行对照分析。结果260例中超声诊断骨折89例（89／260，34．23％），表现为骨折断端错位，约0．6～7．4mm不等，骨折部位周围软组织肿胀。其中超声检出肋骨骨折27例（断裂端〈1Him的细小骨折12例），锁骨骨折8例，胸骨骨折1例，上肢骨折21例（尺骨6例，掌指骨、桡骨及肱骨各5例），下肢骨折32例（外踝9例、股骨8例、跖骨5例、跟骨及髌骨各4例、距骨2例）。X线诊断骨折50例（50／55，90．91％，细小肋骨骨折7例）。结论与传统X线检查比较，超声分辨力高，对细小结构显示清晰，对细小骨折的诊断有较高的敏感性，且超声仪携带方便、在地震等自然灾害或大规模突发伤害环境下可快速检出骨折，为伤员的快速救治提供影像学诊断依据。     

数字化X线摄影在股骨颈骨折中的诊断价值分析

目的：探讨数字化X线摄影诊断股骨颈骨折的临床价值.材料与方法：回顾性分析79例临床确诊的股骨颈骨折患者的临床资料,患者术前均行数字化X线摄影和CT扫描检查,总结数字化X线摄影诊断正确率,评价数字化X线摄影诊断股骨颈骨折的漏诊原因.结果：数字化X线摄影诊断股骨颈骨折75例,漏诊4例,诊断准确率为94.94％,漏诊率为5.06％.漏诊4例均为Garden Ⅰ型骨折,其中3例为外展嵌插型骨折,1例为不完全骨折.漏诊原因主要是老年股骨颈骨折特点和数字化X线摄影检查局限性.结论：数字化X线摄影是诊断股骨颈骨折的重要影像学检查方法,检查准确率较高,但对于外展嵌插型骨折、不完全骨折等的检查,数字化X线摄影易漏诊,需行CT扫描或MRI进一步检查.     

产前超声诊断胎儿膈疝的临床价值

目的:探究产前超声诊断胎儿膈疝的临床价值。方法:探究对象选取2014年9月~2017年9月期间我院妇产科超声检查中发现的14例胎儿膈疝,将产后随访结果与尸检作为对照。结果:本次超声诊断14例胎儿膈疝中,12例为左侧膈疝,2例为右侧膈疝,主要表现为胸腔内异常、唇裂、心脏纵膈移位、骨骼发育异常、泌尿系统异常、羊水过多或其他畸形。但在14例胎儿膈疝中只有11例随访到位,3例失访,其中有3例在产后实行手术治疗,有8例进行引产并尸检。结论:产前超声诊断先天性膈疝胎儿具有较高的临床价值,该诊断方法具有的安全、方便、无辐射等优势,只需要将检测手法熟练,掌握先天性膈疝的图像特点,并进行跟踪随访,在早期进行诊断有着重要的意义。     

X线检查在踝关节骨折诊断中的应用及影像学特点研究

目的:探讨X线检查在踝关节骨折诊断中的应用及影像学特点。方法:回顾性分析我院2018年10月至2019年6月收治的50例踝关节扭伤导致踝关节骨折的患者,所有患者进行X线检查,并将检查结果与多层螺旋CT作对比。结果:50例踝关节骨折的患者均经多层螺旋CT检查证实为骨折。其中中X线检查诊断出45例,诊断符合率为90.00%。其中包括9例内踝骨折,11例外踝骨折,19例踝骨粉碎性骨折,5例距骨骨折,1例合并根骨骨折。5例为踝关节周围软组织肿胀合并关节囊肿胀。结论:X线检查在踝关节骨折诊断中的应用价值高,诊断符合率高,X线表现中踝关节周围软组织肿胀合并关节囊肿胀的患者需要着重考虑是否存在踝关节骨折。该检查方法值得临床推广应用。     

胎儿脊柱裂发生机制及超声诊断临床价值

目的探讨胎儿脊柱裂发生机制及超声表现,分析产前超声对此类畸形的诊断价值。方法回顾性分析14例产前诊断为胎儿脊柱裂的超声表现,并经引产或生产后放射影像学资料对比证实,总结其声像图特点。结果产前超声诊断脊柱裂14例,其中12例显性脊柱裂,2例隐性脊柱裂。胎儿脊柱裂的超声表现具有特征性。超声诊断与产后诊断符合率达100%。结论产前超声检查可以准确地诊断胎儿脊柱裂,具有可靠临床应用价值。     

支气管囊肿的X线、CT影像分析(附11例报告)

目的 探讨中、老年人先天性支气管囊肿的影像学特点及X线、CT检查的诊断价值。方法 回顾性分析11例经手术、病理证实的先天性支气管囊肿的X线和CT资料。结果 位于纵隔3例,位于肺内8例。其中液囊肿9例,气液囊肿和气囊肿各1例。结论 中、老年人先天性支气管囊肿的影像学表现复杂多样,以肿块样表现为特殊,“块中囊”可提示本病的诊断,CT检查可对本病做出正确的诊断。     

产前超声及胎儿磁共振对先天性食管闭锁的诊断价值

目的:提高对先天性食管闭锁(CEA)的认识,探讨产前超声及胎儿MRI对CEA的临床价值.方法:回顾性分析29例经临床证实的CEA胎儿产前超声及胎儿MRI资料.纳入29例正常胎儿作为对照组.分析CEA影像征象,比较组间羊水深度(AFD)、羊水指数(AFI)、双顶径(BPD)、头围(HC)、腹围(AC)、股骨径(FL)、脐...     

产前超声诊断先天性膈膨升及漏误诊分析

目的:探讨超声诊断胎儿先天性膈膨升的声像图特征并对漏诊、误诊进行分析.方法:分析2014年1月—2018年12月产前超声诊断先天性膈膨升的10例胎儿病例资料及随访结果,总结其胸腔横切面、冠状面、矢状面的产前超声图像特征,观察双侧膈肌的矛盾运动,并与产前MRI、产后胸片、解剖结果对比分析.结果:10例胎儿膈膨升中右侧6例...     

Rare sonographic finding of osteogenesis imperfecta type 2: fluid retention in the subarachnoid space

Osteogenesis imperfecta (OI) type 2 is the most severe form of this osteogenetic disorder. A 26-year-old woman was referred to our hospital for suspected fetal hydrocephalus at 26 weeks’ gestation. Detailed ultrasonographic examination revealed fluid retention in the subarachnoid space. The fetal head was expanded, and the skull bone was easily deformed by the pressure of the ultrasound probe. Pleural effusion and ascites were noted, and the upper and lower extremities were extremely shortened and deformed. On helical 3D-CT, the skull bones could not be imaged, and multiple rib fractures and deformed long bones were suspected. Based on these findings, the fetus was diagnosed with OI type 2, and it was explained to the patient and her family that this disease was fatal. Due to non-reassuring fetal status at 28 weeks, induced breech delivery resulted in a stillborn infant. The head of the infant was soft, and the upper and lower extremities were extremely shortened. Post-mortem radiography confirmed the presence of deformed long bones and ribs with multiple fractures, while the skull bones could not be imaged. Detailed ultrasound observation may detect cerebrospinal fluid retention in the subarachnoid space, a finding that may be associated with the membranous skull bones of this osteogenetic disorder.     

The role of ultrasound in the early diagnosis of fetal structural defects following maternal anticonvulsant therapy

A total of 162 pregnant subjects using anticonvulsant drugs were examined for fetal congenital defects over a period of five years. In 138 of these subjects, alpha-feto-protein (AFP) levels were determined in amniotic fluid at 16 weeks of gestation to rule out spina bifida. In all instances, a fetal anomaly scan was performed between 18 and 20 weeks of gestation. AFP levels were always within the normal range; neonatal examination revealed no spina bifida; however, in seven newborns, a single, or multiple structural defect was established. Apart from cases of severe hydrocephaly, hypospadia, and radius aplasia, the anomalies were too small to be detected by present-day ultrasound equipment. Couples should be informed of the limitations of ultrasound in the early detection of structural defects previously associated with the use of anticonvulsant drugs.     

羊水量异常的超声诊断与胎儿畸形的关系

目的 探讨羊水量异常与胎儿畸形的关系.方法 回顾分析2004年3月至2006年11月在本院进行二维及三维超声检查34 900例20周以上的胎儿,其检出羊水量异常160例,并研究分析羊水量多少与胎儿畸形的关系.结果 160例羊水量异常中,羊水过多100例,羊水过少60例,二者畸形的发生率分别为37%、31.6%.结论 超声是诊断羊水量异常的首选方法,而且还能发现胎儿畸形,进一步证明羊水量异常与胎儿畸形的发生密切相关.     

超声与MRI诊断胎儿前脑无裂畸形的比较

目的探讨胎儿前脑无裂畸形的超声类型及其声像图特征。方法收集超声诊断为前脑无裂畸形胎儿及部分接受MRI检查胎儿的完整资料,与产后新生儿特殊检查或引产后尸体解剖及病理检查结果相比较,分析总结其超声类型及声像图特征。并对其绒毛、羊水或脐血染色体检查结果进行分析,新生儿随访至出生后6个月,追踪其预后。结果本组82 777例胎儿(82 773例孕妇)中超声共检出68例前脑无裂畸形,前脑无裂畸形检出率为8.2/10 000(68/82 777);漏诊及误诊各1例叶状前脑无裂畸形(产后新生儿头颅彩超核实),超声诊断前脑无裂畸形的诊断符合率97.1%(68/70)。其中14例于孕10+¹3+周行超声检查时检出,54例于孕16+13+周行超声检查时检出,54例于孕16+⁴0周行常规超声检查时检出。39例胎儿接受MRI检查,MRI诊断无叶前脑无裂畸形11例、半叶前脑无裂畸形19例、叶状前脑无裂畸形6例,漏诊3例叶状前脑无裂畸形,MRI诊断前脑无裂畸形的诊断符合率为92.3%(36/39),与超声比较,差异无统计学意义(χ2=0.96,0.25相似文献   

Megacystis-microcolon-intestinal hypoperistalsis syndrome: in utero sonographic appearance and the contribution of vesicocentesis in antenatal diagnosis.

OBJECTIVE: The purpose of this report is to describe the in utero sonographic appearance of megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) and examine the role of vesicocentesis. METHODS: Two cases of the sonographic appearance of MMIHS were reviewed. We performed vesicocentesis in 2 fetuses with MMIHS and performed vesicoamniotic shunting in 1 of them. The sonographic findings after these procedures were compared with those before puncture. RESULTS: In both cases, ultrasound examination showed a massively enlarged fetal bladder and bilateral hydroureteronephrosis with a normal amount of amniotic fluid. Fetal urinary sodium and chloride concentrations were within normal limits in both cases; this suggested normal fetal renal function. Generally, it is difficult to detect the dilated fetal bowel in MMIHS, probably because of the disturbance caused by a large bladder. In our cases, however, the ultrasound examination clearly showed fetal bowel dilatation after these procedures; this made the antenatal diagnosis of MMIHS more definite. CONCLUSIONS: The sonographic features after vesicocentesis may be helpful in confirming the antenatal diagnosis of MMIHS.     

产前超声对单脐动脉合并胎儿先天性结构畸形的诊断价值

目的：探究产前超声检查对单脐动脉合并胎儿先天性结构畸形的诊断价值。方法对大理州人民医院2008年7月至2012年7月产前筛查出的60胎单脐动脉合并先天性结构畸形胎儿的超声特点进行回顾性分析,然后分析其羊水染色体检查结果,并和产后新生儿特殊检查或引产后尸体解剖及病理检查结果进行比较分析。结果200例单脐动脉胎儿中,单脐动脉合并胎儿先天性结构畸形共60胎,发生率为30％,其中居前3位的分别是心血管系统、泌尿系统、中枢神经系统畸形。单脐动脉合并胎儿先天性结构畸形极为常见,其染色体异常的发生率与其种类呈正相关关系。结论产前超声检查可以较准确地诊断单脐动脉合并胎儿先天性结构畸形。     

Predicting macrosomia.

OBJECTIVE: The purpose of this study was to evaluate the prediction of fetal macrosomia based on ultrasound estimates of fetal weight and amniotic fluid volume combined with clinical risk factors. METHODS: A retrospective cohort study of women undergoing indicated obstetric ultrasound examinations within 7 days of delivery was conducted. RESULTS: A total of 3115 women gave birth within 7 days of ultrasound examinations that included an estimated fetal weight (EFW) and an amniotic fluid index (AFI). Clinical risk factors were associated with an 8% positive predictive value for a birth weight of 4000 g or higher. Adding an ultrasound EFW of 4000 g or higher increased the positive predictive value to 62%. Adding an AFI of 20 cm or higher to the clinical risk factors and the ultrasound EFW further increased the positive predictive value to 71%. CONCLUSIONS: An ultrasound EFW of 4000 g or higher within 1 week of delivery combined with clinical risk factors and an increased AFI is associated with macrosomia at birth in 71% of cases.     

三维超声诊断胎儿宫内窘迫的临床价值

目的探讨三维（3D）超声检测胎儿宫内窘迫（IFD）的临床价值。方法用GElog9三维超声诊断仪对48例单胎孕妇分别进行二维多普勒超声检查（2D）和三维超声图像重建,通过观察胎心率,脐动脉收缩期峰值和舒张末期流速之比（S/D）,羊水,胎动等指标做出超声诊断。结果胎心率、胎动异常是判断胎儿有无缺氧和缺氧程度的主要指标;脐带、羊水异常是造成胎儿宫内窘迫的原因。重建的胎儿脐带血管解剖结构清晰,螺旋层次分明,脐带绕颈及周数一目了然,与2D超声相比较有较高的特异性和敏感性。结论 3D超声能直接形象和层次分明的显示脐带血管解剖形态、空间转向,诊断胎儿宫内窘迫的符合率100%,明显高于2D。为临床提供重要参考依据,对提高胎儿质量、预防和降低围产期胎儿死亡率具有重要的临床意义。