Very echogenic amniotic fluid: ultrasonography-amniocentesis correlation.

Very echogenic amniotic fluid has been variably attributed to meconium, blood, or vernix caseosa. However, most previous reports have been case reports, and most cases have not had proof by amniocentesis. In a larger series of patients with proof by amniocentesis, we sought to determine the relative frequency of these substances as causes of very echogenic amniotic fluid. We retrospectively identified obstetric sonograms in which the amniotic fluid was homogeneously filled with innumerable echogenic particles. The cause of the increased echogenicity was determined by fluid appearance at amniocentesis. Of 86 cases identified, immediate proof by amniocentesis was available in 19 patients for whom the gestational age ranged from 32.8 to 39.4 weeks. Vernix was present in 18 (95%) patients and meconium in one (5%) patient. Very echogenic amniotic fluid in the third trimester is most often due to vernix and infrequently due to meconium. This sonographic finding is not a reliable indicator of meconium or blood in amniotic fluid and should not typically alter antenatal management.     

Small echogenic foci in the ovaries: correlation with histologic findings.

OBJECTIVE: The purpose of this study was to determine the histologic correlate of small echogenic foci in the ovary and to assess for any association with endometriosis or endosalpingiosis. METHODS: Women planning to have a normal ovary surgically removed were scanned preoperatively with transvaginal sonography. If echogenic foci were present in either normal ovary on the preoperative scan, the removed ovary was scanned in a saline bath, and the surface was marked with india ink over an echogenic focus. Histologic sections were then obtained at the marked site. RESULTS: Echogenic foci were detected in 23 ovaries of 16 women. Possible causes were found in 17 of the 23 ovaries: hemosiderin in 6 cases, calcification in 5 cases, hemosiderin and calcification in 2 cases, clusters of inclusion cysts in 2 cases, 1 of which also had hemosiderin, and dense cortical nodules in 2 cases. Histologic findings were benign in all cases except in 1 patient who had primary peritoneal carcinoma unrelated to the echogenic foci. One ovary in another patient had both endosalpingiosis and endometriosis. One other patient had endometriosis involving a fallopian tube but not the ovary. There were no other cases of endometriosis or endosalpingiosis. CONCLUSIONS: Small echogenic foci in the ovaries are most frequently due to hemosiderin or calcification. A few small echogenic foci in the ovaries are associated with benign histologic changes and do not appear to be reliable indicators of endosalpingiosis or endometriosis.     

Perihepatic fluid collection with mobile echogenic foci

A history of laparoscopic cholecystectomy and mobile echogenic foci identified on abdominal ultrasound may distinguish dropped gallstones complicated by abscess from other conditions that exhibit similar findings.     

Endometrial and endocervical micro echogenic foci: sonographic appearance with clinical and histologic correlation.

OBJECTIVE: The purpose of this research was to determine the clinical and histologic importance of small echogenic foci seen in the endometrium/endocervix on pelvic sonography. METHODS: A retrospective study was performed on 62 women, aged 28 to 81 years, who had echogenic foci of the endometrium and endocervix. Patients' medical records were accessed to review pertinent obstetric and gynecologic information. Additionally, histopathologic slides from patients who underwent diagnostic procedures (endometrial biopsy or dilation and curettage) or hysterectomy were reviewed. RESULTS: The clinical information for the 62 women included the following: mean age, 49 years; history of exogenous hormonal use, 84%; prior abortion (therapeutic or spontaneous), 57%; prior dilation and curettage, 56%; prior cesarean delivery, 28%; and sexually transmitted disease, 36%. The initial finding of echogenic foci was followed by ultrasound examinations in 18 patients for a mean interval of 16 months. Of the 18 patients, the foci remained unchanged in 13 women and disappeared or became less prominent in the other 5. Histopathologic results were available in 28 women, and microcalcifications were found in 15 of them. The etiology most common was microcalcification but also included crystals, debris from laminaria, and ossified tissues. Clinical follow-up in 62 patients showed that this condition was mostly benign (endometrioid carcinoma developed in 1 patient). CONCLUSIONS: Histopathologic studies showed microcalcifications, which are the most common cause of echogenic foci. The foci were stable with time and seemed to be an incidental finding associated mostly with benign conditions. The etiologic factors for echogenic foci may be numerous.     

First-trimester echogenic amniotic fluid in the acrania-anencephaly sequence.

OBJECTIVE: To describe the association between echogenic amniotic fluid and first-trimester fetal acrania. METHODS: Nine fetuses with acrania were examined between 11 weeks' and 13 weeks 6 days' menstrual age for the presence of echogenic free-floating particles in the amniotic fluid. Cases were classified into 3 types according to the echogenicity of the amniotic fluid: similar to (type 0), slightly greater than (type 1), and clearly more echogenic than (type 2) that of the extracelomic fluid. RESULTS: In 1 pregnancy, no free-floating particles were identified (type 0). In 6 cases, small free-floating particles scattered within the amniotic cavity were identified, making the amniotic fluid slightly more echogenic than the extracelomic fluid (type 1). In the remaining 2 cases, the amniotic fluid was homogeneously and clearly more echogenic than the extracelomic fluid (type 2). CONCLUSIONS: A high percentage (89%) of fetuses with acrania had echogenic amniotic fluid, suggesting that this finding could potentially be used as a marker of fetal acrania in the first trimester. This finding also supports the hypothesis of the transition from acrania to anencephaly, with the unprotected brain undergoing progressive destruction from the first trimester, leading to the classic finding of anencephaly in the second trimester.     

Left ventricular echogenic focus in the fetal heart: pathologic correlation.

Echogenic foci within the left ventricle of the heart have been found in a minority of fetuses and generally are believed to be a normal variant. The cause and exact location of these foci have remained speculative, however. We identified three fetuses with this sonographic finding in whom pathologic correlation was available. The only consistent histologic finding present in all three fetuses was mineralization within a papillary muscle; the chordae tendineae were normal. One of the three fetuses had trisomy 21. Echogenic foci within the left ventricle of the fetal heart represent papillary muscle mineralization. Until more data are available to investigate any possible association with aneuploidy, an echogenic focus in the left ventricle should still be considered a normal variant.     

Postpartum hemoperitoneum due to avulsion of pelvic uterine adhesion band

A 31-year-old nulliparous woman presented in labor with preterm rupture of membranes at 35 weeks of gestation. The ensuing intrapartum course was uneventful, and she delivered a healthy infant (birth weight, 2,850 g) vaginally. Four hours after delivery, the patient had a syncopal episode due to hypovolemic shock. At laparotomy, a fibrous band between the right fallopian tube and uterus was found to be avulsed and actively bleeding, confirming preoperative findings obtained with multidetector row computed tomographic angiography.     

Prolactin in amniotic fluid: its correlation with maternal plasma prolactin.

Prolactin concentrations in amniotic fluid from 319 women with normal pregnancies and 29 women with complicated pregnancies were determined by radioimmunoassay. Prolactin levels varied from 36 ng/ml to 1800 ng/ml mean +/- S.D. = 408 +/- 297) in the normal pregnancy group but showed no definite pattern of rise or fall during pregnancy. No difference in levels was found in complicated pregnancies. Prolactin concentrations in the plasma from 203 of these women were also assayed. The levels in the amniotic fluid were about 9 fold higher than those in the plasma. There was no significant correlation between amniotic fluid and plasma levels of prolactin.     

Sonographic detection of free pelvic peritoneal fluid.

Transvaginal ultrasonography was performed on 113 women prior to laparoscopic sterilization. The amount and character of the peritoneal fluid present in the pelvis was assessed at the end of the operative procedure. Sonographically, free pelvic peritoneal fluid was seen in 42.5% of the patients. Laparoscopically, the average amount of fluid present was 11.2 ml with an average of 16.5 ml present in patients with FPPF and 7.2 ml present in patients without FPPF (P < 0.0001). Sonographic measurement of fluid volume was found to significantly underestimate the amount of fluid present at laparoscopy (P < 0.0001). Endometriosis and pelvic adhesions significantly changed the sonographic findings.     

Cardiac function in fetuses with intracardiac echogenic foci.

OBJECTIVE: To evaluate cardiac dimensions and function in euploid fetuses with intracardiac echogenic foci. STUDY DESIGN: Forty-eight fetuses with a single cardiac echogenic focus situated in the left ventricle had echocardiography performed at 22-24 weeks of gestation. Fifty normal fetuses at 22-24 weeks' gestation served as controls. Two-dimensional and M-mode directed fetal echocardiography were used to exclude cardiac anomalies and measure right and left ventricular free walls and interventricular septal thickness and ventricular systolic and diastolic dimensions. Cardiac size was expressed as a ratio of ventricular wall thickness/biparietal diameter, and cardiac function was expressed as ventricular shortening fraction. Doppler fetal echocardiography measurements included pulmonary and aortic maximum systolic velocities and time to peak velocities as indices of ventricular systolic function, and the ratio between early ventricular filling (E-wave) and active atrial filling (A-wave) peak velocities at the level of the atrioventricular valves as an index of ventricular diastolic function. RESULTS: Early ventricular filling/active atrial filling peak velocity ratios were significantly lower in fetuses with intracardiac echogenic foci than in control fetuses. In the mitral valve the ratio was 0.37 +/- 0.14 (0.039) (mean +/- SD (95% confidence interval for difference between the means)) vs. 0.59 +/- 0.19 (0.052) and in the tricuspid valve it was 0.42 +/- 0.16 (0.045) vs. 0.62 +/- 0.21 (0.058). No significant differences were found in cardiac dimensions, ventricular shortening fraction and Doppler systolic indices. CONCLUSION: Euploid fetuses with intracardiac echogenic foci show low E/A ratio values in midtrimester echocardiography. This finding might indicate cardiac diastolic dysfunction.     

Postmenopausal intrauterine fluid collection: correlation between ultrasound and hysteroscopy.

Postmenopausal intrauterine fluid is an alarming sign related to malignancy. Twenty postmenopausal women with intrauterine fluid were prospectively studied by means of sonographic evaluation, and hysteroscopic and histological examinations, to determine the correlation between ultrasound and hysteroscopy. All patients underwent endovaginal sonography, followed by hysteroscopy. Biopsies were performed on all patients with abnormal endometrium, and randomly on selected patients with normal or atrophic endometrium. In patients with abnormal endometrial structure and thickness (< 4 mm), two cases of endometrial cancer were histologically detected and one was revealed by cytology (Pup smear). Seventeen patients with thin endometrium (相似文献   

Prenatal diagnosis of echogenic lung: evolution and outcome.

OBJECTIVES: Despite the feasibility of detecting lung lesions by antenatal ultrasound, there are problems in correlating the prenatal diagnosis with the final histology and in predicting the outcome. In order to better describe these factors, we reviewed the outcome of fetuses that had been diagnosed with echogenic lung in a referral fetal medicine unit. METHODS: We searched the database of a tertiary fetal medicine unit for all cases of fetal echogenic lung seen since 1994 and studied the maternal and neonatal records found. RESULTS: There were 48 cases of echogenic lung diagnosed at a median gestational age of 21 (range, 19-29) weeks, including 43 (90%) cases of congenital cystic adenomatoid malformation (CCAM) and 5 (10%) of pulmonary sequestration (PS). The evolution of the fetal abnormality after diagnosis was: in 22 (45.8%) cases the lesion disappeared; in 17 (35.5%) cases the lesion remained stable and six (12.5%) cases became severe. Three (6%) women underwent termination of pregnancy. The lesions were equally distributed between the two sides of the thorax. Mediastinal shift was associated with a threefold increase in the possibility of clinical deterioration (17% vs. 5%), and the disappearance of the lesion was twice as likely to occur when the lesion was classified as microcystic as when it was macrocystic (67% vs. 36%). Features of hydrops were found in 9 (21%) fetuses and in six (13%) cases progressed and resulted in intrauterine or neonatal death. Sixty-four percent of cases with lesions that disappeared during the pregnancy had an abnormal computed tomography (CT) scan, and the prenatal diagnosis correlated with histology in 36% of these cases. Of the cases in which the lesions remained stable, 70.5% had an abnormal CT scan and the prenatal diagnosis correlated with the histology in 67% of the cases. CONCLUSIONS: Prenatally diagnosed echogenic lung has a good prognosis in the absence of hydrops. The ability to correctly assess echogenic lung lesions and the need for surgery by prenatal ultrasound is limited.     

Pseudo perisplenic "fluid collections": a clue to normal liver and spleen echogenic texture

In a number of cases the ultrasound examination of the left upper quadrant showed an appearance suggesting a fluid collection around the superior and lateral aspects of the spleen. Subsequent investigations including careful real-time evaluation, computed tomography, and magnetic resonance imaging have demonstrated that the pseudo-"fluid collection" is the normal left lobe of the liver extending into the left subdiaphragmatic space to lie superior and even lateral to the spleen. The echogenicity of the normal liver was observed to be less than that of the normal spleen. The ability to simultaneously visualize both the liver and the normal spleen at the same depth and the same field of view gives a true indication of the relative echogenic consistency of the liver and the spleen, which is different from that which had been previously reported.     

Minimal pelvic fluid in asymptomatic children: the value of the sonographic finding.

OBJECTIVE: To determine the presence of minimal pelvic fluid in asymptomatic children who underwent abdominal sonography. METHODS: Between August 1999 and January 2001, we performed abdominal sonography in 396 asymptomatic children and 266 symptomatic children (acute and chronic abdominal pain). The 2 groups were evaluated for the presence of minimal fluid in the pelvis. All the children were divided into 4 subgroups according to age and sex. RESULTS: Minimal pelvic fluid was noted in 28 (7%) of the asymptomatic children, and it was more common in girls (10.2%), especially in girls between the ages of 5 and 15 years. On the contrary, no difference between the age groups was seen in boys. Minimal pelvic fluid was found in 76 (28.6%) of the symptomatic children, with no difference seen between the sexes or age groups. The presence of pelvic fluid was significantly greater in the symptomatic group than in asymptomatic group (P < .001). CONCLUSIONS: Our data suggest that the presence of minimal pelvic fluid in children of all ages and both sexes is a physiologic finding and should be evaluated in the appropriate clinical context.     

Penetrance of nafcillin into human ventricular fluid: correlation with ventricular pleocytosis and glucose levels.

Fourteen hydrocephalic pediatric patients with suspected shunt infections were studied for penetrance of nafcillin into the ventricular fluid after intravenous administration. In seven patients with bacterial ventriculitis, the concentration of nafcillin in ventricular fluid was 0.8 to 20.4% of the peak concentration in serum. In the remaining seven patients without bacterial ventriculitis, ventricular fluid levels ranged between less than or equal to 0.02 to 4% of peak serum concentrations. Although the degree of pleocytosis correlated poorly with penetrance, ventricular fluid glucose levels correlated inversely with penetrance of nafcillin (r = -0.7275, P less than 0.001).