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N E Budorick

Publications and source records attributed to N E Budorick.

9 recordsLinked to original sources

Second-trimester echogenic bowel and chromosomal abnormalities.

OBJECTIVE: Our objective was to examine the outcomes of pregnancies in which echogenic bowel was detected in the second trimester. STUDY DESIGN: Twenty-two cases with a prospective diagnosis of echogenic bowel were reviewed. Karyotypic studies were performed in 19 cases, and 17 families had deoxyribonucleic acid-based risk assessment for cystic fibrosis. The echogenicity of the bowel was retrospectively reviewed and graded as mild or bright. RESULTS: Five cases of trisomy 21 and one case of trisomy 18 were detected; four of these had other ultrasonographic abnormalities. Twenty-seven percent of fetuses with echogenic bowel were aneuploid. Risk was greatest for cases with brightly echogenic bowel. No cystic fibrosis mutations were detected. The diagnosis of echogenic bowel was reproducible. CONCLUSION: Brightly echogenic bowel in the second trimester was found to be associated with a significant risk of fetal aneuploidy.

Chromosome Aberrations

Spontaneous improvement of intrathoracic masses diagnosed in utero.

The diagnosis and pregnancy outcome for 14 fetuses with sonographically detected chest masses were reviewed retrospectively. Six lesions became smaller or less apparent during gestation or resolved between antenatal and perinatal imaging studies; these included all three types of cystic adenomatoid malformation (CAM), as well as one case of pulmonary sequestration (PS). This information is extremely important in counseling patients in the second trimester who are considering termination of pregnancy. The poor prognosis traditionally assigned to type II and type III CAM needs changing to reflect the phenomenon of improvement with excellent long-term outcomes. Sonographic indicators of poor outcome were polyhydramnios, hydrops or marked cardiac deviation.

Adult

Linear echoes in the fetal cisterna magna.

Linear echoes are seen in the fetal cisterna magna, (CM) on obstetrical sonography. These echoes often are paired, joining as they descend toward the base of the posterior fossa. Histologic correlation suggests that these echoes are most consistent with dural folds, which likely represent the inferior attachment of the falx cerebelli. A prospective series of 322 prenatal studies was performed in which the sonographer was asked to look for the linear echoes in the cisterna magna and image them. Linear echoes were identified in 84% of all fetuses studied. Identification of these echoes was dependent on CM size, in that they were seen less commonly when the CM was less than 3 mm in diameter. However, their identification was not dependent on gestational age. In addition, 18 fetuses with Dandy Walker cyst or Dandy Walker variant were evaluated and in 16 linear echoes were not seen. We conclude that recognition of normal anatomy within the fetal brain, specifically the fetal CM, is helpful for identifying abnormalities in the size of the CM, whether large or small.

Cisterna Magna

Abnormal spinal curvature in the fetus.

We reviewed 20 cases of sonographically detected abnormal fetal spinal curvature to help determine the significance of this finding. Both marked (13 cases) and mild (7 cases) curves were diagnosed sonographically. Sonography showed associated anomalies in 19 fetuses, including neural tube and ventral wall defects. Outcomes were poor, with only three infants surviving. Isolated scoliosis was identified prenatally in one neurologically normal infant with hemivertebrae. We conclude that abnormal spinal curvature in the fetus is a significant finding, whether mild or severe. Even as an isolated finding, it is significant, as prenatal detection assists postnatal management.

Female

Ossification of the fetal spine.

The neural arch ossification centers in the distal fetal spine were evaluated with ultrasound (US) during the second trimester of pregnancy in 239 fetuses. Ossification of the neural arch centers occurred in a predictable pattern and in a caudal direction. An additional vertebral level became ossified every 2-3 weeks from L-5 through S-5 after 16 weeks gestational age; by 22 weeks, S-2 was ossified in all fetuses studied. Radiographic and histologic correlation was performed in one fetus, and the method of establishing vertebral level with US proved accurate. In addition, the origin of the echoes at US corresponded to the histologic ossification centers. In 95% of the fetuses, S-1 was at the top of the iliac wing. Therefore, the level of ossification in the distal fetal spine could be rapidly assessed. Ossification to S-2 by 22 weeks, with a normal transverse configuration, normal overlying integument, and normal cranial structures, should lead to reassurance in excluding neural tube defects, except for distal sacral lesions.

Female

Significance of nonvisualization of the fetal urinary bladder.

The fetal urinary bladder was visualized sonographically in 1254 (94%) of 1335 consecutive fetuses of 14 weeks of development or older, but it could not be seen in 81 cases (6%). Five of these cases were lost to follow-up and were excluded from the study. Of the remaining 76 cases, 69 (91%) of the pregnancies progressed to term, and the infants were normal at birth and at 6 week perinatal follow-up. Seven (9%) of the fetuses had a variety of associated obstetrical abnormalities that resulted in fetal demise or termination of the pregnancy (oligohydramnios, hydrops, intrauterine growth retardation [IUGR], ventriculomegaly, diaphragmatic hernia, cystic hygroma, and triploidy). Notably, none of these were renal tract anomalies. We concluded that (1) nonvisualization of the fetal urinary bladder with an otherwise normal sonogram, including normal volume of amniotic fluid and normal renal areas, is of no clinical concern and does not require follow-up, and (2) nonvisualization of the fetal urinary bladder in the setting of associated obstetrical abnormalities may be secondary to renal tract anomalies or may only be a consequence of the associated abnormalities.

Female

The pulmonary veins.

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Arteriovenous Malformations

Benign mediastinal cysts: pointed appearance on CT.

A case of bronchogenic cyst and two cases of pericardial cysts are presented. Our report illustrates the diagnostic utility of a pointed contour and the dependence of contour on position on CT in establishing the cystic nature of mediastinal mass.

Aged