Feasibility of Fetal Portal Venous System Ultrasound Assessment at the FT Anomaly Scan.

Rodica Daniela Nagy,Anca-Maria Istrate-Ofiţeru,Dan Ruican,George-Lucian Zorilă,Dominic Gabriel Iliescu,Anne Marie Badiu

doi:10.3390/diagnostics12020361

Rodica Daniela Nagy, Anca-Maria Istrate-Ofiţeru + Show 4 more

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https://doi.org/10.3390/diagnostics12020361

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Journal: Diagnostics	Publication Date: Jan 31, 2022
Citations: 5	License type: CC BY 4.0

Affiliation: University of Medicine and Pharmacy of Craiova

Abstract

Objective: To investigate the feasibility of the first trimester (FT) ultrasound scan (US) for the evaluation of the fetal portal venous system (PVS) anatomy, and to evaluate the potential of microcopy for a proper pathology evaluation for the PVS in the FT. Methods: We evaluated the PVS in 200 scan examinations performed in FT pregnancy. Half of the cases were scanned by two operators with extensive experience in obstetric ultrasound—Group I, and the other half was evaluated by two sonographers with less experience—Group II. Second-trimester US and autopsy in terminated pregnancies were used as follow-up. The pathologic evaluation was supported by microscopy. Results: all PVS features were successfully assessed by transabdominal ultrasound (TAUS) in 27% of the Group I cases and 14% in Group II. These rates increased to 88% in Group I and in 72% in Group II, after rescanning and using transvaginal ultrasound (TVUS). The conditions that led to rescanning and TVUS were: BMI greater than 24 in 26% cases, unfavorable fetal position (12.32%), retroverted uterus (12.32%), abdominal scar (10.96%), fibroids (4.11%), and combinations of the above (34.23%). The L-shaped UV confluence was identified transabdominally in 91% in Group I and in 79% in Group II and increased to 98% and 95%, respectively, following reevaluations. Microscopy represented a useful audit in all FT investigated cases. Conclusions: At the end of the FT, the visualization of a normal L-shaped UV confluence, that excludes major PVS abnormalities, is achievable in approx. 80%, indifferently the examiners experience. The sonographers experience, pregnant women BMI, and uterine anomalies as fibroids or retroversion significantly affect the rate of visualization, and necessitates vaginal approach and reexamination. The FT pathology, the audit of the ultrasound findings can only be performed microscopically, with relatively little resources involved and good results.

Highlights

The venous system starts to develop in a 4-week embryo, from three symmetric paired veins: the umbilical veins (UVs) which drain the chorion, vitelline veins (VVs) draining the yolk sac, and cardinal veins (CVs) which drain the body of the embryo
In Group I we identified one case with an atypical Hshaped type portal venous confluence which associated ductus venosus agenesis (ADV) with umbilical vein drainage into inferior vena cava (IVC) and increased nuchal translucency (5 mm) (Figure 3)
Another abnormal finding in this group was a case of total portal venous system agenesis (TPVSA) which associated aorto-umbilical fistula and cystic hygroma (Figure 4, white arrow)

Summary

Introduction

The venous system starts to develop in a 4-week embryo, from three symmetric paired veins: the umbilical veins (UVs) which drain the chorion, vitelline veins (VVs) draining the yolk sac, and cardinal veins (CVs) which drain the body of the embryo. The fetal liver starts to develop in the septum transversus and allows the connection between the VVs and UVs with the sinusoids. The right umbilical vein (UV) and the left cranial segment of the left UV will atrophy, and the left UV becomes the main pathway of the blood from the placenta [1]. The primitive VVs develop within the liver to form the future portal venous system (PVS). The VVs are at the origin of the superior mesenteric and splenic veins development, which join into the hepatic portal vein [1] (Figure 1)

Results

Discussion

Conclusion