Three- and four-dimensional sonographic diagnosis of fetal intra-abdominal umbilical vein varix.

Abstract

Fetal intra-abdominal umbilical vein (FIUV) varix is a rare sonographic finding of a focal dilatation of the umbilical vein. Diagnostic criteria are as follows: an FIUV varix diameter [50 % wider than the adjacent umbilical vein’s diameter, and an intra-abdominal umbilical vein diameter [9 mm [1]. We present antenatal three(3D) and fourdimensional (4D) sonographic diagnoses of FIUV varix. A 30-year-old pregnant Japanese woman, gravida 1, para 0, was referred to our ultrasound clinic at 20 weeks and 3 days of gestation due to a sonographic finding of bilateral choroid plexus cysts. A thorough two-dimensional (2D) sonographic anatomical scan confirmed the presence of bilateral choroid plexus cysts, but there were no other abnormalities. Anatomical re-evaluation at 27 weeks and 3 days revealed the disappearance of the previously noted choroid plexus cysts. However, a dilatation of the intraabdominal portion of the umbilical vein (11.5 mm) was identified between the fetal abdominal wall and inferior edge of the liver. 3D power Doppler (3D HD-flow) with the glass-body mode (Voluson E8; GE Medical Systems, Milwaukee, Wi, USA; curved array transabdominal transducer, 2–8 MHz) revealed the widening and course of the FIUV varix and spatial relationships between the FIUV varix and surrounding vessels (Fig. 1). The 3D inversion mode highlighted the presence of the dilated portion of the vessel in comparison with the adjacent normal segment (Fig. 2). Several follow-up examinations were conducted until term, and a decrease in the size of the cystic portion to a normal diameter was confirmed. A healthy female infant weighing 3,648 g was delivered vaginally at 41 weeks and 3 days of gestation, with an umbilical artery pH of 7.229, and an Apgar score of 7/9 at 1 and 5 min, respectively. No cord or other abnormalities were identified. Image reconstruction of the intra-abdominal anechoic mass positively identified the diagnostic criteria for FIUV varix in the present patient. The 3D/4D color/power Doppler modality, even though diagnostically useful, effectively supports the sonographic diagnosis. However, 2D sonography is difficult to interpret in some cases based on the characteristics of varices. In the abdominal area, this vascular anomaly can be differentiated from other cystic lesions using 2D color/power Doppler sonography [1]. 3D/ 4D color/power Doppler clarified the entire varix and affected vein’s shape and contour. The 3D inversion mode provides data on the anatomy and pathology of fetal fluidfilled structures (digital casts) not possible with standard 2D sonography [2]. This, to our knowledge, is the first report of a FIUV varix imaged using the 3D inversion mode as a sonographic adjunct to 3D/4D color/power Doppler. 3D/4D technology has allowed sonologists to more effectively visualize fetal structures employing multiplanar reconstruction, not previously achievable with conventional 2D sonography. The additional information it yields aids physicians and couples by supporting the diagnosis, allowing better visualization, and improving understanding of and counselling for fetal anomalies. It must be remembered that 3D/4D technology is a supplementary modality, whose use does not ultimately alter the diagnosis, outcome, or counseling provided. B. S. Austria U. Hanaoka M. Sato T. Hata (&) Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa 761-0793, Japan e-mail: toshi28@med.kagawa-u.ac.jp