Prenatal Ultrasonographic Features Research Articles

EP10.16: Prenatal ultrasonographic features and outcomes of 19 cases of congenital intrahepatic portosystemic venous shunts

EP10.16: Prenatal ultrasonographic features and outcomes of 19 cases of congenital intrahepatic portosystemic venous shunts

Analysis of clinical phenotype and pathogenic variant of a fetus with Cornelia de Lange syndrome type II

To explore the prenatal ultrasonographic features and genetic basis for an abortus suspected for type II Cornelia de Lange syndrome (CdLS2). A fetus diagnosed with CdLS2 at the Shengjing Hospital Affiliated to China Medical University on September 3, 2019 was selected as the study subject. Clinical data of the fetus and family history was collected. Following induced labor, whole exome sequencing was carried out on the abortus. Candidate variant was verified by Sanger sequencing and bioinformatic analysis. Prenatal ultrasonography (33 weeks of pregnancy) has revealed multiple anomalies in the fetus, which included slightly widened cavity of septum pellucidum, blurred corpus callosum, slightly reduced frontal lobe volume, thin cortex, fusion of lateral ventricles, polyhydramnios, small stomach bubble, and digestive tract atresia. Whole exome sequencing has revealed a heterozygous c.2076delA (p.Lys692Asnfs*27) frameshifting variant in the SMC1A gene, which was found in neither parent and was rated as pathogenic based on the guidelines of American College of Medical Genetics and Genomics (ACMG). The CdLS2 in this fetus may be attributed to the c.2076delA variant of the SMC1A gene. Above finding has provided a basis for genetic counseling and assessment of reproductive risk for this family.

Novel qualitative and quantitative ultrasound markers to facilitate prenatal diagnosis of congenital duodenal obstruction

Objective Accurate prenatal diagnosis of congenital duodenal obstruction (CDO) is challenging. We aimed to determine new ultrasound metrics for accurate prenatal diagnosis of fetal CDO. Methods Data pertaining to 46 fetuses with suspected small intestinal obstruction (26 CDO; 16 high jejunal obstructions) were retrospectively analyzed. Prenatal ultrasonographic features including dilated intestinal length, stomach length, maximum intestinal dilatation, ratio of dilated intestinal length at late gestation and dilated stomach length (I/S ratio), and location of distal end of dilated bowel segment relative to spine were compared between CDO and high jejunal obstruction groups. The diagnostic performance of ultrasound indices was evaluated using receiver operating characteristics curve analysis. Results In 25 out of 26 CDO cases, the distal end of the dilated small intestine segment was located on the right side of spine, while that in the high jejunal obstruction group was located on the left side of spine. The dilated intestinal length and I/S ratio in CDO group were significantly smaller than those in high jejunal obstruction group (p < .05). Dilated intestinal length <51 mm or I/S ratio <1 showed high sensitivity (100, 100%) and specificity (96.1, 92.3%) for CDO (area under the curve: 0.995 and 0.988, respectively). There were no significant differences in the AUCs of dilated intestinal length and I/S ratio. Significant correlation of the site of obstruction in CDO with fetal dilated intestinal length and I/S ratio (r = 0.686; 0.660, p < .001, respectively) were noted. Conclusion Location of the distal end of the dilated small intestine segment relative to the spine, dilated intestinal length, and I/S ratio may help differentiate fetal CDO from high jejunal obstruction. The latter two metrics were associated with the site of obstruction in CDO patients.

Prenatal ultrasonographic features and follow-up outcomes of 19 cases of congenital intrahepatic portosystemic venous shunts diagnosed during the foetal period

BackgroundTo investigate the prenatal ultrasonographic features and case characteristics of the congenital intrahepatic portosystemic venous shunt (IHPSS) diagnosed during the foetal period and analyse its prognosis.MethodsWe conducted a retrospective cohort study of patients diagnosed with IHPSS between 2016 and 2021. IHPSS was defined as an abnormal connection between the foetal intrahepatic portal and the hepatic veins.ResultsIn this study, 19 foetuses were identified, including 12 cases of single shunt and 7 cases of multiple shunts, with a gestational age of 33.8 ± 4.5 (range 25–40) weeks at diagnosis. In the single-shunt group, the origin position of the shunts was all from the left branch of the portal vein (LPV), whereas in the multiple-shunt group, the origin position of the shunts was from the LPV in six cases. Common concomitant intrauterine abnormalities of IHPSS include foetal growth restriction (47.4%) and foetal cardiac enlargement (21.1%). The postnatal manifestations of IHPSS include biochemical abnormalities (increased gamma-glutamyl transferase and bilirubin levels), neonatal hypoglycaemia, neonatal hyperammonaemia, pulmonary hypertension, multiple intrahepatic hyperechoic nodules, and cutaneous haemangiomas. Spontaneous closure of shunts occurred in ten cases, and the mean time to shunt closure was 8.1 months (1–28 months).ConclusionsMost IHPSS found during the foetal period is located in the left branch of the portal vein, and the gestational age at diagnosis is usually in the late second or third trimester. Spontaneous closure of shunts can occur in most live births, and the prognosis is good.

Prenatal ultrasonographic features in Blomstrand osteochondrodysplasia: Antenatal case series confirmed by postmortem radiology and molecular diagnosis.

Blomstrand osteochondrodysplasia (BOCD, MIM #215045) is an ultrarare lethal skeletal dysplasia (LSD) perinatally, characterized by extremely advanced bone maturation, generalized osteosclerosis, and severe tetramicromelia caused by biallelic loss-of-function mutations in the parathyroid hormone receptor-1 gene (PTHR1). We aim to describe prenatal ultrasonographic features in a retrospective fetal case series of BOCD and emphasize the importance of multidisciplinary antenatal evaluation of LSDs to improve the differential diagnosis. Prenatal ultrasound findings of five fetal cases diagnosed with BOCD between 2000 and 2019 in the Prenatal Diagnosis Unit and Medical Genetics were reviewed, along with postmortem examination results and confirmatory molecular results. All fetuses presented with severe sonographic findings of LSDs comprising tetramicromelia, thoracic hypoplasia, and retro-micrognathia. Marked cervical hyperextension was present in three fetuses. Flared metaphyses were prenatally identified in only one fetus. X-rays of four fetuses evaluated postmortem showed advanced bone maturation, generalized osteosclerosis, and dumbbell-like appearance of long bones due to metaphyseal enlargement. The presence of retro-micrognathia along with a protruding tongue and severe metaphyseal flaring can suggest a diagnosis of BOCD, when prenatal ultrasound findings are indicative for LSD. The diagnosis can be ascertained through postmortem clinical and radiological evaluation and/or molecular testing.

Proposal for Practical Approach in Prenatal Diagnosis of Beckwith-Wiedemann Syndrome and Review of the Literature.

Background: Beckwith–Wiedemann syndrome (BWS) is a phenotypically and genetically heterogeneous disorder associated with epigenetic/genetic aberrations on chromosome 11p15.4p15.5. There is no consensus criterion for prenatal diagnosis of BWS. Methods: Three BWS patients with their clinical histories, prenatal ultrasonographic features, and results of molecular diagnosis were presented. Likewise, by incorporating the findings of our cases and literature review, the phenotypic spectrum and genotype–phenotype correlations of fetal BWS were summarized, and a practical approach in prenatal diagnosis of BWS was proposed. Results: A total of 166 BWS cases with prenatal features were included for analysis. Common fetal features include abdominal wall defects (42.8%), polyhydramnios (33.1%), and macrosomia (32.5%). Molecular pathologies include methylation changes in imprinting control region 1 and 2 (ICR1 and ICR2), paternal uniparental disomy of chromosome 11p15.5, copy number change involving 11p15, etc. Some genotype–phenotype correlations were observed. However, the broad phenotypic spectrum but limited features manifested by affected fetuses rendering ultrasonographic diagnosis not easy. Conclusions: Molecular tests are used for prenatal diagnosis of BWS suspected by ultrasonography. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) is recommended as the first-line molecular tool because it simultaneously detects ICR1/ICR2 methylation statuses and copy numbers that solve the majority of clinical cases in the prenatal scenario.

Prenatal ultrasound diagnostic clues of congenital dislocation of the knee

Objective To explore prenatal ultrasound diagnostic clues of congenital dislocation of the knee(CDK). Methods The prenatal ultrasonographic features of 13 CDK fetuses diagnosed from January 2013 to December 2018 in the Third Affiliated Hospital of Zhengzhou University were retrospectively analyzed, combined with the results of gene detections and pathological findings. Results Thirteen fetuses were diagnosed by prenatal ultrasound during the second trimester. Two-dimensional and three-dimensional ultrasound showed dislocation of the knee(unilateral in 3 cases and bilateral in 10 cases). All cases were accompanied with multiple abnormalities, including talipes(5 cases), overlapping fingers(2 cases), short nasal bone(1 case), thicken nuchal fold(1 case), narrow thorax(1 case), abnormal vertebral development(1 case), etc. Ultrasound diagnosis included Larsen syndrome in 2 cases, arthrogryosis multiplex congenital in 3 cases, asphyxiating thoracic dysplasia in 1 case, and congenital dislocation of the knee in 7 cases. CDK was confirmed in all fetuses after termination of pregnancy. Three of them were known to undergo chromosome examinations with normal chromosomal microarray analysis (CMA). One case was confirmed to be Larsen syndrome by further second-generation sequencing combined with first-generation sequencing screening, suggesting there was FLNB gene mutation. Conclusions CDK can exist isolated, and it can also be a common manifestation of various diseases. Therefore, attention should be paid to other associated abnormalities in the prenatal detection of knee flexion, and further detection of related genes can provide valuable information for genetic counseling. Key words: Prenatal ultrasonography; Fetal; Congenital dislocation of the knee; Gene

Prenatal ultrasound diagnosis and prognosis analysis of vasa previa

Objective To investigate the prenatal ultrasonographic features and prognosis of vasa previa, to explore the application value of sector scanning in the intracervical mouth by antenatal ultrasound, then to increase vasa previa detection rate. Methods Prenatal ultrasound images, clinical characteristics and pregnancy outcome of 35 pregnant women with vasa previa confirmed by surgery and pathology were analyzed retrospectively, the diagnostic effectiveness of sector scanning in the intracervical mouth was evaluated. Results Thirty-three of the 35 vasa previa cases were detected by sector scanning in the intracervical mouth, with a detection rate of 94.3% (33/35). Of the 35 cases, 20 cases (60.6%) were first contacted in second trimester and 13 cases (39.4%) were first contacted in third trimester. Two cases were missed or misdiagnosed, which were all first contact in third trimester. Among the 35 cases, 25 were velamentous placenta and 4 were battledore placenta. Twenty cases were low-lying placenta or marginal placenta previa. All 35 women underwent cesarean section. No neonatal mortality, 11 term infants, 20 premature infants of more than 34 weeks and 4 premature infants of less than 34 weeks. All placentas underwent pathological examination after delivery, 4 cases placentas underwent vascular casting, and it was found that 2 cases were vasa previa of umbilical artery branch and 2 cases were vasa previa of allantoic veins branch. Conclusions Vasa previa can be effectively detected by prenatal ultrasonography through sector scanning in the intracervical mouth. Second trimester is the best period to detect vasa previa. Pathomorphological examination on placenta after delivery and vascular casting are helpful to the understanding of vasa previa. Key words: Ultrasonography, prenatal; Vasa previa; Vascular casting

Examination of Prenatal Sonographic Findings: Intra-Abdominal Bowel Dilation Predicts Poor Gastroschisis Outcomes

Background: Gastroschisis is an anterior abdominal wall defect with variable outcomes. There are conflicting data regarding the prognostic value of sonographic findings. Objectives: The aim of this study was to identify prenatal ultrasonographic features associated with poor neonatal outcomes. Method: A retrospective review of 55 patients with gastroschisis from 2007 to 2017 was completed. Ultrasounds were reviewed for extra-abdominal intestinal diameter (EAID) and intra-abdominal intestinal diameter (IAID), echogenicity, visceral content within the herniation, amniotic fluid index, defect size, and abdominal circumference (AC). Ultrasound variables were correlated with full enteral feeding and the diagnosis of a complex gastroschisis. Results: Bivariate analysis demonstrated an increased time to full enteral feeds with increasing number of surgeries, EAID, and IAID. Additionally, there was a significant relationship between IAID and AC percentile with the diagnosis of complex gastroschisis. On multivariate analysis, only IAID was significant and increasing diameter had a 2.82 (95% CI 1.02–7.78) higher odds of a longer time to full enteral feeds and a 1.2 (95% CI 1.05–1.36) greater odds of the diagnosis of a complex gastroschisis. Conclusions: Based on these findings, IAID is associated with a longer time to full enteral feeding and the diagnosis of complex gastroschisis.

Prenatal ultrasonographic features of fetal total anomalous pulmonary venous connection

Objective To investigate the prenatal ultrasonographic features of fetal total anomalous pulmonary venous connection (TAPVC). Methods Forty-one cases who received prenatal ultrasound examination and then were diagnosed with TAPVC by postnatal surgery at the Third Affiliated Hospital of Zhengzhou University from June 2013 to June 2018 were enrolled. Echocardiography findings of all cases were analyzed retrospectively, and the prenatal imaging features were summarized. Results Among all cases, 21 were confirmed as supracardiac type, 14 as intracardiac type, four as infracardiac type and two as mixed type after surgery. The echocardiographic features of TAPVC were as follows: all 41 cases showed smooth posterior wall of left atrium without visible part of pulmonary venous connected to the left atrium in the-four chamber view; in 33 cases, the space between left atrium and descending aorta was widened and the pulmonary venous confluence was observed in the four-chamber view; ten cases showed a dilated coronary sinus in the four-chamber view and 27 cases showed vertical vein in the three vessels and trachea or the upper abdomen view. None of the 41 cases was complicated by other structural intracardiac abnormalities. However, seven cases were complicated by obstruction of blood flow, and the blood flow velocity measured by Doppler ultrasound was 0.76 m/s to 1.25 m/s. Conclusions Blood flow in pulmonary veins should be carefully observed in prenatal ultrasonography, and anomalous pulmonary venous connection should be considered when pulmonary veins do not connect to the left atrium. Key words: Pulmonary veins; Congenital abnormalities; Scimitar syndrome; Ultrasonography, prenatal

Clues and techniques of prenatal ultrasonographic diagnosis for fetal aortic arch anomalies

Objective To explore the ultrasonographic features, diagnostic clues and methods of fetal aortic arch anomalies, and to improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomalies. Methods Fetuses with aortic arch anomalies diagnosed by prenatal ultrasound were selected as the study objects. The prenatal ultrasonographic features of the three views of the aortic arch were carefully observed. The three views included the followings: the transverse view(the view of three vessels and trachea), the sagittal view (the longitudinal view of the aortic arch), and the coronal view (the coronal view of the descending aorta). The prenatal diagnostic clues and diagnostic techniques of aortic arch anomalies were summarized and analyzed. Results Eighty-one cases with aortic arch anomalies were followed up. Fifteen cases were left-sided aortic arch and left-sided ductus arteriosus with aberrant right subclavian artery, 22 cases with right aortic arch and left-sided ductus arteriosus with aberrant left subclavian artery, 4 cases were mirror right aortic arch and left-sided ductus arteriosus, 2 cases were mirror right aortic arch and right-sided ductus arteriosus, 11 cases were double aortic arch, 23 cases were coarctation of the aorta, and 4 cases were interruption of aortic arch. Among them, 27 cases were complicated with other cardiac and extra-cardiac malformations and 13 cases with chromosomal abnormalities. Prenatal ultrasonographic clues for diagnosis of coarctation of the aorta included the three vessels and trachea view showing small diameter and disproportion to the diameter of the ductus arteriosus. And the longitudinal view of the aortic arch was helpful for showing the position and the extent of coarctation of the aorta. Prenatal ultrasonographic clues for diagnosis of interruption of aortic arch were that the three vessels and trachea view and the longitudinal view of the aortic arch showed the interruption between aortic arch and descending aorta. And the abnormal combination cases of the aortic arch segments also had their corresponding diagnostic clues. These clues included that the three vessels and trachea view showed abnormal position, arrangement and running of the branches of the aortic arch. And the coronal view of the descending aorta also showed abnormal changes in the branches of aortic arch. Conclusions Various types of congenital aortic arch anomalies have characteristic ultrasonography and their corresponding diagnostic clues and methods. The combined use of the three views of the aortic arch is effective in prenatal diagnosis for aortic arch anomalies. Key words: Ultrasonography, prenatal; Aortic arch anomalies; Diagnostic clues

Risk stratification and outcome determinants in gastroschisis

Selection of outcome determinants and risk stratification are necessary to identify patients at higher risk for morbidity and mortality. This facilitates human and material resource allocation and allows for improved family counseling. While several different factors, including prenatal ultrasonographic bowel features, the timing and mode of delivery, and the features of bowel injury have been investigated in gastroschisis, there is still significant debate as to which of these best predicts outcome. This article reviews the different outcome predictors and risk prognostication schemata currently available in the literature to help guide clinicians caring for infants with gastroschisis.

Value of ultrasonic scoring system for predicting risks of placenta accreta

Objective To explore the value of ultrasound scoring system in predicting the type and risk of placenta accreta. Methods Clinical data of 180 placenta accreta patients who delivered in the Peking University Third Hospital between January 2005 and November 2014, were retrospectively analyzed. Prenatal ultrasonographic features were analyzed, including position and thickness of the placenta, disappearance of hypo-echoes in posterior placenta, continuousness ofbladder line, existence of lacuna, condition of the subplacental vascularity, completeness of cervical morphology, existence of cervical sinus, and history of cesarean section. A score of 0, 1 or 2 was given to each item, and a sum-up was calculated for each patient. The cut-off scores of patients with placenta accreta, placenta increta and placenta percreta were calculated by receiver operating characteristic carve, respectively. At the same time, blood loss and hysterectomy rate were compared among the three groups. Variance analysis, rank sum or Chi-square tests were used for statistical analysis. Results Among the 180 cases, there were 115 cases of placenta accreta, 38 of planceta increta and 27 of placenta percreta. Placenta increta and percreta were defined as the severe type. Blood loss in placenta accreta was lower than in the severe type [200 (100-4 000) ml vs 3 025 (100-15 000) ml, P<0.01]. There was no difference in blood loss between patients with placenta increta or percreta (P=0.350). No hysterectomy was performed for patients with placenta accreta, the rate being lower than in the severe type [0 vs 29.2% (19/65), P<0.01]. Among the severe type, 18.4% (7/38) of the placenta increta patients underwent hysterectomy, the rate being lower than in placenta percreta patients [44.4% (12/27), P<0.01]. The score in placenta accreta was lower than in the severe type [(1.88±1.45) vs (7.01±2.15) scores, P<0.01]. In the severe type, the score in placenta increta was lower than in placenta percreta [(6.08±2.62) vs (8.74±2.75), P<0.01]. The receiver operating characteristic curve showed that the cut-off score of placenta accreta and the severe type was 5 [area under the curve (AUC)=94.3%, the score ≥4.5, the sensitivity=81.5%, and the specificity=95.7%], the cut-off score of placenta accreta and increta was 3 (AUC=91.1%, score ≥2.5, the sensitivity=92.1%, and the specificity=75.7%), and the cut-off score of placenta increta and percreta was 10 (AUC=74.6%, score ≥9.5, the sensitivity=55.6%, and the specificity=89.5%). Conclusions Ultrasound scoring system is effective in assessing types of placenta accreta and predicting its associate risks, and alerting the possibility of hysterectomy. It also facilitates preoperative planning and guides physicians in formulating subsequent treatment plans. Placenta accreta and the severe type (placenta increta and percreta) can be distinguished by cut-off scores ≥5, and a score ≥10 implies a higher risk of placenta percreta. Key words: Placenta accreta; Ultrasonography, prenatal; Severity of illness index; Blood loss, surgical; Forecasting

Analysis of prenatal sonographic characteristics and postnatal outcomes of absent pulmonary valve syndrome

Objective To investigate the prenatal ultrasonographic features of absent pulmonary valve syndrome(APVS). Methods The ultrasonographic images, follow-up results and the other clinical data of 17 fetuses suffering from APVS were retrospectively analyzed. According to the difference of the pulmonary artery diameter, subjects were divided into pulmonary artery(PA) dilated group (14 cases) and non-dilated group (3 cases). The sonographic features of the two groups were analyzed and compared. Results All 17 fetuses had rudimentary or absent pulmonary valves, and stenosis of the pulmonary annulus. Moderate or severe regurgitation flowed through pulmonary artery and right ventricular outflow in diastole. PA dilated group might be combined with Tetralogy of Fallot, double outlet of right ventricle or right ventricular aneurysm, there were 85.7% (12/14) with absent ductus arteriosus. The forward flow velocity during systole through pulmonary annulus was significantly fast. PA non-dilated group could be accompanied by Ebstein′s anomaly or tricuspid atresia. Ductus arch was always present. The forward flow velocity during systole through pulmonary annulus was slow. Conclusions The fetal pulmonary artery diameter with APVS can dilate or not. Reverse flow during diastolic period, which rushes from arteriosus ductus to the right ventricular outflow tract, contributes to the prenatal diagnosis of non-dilated PA. Key words: Ultrasonography, prenatal; Absent pulmonary valve syndrome

Diagnostic et évolution prénatale de l’ouraque perméable : à propos d’un cas

Prenatal ultrasonographic features of patent urachus consist in anechoic proximal cord cyst communicating with the bladder associated with large umbilicus. Distinction should be made with omphalocele and bladder extrophy. Spontaneous evolution leads to rupture during mid-trimester and bladder protrusion. Karyotyping is not mandatory in isolated typical cases. Early postnatal surgery is usually required.

Prenatal ultrasonographic features of Joubert syndrome

We describe the prenatal imaging of 2 fetuses at risk for Joubert syndrome (JS). In the first case, the mother, who had previously given birth to a child with JS, was referred to our hospital at 17 weeks' gestation. The prenatal diagnosis of JS complicated with an encephalocele was made. In the second case, the mother had previously given birth to 2 children with JS. A diagnosis of JS complicated with postaxial polydactyly of the right foot was made. In both cases, the pregnancy was terminated following genetic counseling. Postmortem examinations confirmed the diagnosis of JS.

Congenital epulis: prenatal ultrasonographic and postnatal MR features with pathologic correlation

On prenatal ultrasonogram, a fetus was found to have a protruding mass in the oral cavity. Postnatal magnetic resonance imaging (MRI) revealed the mass to have 2 components: a main portion exhibiting isointensity on T1- and T2-weighted images with mild contrast enhancement and a contrast-enhancing rim showing T1 isointensity and T2 hyperintensity. Histologic examination revealed a congenital granular cell tumor with prominent peripheral vessels.

Prenatal ultrasound diagnosis and management of body stalk anomaly: analysis of nine singleton and two multiple pregnancies.

To determine prenatal ultrasonographic features and management of fetuses with body stalk syndrome in singleton and multiple gestations. In a retrospective chart analysis we reviewed all cases with body stalk anomaly diagnosed in our prenatal unit between 1994 and 2001. During this time period we adopted a uniform approach to the investigation of cases of body stalk anomaly, including amniocentesis or chorionic villus sampling (CVS) for fetal karyotyping. A general schematic sonographic examination was performed to search for fetal abnormalities and was followed by detailed two-dimensional and color-coded Doppler echocardiography. Nuchal translucency (NT) measurements were performed before 14 weeks of gestation. Postmortem examinations of fetuses were performed following termination by induction with prostaglandin. Eleven fetuses with body stalk anomaly were diagnosed, including two multiple pregnancies complicated by discordant body stalk anomaly. The typical ultrasonographic features were a major abdominal wall defect, severe kyphoscoliosis, limb abnormalities, neural tube defects, and a malformed, short umbilical cord with a single artery. None of the fetuses demonstrated craniofacial defects. All placentae that were examined showed evidence of persistence of the extra-embryonic celomic cavity. NT measurements were abnormal in all cases. Fetal karyotyping was normal in ten cases. In one case CVS showed a mosaic trisomy 2 (46,XX/47,XX,+ 2). Selective fetocide was performed in one trichorionic-triamniotic triplet pregnancy in early gestation, which was followed by normal development of the remaining healthy dichorionic-diamniotic twins. In a monochorionic-diamniotic twin pregnancy with one affected fetus ultrasound surveillance showed the normal development of the unaffected twin. We present a large series of body stalk anomaly, including multiple gestations, with thoraco- and/or abdominoplacental attachment and without craniofacial defects. This specific phenotype may be explained by embryonic maldevelopment. The typical features of body stalk anomaly can be detected by ultrasound by the end of the first trimester, which is important for patient management. Consequently, this anomaly should be distinguished from other fetal abdominal wall defects.

Prenatal diagnosis and perinatal management of a lingual lymphangioma

We describe the prenatal ultrasonographic features that led to the diagnosis of a lingual lymphangioma. The risk of upper airway obstruction, which is associated with this rare abnormality, prompted us to plan careful perinatal management. We believe that, in cases of suspected lymphangioma of the tongue or other oropharyngeal tumors, elective delivery should be carried out in a tertiary referral center in which emergency ventilation and tracheostomy are possible.

Antenatal Diagnosis of Diastematomyelia

Diastematomyelia is a rare condition comprised of saggital division of the spinal cord into halves by either cartilagenous or bony spurs at any level of the spinal cord. It is usually associated with anomalous development of the vertebrae. We present a case demonstrating prenatal ultrasonographic features of diastematomyelia that was confirmed later by autopsy.