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Pediatric Imaging

E2622. From Fetal Life to Childhood: Varied Appearances of Congenital Pleuroperitoneal Cavity Abnormalities

Furman M,  Dibble E,  Lourenco A,  Swenson D,  Cassese J. Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI

Address correspondence to E. Dibble (edibble@lifespan.org)

Background Information: Advances in imaging have allowed for earlier diagnoses of fetal and perinatal abnormalities. For optimal patient care, radiologists should be familiar with the imaging appearance of normal fetal and perinatal structures in the chest, abdomen, and pelvis as well as the appearance of common anomalies.

Educational Goals/Teaching Points: In this exhibit we review the role of imaging, with a focus on ultrasound and MRI, in the evaluation of the fetal and neonatal pleuroperitoneal cavity by reviewing the appearance of normal structures; and review the perinatal imaging findings of the spectrum of common anomalies in the chest, abdomen, and pelvis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Cases are selected from 80 fetal MRI examinations performed over the last 5 years for suspected abnormalities in the pleuroperitoneal cavity at the state’s largest dedicated women’s obstetric and children’s hospitals. We demonstrate the normal and abnormal imaging appearances of structures in the chest, abdomen, and pelvis with a focus on ultrasound and MRI. We emphasize standard fetal anatomic survey images as suggested by the American Institute of Ultrasound in Medicine Practice Parameter for the Performance of Obstetric Ultrasound Examinations with some additional structures for comparison to abnormal findings. For the chest, we describe and show the normal imaging appearance of the fetal lungs and diaphragm and the normal imaging appearance of the heart with examples of the four-chamber view, normal left ventricular outflow tract, normal right ventricular outflow tract, and normal situs. To illustrate fetal and perinatal abnormalities in the chest, we describe and show images of congenital diaphragmatic hernias, bronchopulmonary malformations, cardiac masses and anomalies (including dextrocardia), masses, and esophageal atresia. For the abdomen, we describe and show the normal imaging appearance of the size and location of stomach, kidneys, umbilical cord insertion, and cord vessel number. To illustrate fetal and perinatal abnormalities in the abdomen, we describe and show images of intestinal obstruction, adrenal hemorrhage and cyst, hydronephrosis, renal agenesis, multicystic dysplastic kidney, and abdominal masses and cysts. For the pelvis, we describe and show the normal imaging appearance of the urinary bladder. To illustrate fetal and perinatal abnormalities in the pelvis, we describe and show images of urachal cysts and teratomas.

Conclusion: Radiologist familiarity with the imaging appearance of both normal and abnormal fetal and perinatal structures in the chest, abdomen, and pelvis is critical to early and accurate diagnosis of anomalies.