Volume 11 Issue 1 (February) - Australasian Society for Ultrasound ...

ASM 2007 Abstracts
506 Antenatal diagnosis of cloacal exstrophy
Jacqueline L Cartmill, Australia, Ann Quinton, Nepean Centre
for Perinatal Care and Research, Michael J Peek, University of
Sydney, NSW, Australia
Introduction
We present a case of cloacal exstrophy diagnosed on antenatal
ultrasound.
Case report
A 31-year-old woman in her second pregnancy was referred
following detection of a fetal omphalocoele at a nuchal
translucency scan. Ultrasound performed at 16 + 3 weeks
demonstrated a moderate omphalocoele containing bowel.
The liver, gall bladder and stomach appeared normally
situated. It was difficult to visualise the region between
the omphalocoele and the perineum. Normal bladder and
genitalia could not be adequately visualised. Amniocentesis
confirmed a normal male karyotype (46XY).
A further ultrasound performed at 17 + 5 weeks demonstrated
findings highly suggestive of cloacal exstrophy. The
bladder was not visualised and there was a large infraumbilical
omphalocoele with appearances typical of a prolapsed
ileum (‘elephant trunk’). The patient was counselled regarding
the findings and requested termination of pregnancy.
Postmortem examination of the fetus confirmed cloacal
exstrophy with omphalocoele and imperforate anus (likely
representing omphalocoele-exstrophy-imperforate anus-spinal
defects (OEIS) complex).
Discussion
Cloacal exstrophy is a rare complex anomaly caused by
a defect in the formation of the urorectal septum, which
occurs in 1/200 000 births. This case demonstrates how an
omphalocoele with unusual sonographic features may represent
a more serious underlying defect with a less favourable
prognosis. The ‘elephant trunk’ appearance of the prolapsed
terminal ileum has previously been reported, and it was this
feature that assisted us in making the diagnosis of cloacal
exstrophy antenatally.
507 Intraabdominal lymphangiohaemangiomas
Amaranthi Y De Silva, Monash Medical Centre, Vic, Australia,
Surekha Kumbla, Australia
Objective
To discuss a rare case of recurrent and multiple intussusceptions
due to intraabdominal lymphangiohaemangiomas.
Lymphangiohaemangiomas are rare, and we present a
case of extensive systemic lymphangiohaemangioma presenting
as recurrent intussceptions.
Neonatal intussusception is a common condition, however,
intussusception occurring in the older child requires
evaluation for a lead point.
Our patient presented with two episodes of recurrent
abdominal pain and vomiting on the background of multiple
subcutaneous lymphangiohaemangiomas, and was found to
have multiple intussusceptions on both occasions.
Ultrasound examination demonstrated a complex, multiloculated
cystic mass anterior to the left kidney and two
intussusceptions with similar looking smaller lesions acting
as lead points. Correlative ultrasound examination of the
left flank soft tissue mass demonstrated similar appearance.
These findings were similar to CT findings at the patient’s
previous presentation.
Although, lymphangiohaemangiomas are rare, they can
occur intra-abdominally and, if located in the bowel wall,
may present with intussusception.
508 Epiploic appendagitis: a case report
Tim D Huynh, Austin Health, Vic, Australia
Objective
To demonstrate the use of ultrasound in the diagnosis of
epiploic appendagitis.
Epiploic appendagitis is a benign self limited inflammatory
condition secondary to the infarction of an epiploic
appendage, due to spontaneous torsion or venous thrombosis.
It normally presents as a sudden onset of focal abdominal
pain and most commonly occurs in the left lower quadrant.
This is a case where ultrasound was used in conjunction
with CT in the diagnosis of epiploic appendagitis. The
patient was a 25-year-old male who presented with left
lower quadrant abdominal pain. His blood tests were normal
and his pain was controlled with analgesia. The question was
whether he had an abdominal hernia.
Ultrasound of this patient demonstrated an echogenic
ovoid structure, deep to the anterior abdominal wall, directly
beneath the area of focal pain. No vascularity was demonstrated
within the structure. No hernia was seen. A subsequent
CT was also performed which demonstrated an area
of increased density of fat, with a hyperdense rind, adjacent
to the descending colon. These appearances were consistent
with the diagnosis of an epiploic appendagitis.
509 The normative ranges of amniotic fluid single deepest
pocket, two-diameter pocket and amniotic fluid index in an
Asian population
Lai Mok, Sook-Ling Lee, Stephanie Fook-Chong, Singapore
General Hospital, Singapore, Wei-Ching Tan, Hak-Koon Tan,
Singapore
Introduction
Ultrasonography serves as a useful modality for the evaluation
of amniotic fluid volume, but different techniques
of evaluation may produce significantly different results.
As amniotic fluid volume may be associated with adverse
outcomes in pregnancy, the identification of an accurate
technique for its evaluation is important.
Objective
To establish the normal ranges of single deepest pocket, twodiameter
pocket and amniotic fluid index throughout gestation.
Method
Two-hundred-and-eighty patients with gestational ages
between 14 and 40 weeks were recruited for this crosssectional
study. Inclusion criteria included patients with
well-established dates (confirmed by earlier ultrasound)
and singleton, non-anomalous fetuses. Two sonographers
performed the cases. The protocol for examination was as
follows:
i) The single deepest pocket was identified and measured;
ii) The 2-diameter pocket was calculated by multiplying the
depth and the width of the single largest pocket; and
iii) The amniotic fluid index was obtained by dividing the
abdomen into four quadrants, measuring the largest
pocket in each quadrant and summing these values.
Linear regression models were fitted to the data for
analysis. Polynomial regression models were utilised to
42 ASUM Ultrasound Bulletin 2008 February 11 (1)