ultrasound diagnosis of fatal anomalies

UROGENITAL TRACT
Malini S, Valdes C, Malinak LR. Sonographic diagnosis
and classification of anomalies of the female genital
tract. J Ultrasound Med 1984; 3: 397–404.
Meizner I, Mashiach R, Shalev J, Efrat Z, Feldberg D. The
“tulip sign”: a sonographic clue for in-utero diagnosis
of severe hypospadias. Ultrasound Obstet Gynecol
2002; 19: 250–3.
Neri G, Opitz J. Syndromal (and nonsyndromal) forms of
male pseudohermaphroditism. Am J Med 1999: 89:
201–9.
Smith DP, Felker RE, Noe HN, Emerson DS, Mercer B. Prenatal
diagnosis of genital anomalies. Urology 47: 114–
7.
Speiser PW. Prenatal treatment of congenital adrenal
hyperplasia. J Urol 1999; 162: 534–6.
1
2
3
4
5
Hydronephrosis
Fig. 7.13 Hydronephrosis. Severe bilateral hydronephrosis
at 25 + 2 weeks. The urinary bladder
appears normal, and there is a normal amount of
amniotic fluid.
Definition: Dilation of the renal pelvis due to
ureteropelvic, ureterovesical, vesicourethral stenosis
or reflux. Hydronephrosis constitutes 75%
of the renal anomalies detected prenatally. In
75% of cases, the finding is unilateral.
Incidence: One in 200 to 1 : 1000 births.
Sex ratio: M : F = 4 : 1 (ureteropelvic stenosis), M
F (ureterovesical stenosis).
Clinical history/genetics: Mostly sporadic, but
may occur in association with 70 different syndromes.
Teratogens: Thalidomide, diabetes mellitus, cocaine,
benzodiazepine.
Embryology: There are three different forms of
obstruction—intrinsic, extrinsic, and secondary.
The most common cause is the intrinsic form, due
to an abnormal bundle of muscle leading to obstruction
of the ureter. Over a certain period of
time, this bundle degenerates, and the resulting
fibrous tissue causes compression of the ureter.
In the extrinsic form, the compression is caused
primarily by a lesion outside of the ureter, usually
a blood vessel anomaly (an accessory renal
artery). The secondary form is due to ureterovesical
refluxmimicking urinary tract obstruction.
Associated malformations: In 30% of cases, bilateral
ureteropelvic stenoses are found. Other
urogenital anomalies are found in a further 30%:
cloaca formation, bladder exstrophy, ureterocele,
megacystis, megaureter, urethral valve syndrome,
ureter obstruction, vesicoureteral reflux.
In addition, intra-abdominal tumors and cardiac
anomalies may also be found.
Associated syndromes: In 20% of cases, multiple
anomalies or syndromes coexist; chromosomal
anomalies are found in 5%.
Ultrasound findings: Widening of the renal pelvis
is well detected during abdominal scanning. The
width of the renal pelvis should be measured in
its anteroposterior diameter in a cross-sectional
130