Diagnostic ultrasound ( PDFDrive )

CHAPTER 33 The Fetal Face and Neck 1163
in fetal goiter. Primary fetal thyroid dysfunction may also cause
goiter.
Fetal goiter appears as a midline homogeneous solid mass in
the anterior neck surrounding the trachea (Fig. 33.33). here
may be increased blood low to the goiter. When large, fetal
goiters cause hyperextension of the neck, leading to interference
with fetal swallowing and resultant polyhydramnios. Neck
hyperextension can lead to fetal malpresentation and can cause
diiculties at delivery. Cordocentesis may be necessary to
determine if there is fetal hypothyroidism or hyperthyroidism.
In the setting of fetal hypothyroidism, treatment with intraamniotic
thyroid hormone will oten lead to a decrease in size of
the fetal goiter. 130 Ater treatment with intrauterine thyroxine,
fetal goiter may decrease in size, and hyperextension of the fetal
neck may resolve. In cases of fetal hyperthyroidism, it is important
to evaluate for fetal tachycardia and high-output cardiac
failure.
CONCLUSION
Prenatal sonographic evaluation of the fetal face and neck ofers
an opportunity to identify many abnormalities. hese observations
are oten essential to prenatal counseling and prognosis because
of the association of many of these abnormalities with syndromes
and chromosomal anomalies. Appropriate diagnosis of abnormalities
allows for planning of the appropriate mode of delivery and
therapy when the fetal airway is potentially compromised.
Acknowledgments
We would like to acknowledge with gratitude the assistance of
librarians Alison Clapp and Miriam Geller and the administrative
assistance of Susan Ivey, Department of Radiology, at Children’s
Hospital Boston. Special thanks also to Ants Toi, MD, for the
discussion on craniosynostosis.
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