Diagnostic ultrasound ( PDFDrive )

1428 PART IV Obstetric and Fetal Sonography
A
B
SPL
L
C
D
FIG. 41.23 Meconium Peritonitis. (A)-(D) Transverse views of the fetal abdomen demonstrate echogenic bowel and punctate echogenicities
(arrows) around the spleen (SPL) and liver (L). Note associated ascites (curved arrow in B) and pleural effusion (arrowhead in C).
return, although hypoproteinemia and/or AV shunting can also
play a role.
Meconium peritonitis is associated with fetal cystic ibrosis
in 70% of cases. Bowel rupture results in a sterile chemical
peritonitis, oten with ascites 116 (Fig. 41.23; see also Fig. 41.15).
he ascites may be clear or particulate on ultrasound, and its
appearance may change over time. he bowel will usually have
a bunched or matted appearance, and areas of calciication may
be visible. If this diagnosis is suspected, the parents should be
ofered carrier testing for the common cystic ibrosis
mutations.
Urinary Tract Anomalies
Urinary tract anomalies are rare causes of hydrops. Congenital
nephrosis can lead to severe proteinuria and hypoalbuminemia
as the cause of hydrops. 117 Bladder rupture can lead to urinary
ascites but rarely hydrops (Fig. 41.24).
Lymphatic Dysplasia
Congenital lymphatic dysplasia may be the source of many cases
of hydrops that do not have an obvious cause. Bellini et al. 118
found that six newborns presenting at birth with hydrops of
unidentiied cause all had lymphatic dysplasia.