REVIEW
Improving prenatal detection of abdominal supraumbilical anomalies: The sonographic examination of fetal anechoic spaces of upper abdomen revisited
Waldo Sepulveda MD,
Amy E. Wong MD,
Angela C. Ranzini MD,
Corresponding Author
Waldo Sepulveda MD
FETALMED—Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
Correspondence
Waldo Sepulveda, FETALMED—Maternal-Fetal Diagnostic Center, Estoril 50, Suite 203, Santiago 7591047, Chile.
Email: [email protected]
Search for more papers by this authorAmy E. Wong MD
Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, California, USA
Search for more papers by this authorAngela C. Ranzini MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, Ohio, USA
Search for more papers by this authorWaldo Sepulveda MD,
Amy E. Wong MD,
Angela C. Ranzini MD,
Corresponding Author
Waldo Sepulveda MD
FETALMED—Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
Correspondence
Waldo Sepulveda, FETALMED—Maternal-Fetal Diagnostic Center, Estoril 50, Suite 203, Santiago 7591047, Chile.
Email: [email protected]
Search for more papers by this authorAmy E. Wong MD
Department of Maternal-Fetal Medicine, Palo Alto Medical Foundation, Mountain View, California, USA
Search for more papers by this authorAngela C. Ranzini MD
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, Ohio, USA
Search for more papers by this authorFunding information: Sociedad Profesional de Medicina Fetal “Fetalmed” Ltda., Chile
Abstract
Visualization of the axial plane of the fetal abdomen is mandatory to obtain abdominal biometry in the assessment of fetal growth in the second and third trimesters. The main anatomic landmarks that must be identified in this view include the fetal stomach and the intrahepatic portion of the umbilical vein, which are easily identifiable as they appear anechoic on ultrasound. The gallbladder is the other prominent anechoic structure in this plane. Focused study of the morphological characteristics of, and spatial relationship among, these three anechoic spaces is a simple technique to detect anomalies involving fetal upper abdominal organs. In this review, the sonographic features of those conditions that can be detected using this technique, which was termed the Fetal Examination of the Anechoic Spaces of upper abdomen Technique (FEAST), are classified and illustrated.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- 1Nadel A. Ultrasound evaluation of the fetal gastrointestinal tract and abdominal wall. In: ME Norton, LM Scoutt, VA Feldstein, eds. Callen's Ultrasonography in Obstetrics and Gynecology. 6th ed. Elsevier; 2017: 460-502.
- 2 P Crocco, P Robledo, P Troncoso, Gonzalez M, eds. Routine ultrasound in obstetrics. Perinatal Guidelines. Ministry of Health; 2015: 53-65 (in Spanish).
- 3Bricker L, Medley N, Pratt JJ. Routine ultrasound in late pregnancy (after 24 weeks' gestation). Cochrane Database Syst Rev. 2015; 2015(6):CD001451.
- 4Abuhamad A, Zhao Y, Abuhamad S, et al. Standardized six-step approach to the performance of the focused basic obstetric ultrasound examination. Am J Perinatol. 2016; 33: 90-98.
- 5Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG practice guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2022; 59(6): 840-856.
- 6AIUM practice parameter for the performance of detailed second- and third-trimester diagnostic obstetric ultrasound examinations. J Ultrasound Med. 2019; 38(12): 3093-3100.
- 7Pretorius DH, Gosink BB, Clautice-Engle T, Leopold GR, Minnick CM. Sonographic evaluation of the fetal stomach: significance of nonvisualization. AJR Am J Roentgenol. 1988; 151: 987-989.
- 8Millener PB, Anderson NG, Chisholm RJ. Prognostic significance of nonvisualization of the fetal stomach by sonography. AJR Am J Roentgenol. 1993; 160(4): 827-830.
- 9McKenna KM, Goldstein RB, Stringer MD. Small or absent fetal stomach: prognostic significance. Radiology. 1995; 197(3): 729-733.
- 10Brumfield CG, Davis RO, Owen J, Wenstrom K, Kynerd PM. Pregnancy outcomes following sonographic nonvisualization of the fetal stomach. Obstet Gynecol. 1998; 91(6): 905-908.
- 11McKelvey A, Stanwell J, Smeulders N, Nasr R, Curry J, Pandya P. Persistent non-visualisation of the fetal stomach: diagnostic and prognostic implications. Arch Dis Child Fetal Neonatal Ed. 2010; 95(6): F439-F442.
- 12Tullie L, Hall NJ, Burge DM, Howe DT, Drewett M, Wellesley D. Prognostic value of prenatally detected small or absent fetal stomach with particular reference to oesophageal atresia. Arch Dis Child Fetal Neonatal Ed. 2020; 105(3): 341-342.
- 13Tonni G, Granese R, Martins Santana EF, et al. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med. 2017; 45(2): 149-165.
- 14Feygin T, Khalek N, Moldenhauer JS. Fetal brain, head, and neck tumors: prenatal imaging and management. Prenat Diagn. 2020; 40(10): 1203-1219.
- 15Tsao K, Albanese CT, Harrison MR. Prenatal therapy for thoracic and mediastinal lesions. World J Surg. 2003; 27(1): 77-83.
- 16Bianchi DW, Crombleholme TM, D'Alton ME, Malone FD. Gastrointestinal tract. In: DW Bianchi, TM Crombleholme, ME D'Alton, Malone FD, eds. Fetology. Diagnosis and Management of the Fetal Patient. 2nd ed. McGraw-Hill; 2010: 461-526.
- 17Kalache KD, Wauer R, Mau H, Chaoui R, Bollmann R. Prognostic significance of the pouch sign in fetuses with prenatally diagnosed esophageal atresia. Am J Obstet Gynecol. 2000; 182(4): 978-981.
- 18Depla AL, Breugem CC, van der Horst CM, et al. Polyhydramnios in isolated oral cleft pregnancies: incidence and outcome in a retrospective study. Prenat Diagn. 2017; 37(2): 162-167.
- 19Moore L, Toi A, Chitayat D. Abnormalities of the intra-abdominal fetal umbilical vein: reports of four cases and a review of the literature. Ultrasound Obstet Gynecol. 1996; 7(1): 21-25.
- 20Achiron R, Hegesh J, Yagel S, Lipitz S, Cohen SB, Rotstein Z. Abnormalities of the fetal central veins and umbilico-portal system: prenatal ultrasonographic diagnosis and proposed classification. Ultrasound Obstet Gynecol. 2000; 16(6): 539-548.
- 21Jaeggi ET, Fouron JC, Hornberger LK, et al. Agenesis of the ductus venosus that is associated with extrahepatic umbilical vein drainage: prenatal features and clinical outcome. Am J Obstet Gynecol. 2002; 187(4): 1031-1037.
- 22Loomba RS, Frommelt M, Moe D, Shillingford AJ. Agenesis of the venous duct: two cases of extrahepatic drainage of the umbilical vein and extrahepatic portosystemic shunt with a review of the literature. Cardiol Young. 2015; 25(2): 208-127.
- 23Blazer S, Zimmer EZ, Bronshtein M. Nonvisualization of the fetal gallbladder in early pregnancy: comparison with clinical outcome. Radiology. 2002; 224(2): 379-382.
- 24Ochshorn Y, Rosner G, Barel D, Bronshtein M, Muller F, Yaron Y. Clinical evaluation of isolated nonvisualized fetal gallbladder. Prenat Diagn. 2007; 27(8): 699-703.
- 25Shen O, Rabinowitz R, Yagel S, Gal M. Absent gallbladder on fetal ultrasound: prenatal findings and postnatal outcome. Ultrasound Obstet Gynecol. 2011; 37(6): 673-677.
- 26Shen O, Sela HY, Nagar H, et al. Prenatal diagnosis of biliary atresia: a case series. Early Hum Dev. 2017; 111: 16-19.
- 27Di Pasquo E, Kuleva M, Rousseau A, et al. Outcome of non-visualization of fetal gallbladder on second-trimester ultrasound: cohort study and systematic review of literature. Ultrasound Obstet Gynecol. 2019; 54: 582-588.
- 28He M, Xie H, Du L, Lei T, Zhang L. Postnatal outcomes of fetuses with isolated gallbladder anomalies: be aware of biliary atresia. J Matern Fetal Neonatal Med. 2022; 35: 7005-7010.
- 29Avni FE, Garel C, Naccarella N, Franchi-Abella S. Anomalies of the fetal gallbladder: pre-and postnatal correlations. Pediatr Radiol. 2022. doi:10.1007/s00247-022-05457-w. [Epub ahead of print].
- 30Bezerra JA, Asai A, Tiao G, Mullapudi B, Balistreri WF. Biliary atresia and other disorders of the extrahepatic bile ducts. In: FJ Suchy, RJ Sokol, WF Balistreti, eds. Liver Disease in Children. 5th ed. Cambridge University Press; 2021: 162-181.
10.1017/9781108918978.011 Google Scholar
- 31Duchatel F, Muller F, Oury JF, Mennesson B, Boue J, Boue A. Prenatal diagnosis of cystic fibrosis: ultrasonography of the gallbladder at 17-19 weeks of gestation. Fetal Diagn Ther. 1993; 8(1): 28-36.
- 32Duguépéroux I, Scotet V, Audrézet MP, et al. Nonvisualization of fetal gallbladder increases the risk of cystic fibrosis. Prenat Diagn. 2012; 32(1): 21-28.
- 33Bergougnoux A, Jouannic JM, Verneau F, et al. Isolated nonvisualization of the fetal gallbladder should be considered for the prenatal diagnosis of cystic fibrosis. Fetal Diagn Ther. 2019; 45: 312-316.
- 34Dreux S, Boughanim M, Lepinard C, et al. Relationship of non-visualization of the fetal gallbladder and amniotic fluid digestive enzymes analysis to outcome. Prenat Diagn. 2012; 32(5): 423-426.
- 35Bardin R, Ashwal E, Davidov B, Danon D, Shohat M, Meizner I. Nonvisualization of the fetal gallbladder: can levels of gamma-glutamyl transpeptidase in amniotic fluid predict fetal prognosis? Fetal Diagn Ther. 2016; 39(1): 50-55.
- 36Sepulveda W, Wong AE. Echogenic material in the fetal gallbladder: prevalence, sonographic spectrum, and perinatal outcome in an unselected third-trimester population. J Matern Fetal Neonatal Med. 2020; 33: 1162-1170.
- 37Schwab ME, Braun HJ, Feldstein VA, Nijagal A. The natural history of fetal gallstones: a case series and updated literature review. J Matern Fetal Neonatal Med. 2022; 35(24): 4755-4762.
- 38Annac G, Tekin AB. Echogenicities in the fetal gallbladder: prevalence, sonographic findings, and postnatal outcomes. J Clin Ultrasound. 2022; 50(1): 74-79.
- 39Hertzberg BS, Kliewer MA. Fetal gallstones in a contracted gallbladder: potential to simulate hepatic or peritoneal calcification. J Ultrasound Med. 1998; 17(10): 667-670.
- 40Brown DL, Teele RL, Doubilet PM, DiSalvo DN, Benson CB, van Alstyne GA. Echogenic material in the fetal gallbladder: sonographic and clinical observations. Radiology. 1992; 182(1): 73-76.
- 41Nishijima K, Yoneda M, Hirai T, Takakuwa K, Enomoto T. Biology of the vernix caseosa: a review. J Obstet Gynaecol Res. 2019; 45: 2145-2149.
- 42Mehollin-Ray AR. Congenital diaphragmatic hernia. Pediatr Radiol. 2020; 50(13): 1855-1871.
- 43Cordier AG, Russo FM, Deprest J, Benachi A. Prenatal diagnosis, imaging, and prognosis in congenital diaphragmatic hernia. Semin Perinatol. 2020; 44(1): 51163.
- 44Zani A, Chung WK, Deprest J, et al. Congenital diaphragmatic hernia. Nat Rev Dis Primers. 2022; 8(1): 37.
- 45Salomon LJ, Baumann C, Delezoide AL, et al. Abnormal abdominal situs: what and how should we look for? Prenat Diagn. 2006; 26(3): 282-285.
- 46Lambert TE, Kuller J, Small M, Rhee E, Barker P. Abnormalities of fetal situs: an overview and literature review. Obstet Gynecol Surv. 2016; 71(1): 33-38.
- 47Nemec SF, Brugger PC, Nemec U, et al. Situs anomalies on prenatal MRI. Eur J Radiol. 2012; 81(4): e495-e501.
- 48Eitler K, Bibok A, Telkes G. Situs inversus totalis: a clinical review. Int J Gen Med. 2022; 15: 2437-2449.
- 49Jeanty P. Persistent right umbilical vein: an ominous prenatal finding? Radiology. 1990; 177(3): 735-738.
- 50Hill AD, Mills A, Peterson C, Boyles D. Persistent right umbilical vein: sonographic detection and subsequent neonatal outcome. Obstet Gynecol. 1994; 84: 923-925.
- 51Shen O, Tadmor OP, Yagel S. Prenatal diagnosis of persistent right umbilical vein. Ultrasound Obstet Gynecol. 1996; 8: 31-33.
- 52Blazer S, Zimmer EZ, Bronshtein M. Persistent intrahepatic right umbilical vein in the fetus: a benign anatomic variant. Obstet Gynecol. 2000; 95: 433-436.
- 53Wolman I, Gull I, Fait G, et al. Persistent right umbilical vein: incidence and significance. Ultrasound Obstet Gynecol. 2002; 19: 562-564.
- 54Lide B, Lindsley W, Foster MJ, Hale R, Haeri S. Intrahepatic persistent right umbilical vein and associated outcomes: a systematic review of the literature. J Ultrasound Med. 2016; 35(1): 1-5.
- 55Li J, Yuan Q, Ding H, Yang Z, Wang B, Wang B. Ultrasonic detection of fetal persistent right umbilical vein and incidence and significance of concomitant anomalies. BMC Pregnancy Childbirth. 2020; 20(1): 610.
- 56Toscano P, Saccone G, Di Meglio L, et al. Intrahepatic persistent fetal right umbilical vein: a retrospective study. J Matern Fetal Neonatal Med. 2021; 34(24): 4025-4028.
- 57McCormick BM, Blakemore KJ, Johnson CT, et al. Outcomes of both complex and isolated cases of infants with large stomach on fetal ultrasound. Am J Obstet Gynecol MFM. 2021; 3(1):100272.
- 58Sase M, Asada H, Okuda M, Kato H. Fetal gastric size in normal and abnormal pregnancies. Ultrasound Obstet Gynecol. 2002; 19(5): 467-470.
- 59Katz S, Basel D, Branski D. Prenatal gastric dilatation and infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1988; 23(11): 1021-1022.
- 60Peled Y, Hod M, Friedman S, Mashiach R, Greenberg N, Ovadia J. Prenatal diagnosis of familial congenital pyloric atresia. Prenat Diagn. 1992; 12(2): 151-154.
- 61Rizzo G, Capponi A, Arduini D, Romanini C. Prenatal diagnosis of gastroesophageal reflux by color and pulsed Doppler ultrasonography in a case of congenital pyloric atresia. Ultrasound Obstet Gynecol. 1995; 6(4): 290-292.
- 62Tashjian DB, Konefal SH. Hypertrophic pyloric stenosis in utero. Pediatr Surg Int. 2002; 18(5–6): 539-540.
- 63Dural O, Acar DK, Ekiz A, et al. Prenatal ultrasound findings and a new ultrasonographic sign of epidermolysis bullosa with congenital pyloric atresia: a report of three cases. J Med Ultrason. 2014; 41(4): 495-498.
- 64Estroff JA, Parad RB, Share JC, Benacerraf BR. Second trimester prenatal findings in duodenal and esophageal atresia without tracheoesophageal fistula. J Ultrasound Med. 1994; 13(5): 375-379.
- 65Chitty LS, Goodman J, Seller MJ, Maxwell D. Esophageal and duodenal atresia in a fetus with Down's syndrome: prenatal sonographic features. Ultrasound Obstet Gynecol. 1996; 7(6): 450-452.
- 66Sepulveda W. Combined esophageal and duodenal atresias in a fetus with trisomy 21; 2002. Accessed November 2022. https://thefetus.net/content/combined-esophageal-and-duodenal-atresias-in-a-fetus-with-trisomy-21.
- 67Lyttle BD, Liechty K, Corkum K, et al. In-utero gastric perforation from combined duodenal and esophageal atresia without consistent polyhydramnios. J Surg Case Rep. 2021; 2021(12):rjab551.
- 68Ein SH, Palder SB, Filler RM. Babies with esophageal and duodenal atresia: a 30-year review of a multifaceted problem. J Pediatr Surg. 2006; 41(3): 530-532.
- 69Miscia ME, Lauriti G, Di Renzo D, Riccio A, Lisi G, Lelli Chiesa P. Esophageal atresia and associated duodenal atresia: a cohort study and review of the literature. Eur J Pediatr Surg. 2021; 31(5): 445-451.
- 70Fuster JS, Benasco C, Saad I. Giant dilatation of the umbilical vein. J Clin Ultrasound. 1985; 13(5): 363-365.
- 71Mahony BS, McGahan JP, Nyberg DA, Reisner DP. Varix of the fetal intra-abdominal umbilical vein: comparison with normal. J Ultrasound Med. 1992; 11(2): 73-76.
- 72Estroff JA, Benacerraf BR. Fetal umbilical vein varix: sonographic appearance and postnatal outcome. J Ultrasound Med. 1992; 11(3): 69-73.
- 73Sepulveda W, Mackenna A, Sanchez J, Corral E, Carstens E. Fetal prognosis in varix of the intrafetal umbilical vein. J Ultrasound Med. 1998; 17(3): 171-175.
- 74Di Pasquo E, Kuleva M, O'Gorman N, Ville Y, Salomon LJ. Fetal intra-abdominal umbilical vein varix: retrospective cohort study and systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 51(5): 580-585.
- 75Challis D, Trudinger BJ, Moore L, et al. Intra-abdominal varix of the umbilical vein: it is an indication for fetal karyotyping? [abstract]. Am J Obstet Gynecol. 1997; 176: S93.
- 76Beraud E, Rozel C, Milon J, Darnault P. Umbilical vein varix: importance of ante- and post-natal monitoring by ultrasound. Diagn Interv Imaging. 2015; 96: 21-26.
- 77Novoa V, Shazly S, Ibirogba ER, et al. Perinatal outcomes of fetal intra-abdominal umbilical vein varix: a multicenter cohort study. J Matern Fetal Neonatal Med. 2021; 34: 3393-3396.
- 78Hertzberg BS, Kliewer MA, Bowie JD, McNally PJ. Enlarged fetal gallbladder: prognostic importance for aneuploidy or biliary abnormality at antenatal US. Radiology. 1998; 208(3): 795-798.
- 79Petrikovsky B, Klein VR. Cholecystomegaly and fetal gallstones. Prenat Diagn. 1995; 15(9): 875.
- 80Sepulveda W, Nicolaidis P, Hollingsworth J, Fisk NM. Fetal cholecystomegaly: a prenatal marker of aneuploidy. Prenat Diagn. 1995; 15(2): 193-197.
- 81Bishop JC, McCormick B, Johnson CT, et al. The double bubble sign: duodenal atresia and associated genetic etiologies. Fetal Diagn Ther. 2020; 47(2): 98-103.
- 82Demirci O, Eriç Özdemir M, Kumru P, Celayir A. Clinical significance of prenatal double bubble sign on perinatal outcome and literature review. J Matern Fetal Neonatal Med. 2022; 35(10): 1841-1847.
- 83McEwing R, Hayward C, Furness M. Foetal cystic abdominal masses. Australas Radiol. 2003; 47(2): 101-110.
- 84Cass DL. Fetal abdominal tumors and cysts. Transl Pediatr. 2021; 10(5): 1530-1541.
- 85Shaughnessy MP, Spencer-Manzon M, Cowles RA. Antenatally detected liver and biliary pathology. Semin Pediatr Surg. 2020; 29(4):150939.
- 86Allan M, Asimakidou M, Davenport M. Antenatally-detected liver cysts: causes and characteristics, indications for intervention. J Pediatr Surg. 2020; 55(3): 441-445.
- 87Sepulveda W, Sepulveda F, Gonzalez G, Arce C, Alcalde E. Congenital hepatic cyst: prenatal and postnatal imaging findings. Ultrasound. 2021; 29: 193-198.
- 88Sepulveda W, Ochoa JH, Cafici D, et al. Splenic cyst as a rare cause of fetal abdominal cyst mass: a multicenter series of nine cases and review of the literature. Ultrasound. 2018; 26: 22-31.
- 89Sauvageot C, Faure JM, Mousty E, et al. Prenatal and postnatal evolution of isolated fetal splenic cysts. Prenat Diagn. 2018; 38(6): 390-394.
- 90Degani S, Mogilner JG, Shapiro I. In utero sonographic appearance of intestinal duplication cysts. Ultrasound Obstet Gynecol. 1995; 5(6): 415-418.
- 91Gerscovich EO, Towner D, Sanchez T, Stein-Wexler R, Rhee-Morris L. Fetal gallbladder duplication. J Ultrasound Med. 2011; 30(9): 1310-1312.
- 92Di Meglio L, Toscano P, Saccone G, et al. Prenatal ultrasound diagnosis of duplication gallbladder: a multicenter study. Arch Gynecol Obstet. 2020; 302: 377-382.
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