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Fetal Genitourinary System

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Fetal Genitourinary System

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    1. 12/14/2011 L.Zanin - MS213 - GU 1 Fetal Genitourinary System

    2. 12/14/2011 L.Zanin - MS213 - GU 2

    3. 12/14/2011 L.Zanin - MS213 - GU 3 Genitourinary System Rule of thumb - during the second and third trimesters the kidneys increase in length at approximately 1 mm per week and increase in AP diameter .5 mm per week The normal ureter is not seen sonographically The normal adrenal gland can be visualized at the superior border of the kidney

    4. 12/14/2011 L.Zanin - MS213 - GU 4 Genitourinary System Although the fetal kidneys are functionally immature throughout fetal life, urine production in the fetus begins by 10 weeks gestation However fetal urine does not become the primary source of amniotic fluid volume until 16-18 weeks gestation

    5. 12/14/2011 L.Zanin - MS213 - GU 5 Fetal Kidneys in Transverse Spine up position Notice the renal pelvis's which are filled with urine The stomach is found anterior to the left kidney Notice the spine shadow

    6. 12/14/2011 L.Zanin - MS213 - GU 6 Renals in Sagittal Prominent renal pyramids are normal in the fetus and newborn. This is where you would measure the renal size.

    7. 12/14/2011 L.Zanin - MS213 - GU 7 Fetal kidney

    8. 12/14/2011 L.Zanin - MS213 - GU 8 Normal Kidney

    9. 12/14/2011 L.Zanin - MS213 - GU 9 Adrenal Gland It is observed in a sagittal view and is located above the kidney The adrenal gland is often mistaken for the kidney with renal agenesis Notice the dense central interface

    10. 12/14/2011 L.Zanin - MS213 - GU 10 Normal Kidney - Adrenal

    11. 12/14/2011 L.Zanin - MS213 - GU 11 Renal Anomalies At approximately six menstrual weeks the ureteral bud develops from the urogenital sinus It then develops into the ureter, renal pelvis, calyces and collecting tubules The ureteral bud also contributes to the development of the nephron If there is no ureteral bud, no kidney will develop

    12. 12/14/2011 L.Zanin - MS213 - GU 12 Sagittal Kidney

    13. 12/14/2011 L.Zanin - MS213 - GU 13 Transverse Kidneys

    14. 12/14/2011 L.Zanin - MS213 - GU 14 Sagittal Kidneys

    15. 12/14/2011 L.Zanin - MS213 - GU 15 Potters Syndrome Is the result of severe oligohydramnios The anomalies associated with potters syndrome are due to the long-standing severe oligohydramnios The term Potters Syndrome is now referred to as Potters Sequence or Oligohydramnios Sequence Lungs become hypoplastic which may lead to death from pulmonary insufficiency at birth

    16. 12/14/2011 L.Zanin - MS213 - GU 16 Potters Syndrome Facial abnormalities include Fold of skin above each eye that extends over the inner cheek, low set ears and a turned down nose Limb abnormalities include Abnormal positioning of hands and feet, hyperextension or bowing of legs, clubbed or fused feet, & hip dislocation

    17. 12/14/2011 L.Zanin - MS213 - GU 17 Potters Syndrome

    18. 12/14/2011 L.Zanin - MS213 - GU 18 Renal Agenesis One subclassification of Potter’s Syndrome it consists of: Bilateral renal agenesis Pulmonary hypoplasia Facial anomalies Absence of the ureteral bud to form this causes bilateral renal agenesis and death from pulmonary hypoplasia Sonographicly - severe oligohydramnios will be seen with associated anomalies Non-visualization of the bladder is more important then suspected absence of the kidneys because the adrenal may be mistaken for kidneys

    19. 12/14/2011 L.Zanin - MS213 - GU 19 Renal Agenesis Fatal prognosis with an occurrence of 1 in 3,000 births Male predominance of 2.5 to 1 Absence of the fetal urine production initiates the Potter sequence Absence of the urinary bladder Unilateral renal agenesis is 3-4 times more frequent than bilateral, and it is compatible with life

    20. 12/14/2011 L.Zanin - MS213 - GU 20 No Renal Arteries

    21. 12/14/2011 L.Zanin - MS213 - GU 21 Ultrasound Findings No kidneys or bladder seen with bilateral renal agenesis (must see kidneys by 17-22 weeks and bladder must be seen by 12 wk. Severe oligohydramnios Fetal thorax is abnormally small Unilateral agenesis is rarely associated with oligohydramnios or nonvisualization of the fetal bladder

    22. 12/14/2011 L.Zanin - MS213 - GU 22 Renal Agenesis

    23. 12/14/2011 L.Zanin - MS213 - GU 23 Unilateral Renal Agenesis Occurs more often than bilateral Incidence is 1 in 500 It occurs more commonly on the left than the right side Male predominance of 1.8 to 1 Diagnosed by seeing one kidney, but one has to be careful to evaluate for an ectopic kidney

    24. 12/14/2011 L.Zanin - MS213 - GU 24 Unilateral Renal Agenesis Fluid will be seen in the bladder and normal amniotic fluid volumes should be seen Associated anomalies involving the genital tract are common

    25. 12/14/2011 L.Zanin - MS213 - GU 25 Unilateral Renal Agenesis Transverse view of a 37 week fetus demonstrating a normal left kidney and no right kidney

    26. 12/14/2011 L.Zanin - MS213 - GU 26 Unilateral Renal Artery

    27. 12/14/2011 L.Zanin - MS213 - GU 27 Hypoplastic Kidney Failure of a kidney to develop to their normal size More commonly unilateral Ultrasound appearance - small echogenic kidney

    28. 12/14/2011 L.Zanin - MS213 - GU 28 Ectopic Kidney Can be found in the pelvis, iliac, abdomen, thorax and contralateral side Incidence is 1 in 500 births with no predominance in either sex It is slightly more common on the left side Ectopic kidneys are associated with an increased incidence of contralateral agenesis and with genitalia anomalies

    29. 12/14/2011 L.Zanin - MS213 - GU 29 Ectopic Kidney Sagittal view through the pelvis demonstrating a pelvic right kidney

    30. 12/14/2011 L.Zanin - MS213 - GU 30 Ectopic kidney

    31. 12/14/2011 L.Zanin - MS213 - GU 31 Ectopic kidney

    32. 12/14/2011 L.Zanin - MS213 - GU 32 Multicystic Dysplastic Kidney (MDK) Most common cause of an abdominal mass in the neonate Usually unilateral, sometimes bilateral Development of enlarged kidneys containing encapsulated cysts of varying sizes Cysts distort the renal parenchyma & there is NO communication between the cysts Found in 1 out of 3000 births

    33. 12/14/2011 L.Zanin - MS213 - GU 33 Multicystic Dysplastic Kidney In MDK the normal renal parenchyma is totally replaced by cysts of different sizes This anomaly most likely occurs during embryogenesis, resulting from atresia of the ureteral bud system Causes severe oligohydramnios when seen bilaterally When unilateral - monitored closely When bilateral - neonatal demise will follow

    34. 12/14/2011 L.Zanin - MS213 - GU 34 Multicystic Dysplastic Kidney (MDK) C-section is usually done The involved renal tissue has little or no function When unilateral contralateral renal anomalies are present in 40% Prognosis - good if unilateral, if bilateral it is fatal

    35. 12/14/2011 L.Zanin - MS213 - GU 35 MDK Ultrasound Findings Potter’s type II classifications: A – normal or enlarged kidney B- small aplastic kidney Enlarged kidney(s) with multiple cysts The abdominal circumference is enlarged Renal contour is generally distorted Unilateral Amniotic fluid is normal, multiple cysts in one kidney, bladder is seen Bilateral Fetal bladder is not visualized, severe oligohydramnios, Multiple cysts in both kidneys

    36. 12/14/2011 L.Zanin - MS213 - GU 36 Unilateral MDK Right fetal kidney demonstrates multiple cysts of varying sizes that do not communicate with the renal pelvis

    37. 12/14/2011 L.Zanin - MS213 - GU 37 MDK

    38. 12/14/2011 L.Zanin - MS213 - GU 38 MDK

    39. 12/14/2011 L.Zanin - MS213 - GU 39 Multicystic Dysplastic Kidney

    40. 12/14/2011 L.Zanin - MS213 - GU 40 MDK

    41. 12/14/2011 L.Zanin - MS213 - GU 41 MDK

    42. 12/14/2011 L.Zanin - MS213 - GU 42 MDK

    43. 12/14/2011 L.Zanin - MS213 - GU 43 Multicystic Dysplastic Kidney

    44. 12/14/2011 L.Zanin - MS213 - GU 44 Multicystic Dysplastic Kidney

    45. 12/14/2011 L.Zanin - MS213 - GU 45 Multicystic Dysplastic Kidney

    46. 12/14/2011 L.Zanin - MS213 - GU 46 Polycystic Kidney Disease Autosomal Recessive PKD - Formally known as Infantile (IPKD) (differentiate from Autosomal Dominant APKD) Bilateral dilation of the collecting tubules in the kidneys due to an chromosomal recessive gene Associated with liver fibrosis, microcephaly, & ambiguous genitalia Incidence is 1 in 16,000 births

    47. 12/14/2011 L.Zanin - MS213 - GU 47 IPKD Oligohydramnios is present due to the diminished urine production this initiates the Potter sequence and death may occur shortly after birth from pulmonary hypoplasia It can be present after birth, however, the later the presentation the less severe the renal involvement & the more severe the hepatic involvement

    48. 12/14/2011 L.Zanin - MS213 - GU 48 Ultrasound Findings Can be detected as early as 17 weeks Echogenic multiple tiny cysts 2 echogenic enlarged kidneys Oligohydramnios Renal contour is generally maintained Bladder is frequently not visualized This anomaly is a major feature of the Meckel syndrome hence there would be other associated anomalies

    49. 12/14/2011 L.Zanin - MS213 - GU 49 Infantile Polycystic Kidney 21 week fetal abdomen demonstrates enlarged echogenic kidneys that maintain a renal shape

    50. 12/14/2011 L.Zanin - MS213 - GU 50 Polycystic Kidneys

    51. 12/14/2011 L.Zanin - MS213 - GU 51 Bilateral Polycystic Kidney

    52. 12/14/2011 L.Zanin - MS213 - GU 52 IPKD

    53. 12/14/2011 L.Zanin - MS213 - GU 53 Meckel-Gruber Syndrome A group of anomalies associated with bilateral markedly enlarged echogenic kidneys with small cysts (Not Typically Seen) associated with IPKD Other anomalies associated with this syndrome include Encephalocele Polydactyly Ambiguous external genitalia in males

    54. 12/14/2011 L.Zanin - MS213 - GU 54 Meckel-Gruber Syndrome

    55. 12/14/2011 L.Zanin - MS213 - GU 55 Meckel-Gruber Syndrome

    56. 12/14/2011 L.Zanin - MS213 - GU 56 Meckel-Gruber Syndrome

    57. 12/14/2011 L.Zanin - MS213 - GU 57 Beckwith-Wiedeman Syndrome The syndrome results in the combination of the following conditions together Macrosomia Protruding tongue Enlarged kidneys Omphalocele

    58. 12/14/2011 L.Zanin - MS213 - GU 58 Beckwith-Wiedeman Syndrome Protruding Tongue

    59. 12/14/2011 L.Zanin - MS213 - GU 59 Beckwith-Wiedeman Syndrome Protruding Tongue

    60. 12/14/2011 L.Zanin - MS213 - GU 60 Beckwith-Wiedeman Syndrome

    61. 12/14/2011 L.Zanin - MS213 - GU 61 Renal Vein Thrombosis Results in varying degrees of renal failure Often caused by maternal diabetes Kidneys appear enlarged

    62. 12/14/2011 L.Zanin - MS213 - GU 62 Renal Vein Thrombosis This diabetic mother has a 3rd trimester fetus with echogenic kidneys and calficications due to bilateral renal vein thrombosis.

    63. 12/14/2011 L.Zanin - MS213 - GU 63 Hydronephrosis Hydronephrosis - an obstructed kidney with a dilated collecting system Occurs during early fetal development Caused by a partial ureteral obstruction with a distention of the renal pelvis and calyces Sonographicly - excess collection of fluid within the renal pelvis, diminished urinary output in the fetus & oligohydramnios

    64. 12/14/2011 L.Zanin - MS213 - GU 64 Hydronephrosis Most common fetal renal abnormality Usually an incidental finding May be caused by obstruction or reflux which causes dilation of the ureters and renal pelvis Oligohydramnios will be seen depending on the severity of the obstruction The sites of obstruction include ureteropelvic junction, ureter, ureterovesicle junction, and urethra

    65. 12/14/2011 L.Zanin - MS213 - GU 65 Hydronephrosis If the AP diameter of the renal pelvis is greater than 50% of the the AP diameter of the kidney this indicates hydronephrosis The renal pelvis is considered normal if they measure up to 4 mm prior to 33 weeks and up to 7 mm after 33 weeks

    66. 12/14/2011 L.Zanin - MS213 - GU 66 Hydronephrosis

    67. 12/14/2011 L.Zanin - MS213 - GU 67 Hydronephrosis

    68. 12/14/2011 L.Zanin - MS213 - GU 68 Hydronephrosis

    69. 12/14/2011 L.Zanin - MS213 - GU 69 Hydronephrosis Mild pelviectasis and calyceal dilatation

    70. 12/14/2011 L.Zanin - MS213 - GU 70 Pyelectasis In a transverse plane, measure the AP diameter If the dilation is less than 1 cm and a ratio of pelvic to kidney diameter is less than 50% than the fluid within the pelvis is considered within normal limits Rule of thumb - AP diameter of the reanl pelvis should be no greater than 4-5 mm prior to 33 weeks and no greater than 7mm-1 cm after 33 weeks

    71. 12/14/2011 L.Zanin - MS213 - GU 71 Pyelectasis

    72. 12/14/2011 L.Zanin - MS213 - GU 72 Pyelectasis

    73. 12/14/2011 L.Zanin - MS213 - GU 73 Ureteropelvic Junction (UPJ) UPJ - ureteropelvis junction obstruction (ureter is not dilated) 1/3 of the cases are bilateral Most common congenital cause of obstructive uropathy, representing 2/3 of fetal hydronephrosis UPJ obstructions are more often unilateral Causes include: Fibrous adhesions Kinks Ureteral valves

    74. 12/14/2011 L.Zanin - MS213 - GU 74 Ureteropelvic Junction (UPJ) More common in males with a 2:1 ratio UPJ obstruction can result in rupture of the collecting system and the development of a urinoma If the UPJ is unilateral the bladder and amniotic fluid will be normal

    75. 12/14/2011 L.Zanin - MS213 - GU 75 UPJ Bilateral severe UPJ obstruction-dilated renal pelvis

    76. 12/14/2011 L.Zanin - MS213 - GU 76 UPJ

    77. 12/14/2011 L.Zanin - MS213 - GU 77 Ultrasound Findings Dilatation of the renal pelvis with varying degrees of caliectasis Normal ureter and bladder Renal cortex may be normal or thin The amount of amniotic fluid is usually normal if unilateral however it may be decreased if the obstruction is severe or bilateral

    78. 12/14/2011 L.Zanin - MS213 - GU 78 Uretero Vesicle Junction Obstruction (UVJ) UVJ - uretero vesicle junction obstruction, there is an obstruction where the ureter enters the bladder Rare & typically due to a renal duplication anomaly Unilateral hydronephrosis & hydroureter

    79. 12/14/2011 L.Zanin - MS213 - GU 79 Uretero Vesicle Junction Obstruction (UVJ) The bladder is usually normal Amniotic fluid volume is generally normal More commonly found on the left side & more common in males Depending on severity, it can result in dilation of the ureter with or without hydro

    80. 12/14/2011 L.Zanin - MS213 - GU 80 UVJ Differential diagnosis: Bowel obstruction Dilated ureter secondary to bladder dysfunction A dilated tortuous tubular structure that showed no peristalsis that can be traced back to the renal pelvis = UVJ

    81. 12/14/2011 L.Zanin - MS213 - GU 81 UVJ

    82. 12/14/2011 L.Zanin - MS213 - GU 82 UVJ

    83. 12/14/2011 L.Zanin - MS213 - GU 83 UVJ

    84. 12/14/2011 L.Zanin - MS213 - GU 84 Posterior Urethral Valves (PUV) An urethral obstruction seen in males Most common cause of urinary obstruction in male infants Retrograde filling of the bladder, dilation of bladder, ureters & renal pelvis Can cause severe damage to kidneys, ureters and bladder Prognosis is poor when associated with oligo The ureter is dilated (hydroureter) above the obstruction and is not visualized below it

    85. 12/14/2011 L.Zanin - MS213 - GU 85 Posterior Urethral Valves (PUV) Peristalsis may be noted in the upper ureter The valves are redundant folds of urethral mucosa that cause varying degrees of obstruction Bladder wall thickening is seen Marked hydronephrosis and dilated ureter, dilated posterior urethra and bladder

    86. 12/14/2011 L.Zanin - MS213 - GU 86 PUV Hydronephrosis due to a urethral valve The upper third of the ureter is dilated

    87. 12/14/2011 L.Zanin - MS213 - GU 87 PUV

    88. 12/14/2011 L.Zanin - MS213 - GU 88 PUV

    89. 12/14/2011 L.Zanin - MS213 - GU 89 Ureterocele Ureterocele - dilated ureter that has prolapsed into the bladder It may be simple or ectopic Simple - the the ureteral orifice is in its normal position and the distal end of the ureter protrudes into the bladder Ectopic - the distal ureter does not insert into the fetal bladder but inserts ectopically

    90. 12/14/2011 L.Zanin - MS213 - GU 90 Ureterocele More common in females and is generally more common on the left side A duplicated renal collecting system is a commonly associated anomaly The kidney on the side of the ureterocele tends to be significantly affected

    91. 12/14/2011 L.Zanin - MS213 - GU 91 Ureterocele

    92. 12/14/2011 L.Zanin - MS213 - GU 92 Ureterocele Ureterocele is seen protruding into a partially distended urinary bladder

    93. 12/14/2011 L.Zanin - MS213 - GU 93 Ureterocele

    94. 12/14/2011 L.Zanin - MS213 - GU 94 URETEROCELE

    95. 12/14/2011 L.Zanin - MS213 - GU 95 URETEROCELE

    96. 12/14/2011 L.Zanin - MS213 - GU 96 Bladder Outlet Obstruction Associated with severe obstructive uropathy & is most commonly caused by PUV Bilateral hydronephrosis and hydroureters is seen Unlike UVJ obstruction, bladder outlet obstruction is generally associated with dilatation of the proximal urethra and bladder

    97. 12/14/2011 L.Zanin - MS213 - GU 97 Bladder Outlet Obstruction

    98. 12/14/2011 L.Zanin - MS213 - GU 98 Bladder Outlet Obstruction

    99. 12/14/2011 L.Zanin - MS213 - GU 99 Testicular Hydrocele Accumulation of fluid in the tunica vaginalis May be due to failure of the tunica to separate fromother testicular membranes May be associated with other GU anomalies Frequently benign Sonographic appearance: Fluid surrounds the entire testicle A small amount of fluid in the fetal scrotum is a normal finding

    100. 12/14/2011 L.Zanin - MS213 - GU 100 Hydrocele Collection of fluid within the tunica vaginalis Isolated hydrocele is not significance

    101. 12/14/2011 L.Zanin - MS213 - GU 101 3 D Hydrocele

    102. 12/14/2011 L.Zanin - MS213 - GU 102 Cryptorchidism Undescended Testes Can be detected by the failure to visualize the testes within the scrotum Associated with prune belly syndrome & trisomies 13, 18, 21 If not corrected it can become cancerous

    103. 12/14/2011 L.Zanin - MS213 - GU 103 Descended Testicles The scrotum outlining the descended testicles and penis are seen

    104. 12/14/2011 L.Zanin - MS213 - GU 104 Descended Testicles

    105. 12/14/2011 L.Zanin - MS213 - GU 105 Female Fetus The labia majora Oreo sign

    106. 12/14/2011 L.Zanin - MS213 - GU 106 Fetal Ovarian Cyst

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