Prenatal ultrasound diagnosis of fetal urinary system abnormalities

doi:10.3877/cma.j.issn.1672-6448.2016.05.005

Abstract

Abstract:

Objective

To summarize the prenatal ultrasonography characteristics of fetal urinary system abnormalities. And to investigate the clinical value of prenatal ultrasound diagnosis for these malformations.

Methods

The ultrasound images of 492 cases of fetal urinary system abnormalities detected by prenatal ultrasound were retrospectively analyzed, including associated malformations.

Results

There were total 548 abnormalities in 492 cases. Some malformations were detected in most cases (84.3%, 415/492), including 232 cases of hydronephrosis (47.2%, 232/492), 100 cases of renal agenesis or atrophy (20.3%, 100/492) and 83 cases of polycystic kidney disease (16.9%, 83/492), while other kinds of malformations were detected in less cases (27.0%, 133/492), including renal dysplasia, ectopic kidney, confluent kidney, renal duplication, renal cyst, megalocystis, ureterocele, urachal diverticulum, OEIS and prune belly syndrome. Only five cases of megacystis were detected in the first trimester and the others were found in the second or third trimester. Three hundred and sixty-six cases (74.4%, 366/492) were isolated urinary system abnormalities, and the other 126 cases (25.6%, 126/492) were combined with one or more other malformations, totally 214 associated abnormalities. Eighty-eight cases (69.8%, 88/126) with other structural malformations were as followings, 22 cardiac abnormalities, 19 digestive system abnormalities, 17 cranial malformations, 12 limbs abnormalities, nine facial malformations and nine spinal abnormalities, still another 34 cases (27.0%, 34/126) with oligohydramnios. During follow-up, five cases were found to be misdiagnosed by prenatal ultrasonography. Two normal cases were misdiagnosed as renal duplication, one adrenal cyst was misdiagnosed as renal cyst, and two cases of ectopic kidney were misdiagnosed as renal agenesis.

Conclusion

Ultrasonography is a choice in prenatal diagnosis of fetal urinary system abnormalities. It plays an important role in the early detection of these abnormalities and has great significance for clinical diagnosis and treatment.

Key words: Ultrasonography, prenatal, Fetus, Urinary system abnormalities

Chen Ling, Xuedong Deng, Linliang Yin, Lili Zhang, Qing Liang. Prenatal ultrasound diagnosis of fetal urinary system abnormalities[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(05): 340-348.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2016.05.005

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Figures/Tables 5

References 18

[1]	李胜利, 陈秀兰, 陈琮瑛, 等. 产前超声检查在胎儿泌尿系统畸形诊断中的价值 [J/CD]. 中华医学超声杂志:电子版, 2008, 5(5): 589-594.
[2]	苏虹, 陈明, 任慧斌, 等. 胎儿泌尿系统异常产前超声特征与妊娠结局 [J/CD]. 中华医学超声杂志:电子版, 2011, 8(8): 778-785.
[3]	Bornes M, Spaggiari E, Schmitz T, et al. Outcome and etiologies of fetal megacystis according to the gestational age at diagnosis [J]. Prenat Diagn, 2013, 33(12): 1162-1166.
[4]	李胜利, 文华轩. 中孕期胎儿系统超声检查切面及临床意义[J/CD]. 中华医学超声杂志:电子版, 2010, 7(3): 366-381.
[5]	Swords KA, Peters CA. Neonatal and early infancy management of prenatally detected hydronephrosis [J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(5): F460-464.
[6]	Chapman T. Fetal genitourinary imaging [J]. Pediatr Radiol, 2012, 42(Suppl 1): S115-123.
[7]	Cohen HL, Sansgiri R, Smothers C, et al. Topics in perinatal genitourinary system ultrasound evaluation [J]. Ultrasound Q, 2011, 27(4): 229-254.
[8]	Dario P, Paolo V. Ultrasound of congenital fetal anomalies differential diagnosis and prognostic indicators [J]. Informa UK Ltd, 2007: 231-265.
[9]	邓学东. 产前超声诊断与鉴别诊断 [M]. 北京: 人民军医出版社, 2013: 201-233.
[10]	Dias T, Sairam S, Kumarasiri S. Ultrasound diagnosis of fetal renal abnormalities [J]. Best Pract Res Clin Obstet Gynaecol, 2014, 28(3): 403-415.
[11]	谢红宁. 妇产科超声诊断学 [M]. 北京: 人民卫生出版社, 2005: 132.
[12]	Gęca T, Krzyżanowski A, Stupak A, et al. Complementary role of magnetic resonance imaging after ultrasound examination in assessing fetal renalagenesis: a case report [J]. J Med Case Rep, 2014, 8: 96.
[13]	Osborne NG, Bonilla-Musoles F, Machado LE, et al. Fetal megacystis: differential diagnosis [J]. J Ultrasound Med, 2011, 30(6): 833-841.
[14]	Calvo-Garcia MA. Imaging Evaluation of Fetal Megacystis: How Can Magnetic Resonance Imaging Help? [J]. Semin Ultrasound CT MR, 2015, 36(6): 537-549.
[15]	Batukan C, Yuksel A. Prenatal diagnosis and postnatal outcome of pelvic kidneys [J]. Prenat Diagn, 2011, 31(4): 356-359.
[16]	Godinho AB, Nunes C, Janeiro M, et al. Ureterocele: antenatal diagnosis and management [J]. Fetal Diagn Ther, 2013, 34(3): 188-191.
[17]	Goto S, Suzumori N, Obayashi S, et al. Prenatal findings of omphalocele-exstrophy of the bladder-imperforate anus-spinal defects (OEIS) complex [J]. Congenit Anom (Kyoto), 2012, 52(3): 179-181.
[18]	Solomon BD. VACTERL/VATER Association [J]. Orphanet J Rare Dis, 2011, 6: 56.

泌尿系统异常类型	总例数	早孕期检出例数	中孕期检出例数	晚孕期检出例数	左侧发生例数	右侧发生例数	双侧发生例数	最早检出孕周（周）	最晚检出孕周（周）
肾积水	232	1	129	102	100	57	75	13^＋6	39
肾缺如或萎缩^a	100	0	68	32	32	55	13	14^＋6	39^＋5
肾脏发育不良	18	0	14	4	8	5	5	21^＋3	35^＋3
肾脏异位	15	0	12	3	8	7	0	22^＋4	34^＋1
融合肾	5	0	2	3	0	0	5	22^＋3	32^＋3
肾脏多囊性病变	83	0	72	11	38	30	15	16^＋2	34^＋6
重复肾^b	32	1	17	14	16	15	1	13^＋6	35^＋1
肾囊肿^c	19	0	11	8	10	7	2	22^＋2	36^＋5
巨膀胱	19	5	12	2	-	-	-	12	38^＋1
膀胱输尿管囊肿	9	1	6	2	5	4	0	13^＋6	32^＋4
脐尿管憩室	3	0	1	2	-	-	-	23^＋5	34^＋2
膀胱未显示	5	0	5	0	-	-	-	20^＋5	26^＋1
泄殖腔外翻	3	1	1	1	-	-	-	13^＋2	25
梅干腹综合征	2	0	2	0	-	-	-	19^＋1	21^＋6
巨膀胱-小结肠-肠蠕动迟缓综合征	1	0	1	0	-	-	-	28^＋1	28^＋1
VACTER联合征	1	0	1	0	-	-	-	20^＋2	20^＋2
尿道下裂	1	0	0	1	-	-	-	30^＋3	30^＋3
合计	548	9	354	185	217	180	116	?	?

泌尿系统异常类型	总例数	早孕期检出例数	中孕期检出例数	晚孕期检出例数	左侧发生例数	右侧发生例数	双侧发生例数	最早检出孕周（周）	最晚检出孕周（周）
肾积水	232	1	129	102	100	57	75	13^＋6	39
肾缺如或萎缩^a	100	0	68	32	32	55	13	14^＋6	39^＋5
肾脏发育不良	18	0	14	4	8	5	5	21^＋3	35^＋3
肾脏异位	15	0	12	3	8	7	0	22^＋4	34^＋1
融合肾	5	0	2	3	0	0	5	22^＋3	32^＋3
肾脏多囊性病变	83	0	72	11	38	30	15	16^＋2	34^＋6
重复肾^b	32	1	17	14	16	15	1	13^＋6	35^＋1
肾囊肿^c	19	0	11	8	10	7	2	22^＋2	36^＋5
巨膀胱	19	5	12	2	-	-	-	12	38^＋1
膀胱输尿管囊肿	9	1	6	2	5	4	0	13^＋6	32^＋4
脐尿管憩室	3	0	1	2	-	-	-	23^＋5	34^＋2
膀胱未显示	5	0	5	0	-	-	-	20^＋5	26^＋1
泄殖腔外翻	3	1	1	1	-	-	-	13^＋2	25
梅干腹综合征	2	0	2	0	-	-	-	19^＋1	21^＋6
巨膀胱-小结肠-肠蠕动迟缓综合征	1	0	1	0	-	-	-	28^＋1	28^＋1
VACTER联合征	1	0	1	0	-	-	-	20^＋2	20^＋2
尿道下裂	1	0	0	1	-	-	-	30^＋3	30^＋3
合计	548	9	354	185	217	180	116	?	?

合并异常部位	例数	合并其他系统异常分类
心脏	22	法洛四联症6例，心脏增大5例，肥厚性心肌病3例，室间隔缺损3例，肺动脉瓣闭锁、重度三尖瓣关闭不全、右心房明显增大1例，房室间隔缺损1例，部分型房室间隔缺损、右心室双出口、永存左上腔静脉1例，心内膜垫缺损1例，右心室双出口1例
消化系统	19	局部肠管回声增强7例，消化系统梗阻4例，肠系膜囊肿3例，食道闭锁2例，肛门闭锁、消化道梗阻伴破裂（包裹性积液及点状钙化灶）、肠重复各1例
颅脑	17	后颅窝池增宽3例，侧脑室扩张3例，胼胝体缺失伴双侧脉络膜囊肿、脑膨出、左侧脑室内出血累及脑实质伴左侧脑室扩张、颅骨形态异常、积水性无脑儿、无叶型前脑无裂畸形、后颅窝池增宽伴小脑下蚓部缺失、左侧脑室内血块、大脑发育不良伴脑室扩张、小脑蚓部发育不良、脉络膜囊肿各1例
肢体	12	足内翻6例，股骨短小、左手重叠指及多指、上肢尺骨缺失、右上肢桡骨弯曲、多趾、下肢骨骼发育异常各1例
颜面部	9	唇腭裂5例，小下颌2例，唇腭裂合并喙鼻、未见鼻骨伴眼眶异常各1例
脊柱	9	脊柱裂4例，半椎体2例，颈胸段脊柱及部分右侧肋骨畸形、脊柱腰骶部形态异常、脊柱尾部退化各1例
胸腔	6	肺部发育不良3例，左侧胸腔肺腺瘤样囊肿伴心脏及纵膈移位、胸腔狭小、膈疝伴右移心各1例
其他	120	羊水过少或无羊水34例，羊水过多29例，单脐动脉18例，心包积液8例，胸腔和（或）腹腔积液7例，颈部淋巴水囊瘤7例，脐带囊肿4例，宫内缺氧、永久性右脐静脉各3例，脐膨出2例，轮廓状胎盘、帆状胎盘、部分内脏反位、骶尾部囊性包块、全身水肿各1例

合并异常部位	例数	合并其他系统异常分类
心脏	22	法洛四联症6例，心脏增大5例，肥厚性心肌病3例，室间隔缺损3例，肺动脉瓣闭锁、重度三尖瓣关闭不全、右心房明显增大1例，房室间隔缺损1例，部分型房室间隔缺损、右心室双出口、永存左上腔静脉1例，心内膜垫缺损1例，右心室双出口1例
消化系统	19	局部肠管回声增强7例，消化系统梗阻4例，肠系膜囊肿3例，食道闭锁2例，肛门闭锁、消化道梗阻伴破裂（包裹性积液及点状钙化灶）、肠重复各1例
颅脑	17	后颅窝池增宽3例，侧脑室扩张3例，胼胝体缺失伴双侧脉络膜囊肿、脑膨出、左侧脑室内出血累及脑实质伴左侧脑室扩张、颅骨形态异常、积水性无脑儿、无叶型前脑无裂畸形、后颅窝池增宽伴小脑下蚓部缺失、左侧脑室内血块、大脑发育不良伴脑室扩张、小脑蚓部发育不良、脉络膜囊肿各1例
肢体	12	足内翻6例，股骨短小、左手重叠指及多指、上肢尺骨缺失、右上肢桡骨弯曲、多趾、下肢骨骼发育异常各1例
颜面部	9	唇腭裂5例，小下颌2例，唇腭裂合并喙鼻、未见鼻骨伴眼眶异常各1例
脊柱	9	脊柱裂4例，半椎体2例，颈胸段脊柱及部分右侧肋骨畸形、脊柱腰骶部形态异常、脊柱尾部退化各1例
胸腔	6	肺部发育不良3例，左侧胸腔肺腺瘤样囊肿伴心脏及纵膈移位、胸腔狭小、膈疝伴右移心各1例
其他	120	羊水过少或无羊水34例，羊水过多29例，单脐动脉18例，心包积液8例，胸腔和（或）腹腔积液7例，颈部淋巴水囊瘤7例，脐带囊肿4例，宫内缺氧、永久性右脐静脉各3例，脐膨出2例，轮廓状胎盘、帆状胎盘、部分内脏反位、骶尾部囊性包块、全身水肿各1例

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