Case Presentation A 28-year-old patient, undergoing her second pregnancy, with no pathological or toxic clinical history, presented with an intra-abdominal fetal mass identified during 34-week gestational age routine ultrasound. A Fetal Magnetic Resonance Imaging (fMRI) was performed, revealing findings compatible with Fetus in Fetu (FiF). Findings The ultrasound examination revealed an intraperitoneal mass in the middle of the fetal abdomen, solid, heterogeneous, with fatty areas and calcified structures resembling long bones. Vascularized by the superior mesenteric artery and displaced abdominal organs without invading them. These findings were confirmed later with fMRI. Birth was delivered via cesarean section at 38 weeks. Due to suspicion of FiF vs. Teratoma (Tt), tumor markers were tested with negative results. During follow-up, FiF growing was observed, leading to the decision to surgically remove the tumor at two months of age. Anatomopathologic examination confirmed the diagnosis of FiF. A computed tomography of the surgical specimen revealed characteristic FiF signs. Discussion With an estimated incidence of 1 in 500,000 births, FiF is a condition in which, due to abnormal embryogenesis in a monochorionic diamniotic pregnancy, one fetus grows abnormally within the body of the other. The diagnosis is based on imaging findings and is characterized by the presence of a separate vertebral column and the development of organs around this axis, indicating an early stage of fetal development. These features distinguish it from a highly differentiated Teratoma. Although it is a benign condition, the mass can affect surrounding structures. Prenatal diagnosis is more feasible nowadays, and suspicion should arise when an encapsulated cystic mass with calcified components is identified. Conclusion Imaging plays a crucial role in the diagnosis due to its similarity to a teratoma, which could have malignant potential. Surgical treatment is required, and early detection allows for a favorable prognosis. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Montalvetti Pablo

Keywords: Fetal MRI, Fetus in fetu

Ultrasound offers high sensitivity in diagnosing vitreous pathologies in pediatric patients and is increasingly being used as the preferred method for diagnosis since it does not use ionizing radiation. The vitreous body is a transparent, gelatinous substance found inside the eye cavity and occupies the space between the lens and the retina. It is avascular and its echostructure is anechoic. Its main function is to provide structural stability, giving volume to the eyeball and providing support to the retina. Different pathologies can affect it, both congenital and acquired. In pediatrics the most common ones are vitreous hemorrhage, vitritis, posterior vitreous detachment, synchysis scintillans and asteroid hyalosis. Clinically, they can present asymptomatically or with various symptoms such as myodesopsias, photopsias and decreased visual acuity, among others. Ultrasound and Doppler are excellent methods for studying the eyeball, as it is a superficial organ with a liquid component. Furthermore, they are accessible, non-invasive methods that do not require anesthesia and it provide relevant information, especially when opacification of the anterior segment hinders direct ophthalmological examination. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Joulia Vulekovich Lara, Musso Marcos, Montalvetti Pablo

Keywords: Vitreous, orbit, Ultrasonography

This educational work aims to describe and differentiate possible diagnostic scenarios in crystalline lens pathology. It seeks to showcase the signs that enable differential diagnosis through ultrasound imaging. The crystalline lens is a transparent, biconvex, flexible, and avascular structure located behind the iris and in front of the vitreous body. Sonographically it is anechoic, with a 3.5 mm thickness in newborns and 4.5 mm in adults. Its primary function is accommodation, to adjust the eye's vision for different distances. It is the site of various pathologies at different stages of life, in which the lens may be absent, altered in shape, or echogenicity. Clinically, it presents with a loss or decrease in visual acuity, with or without lens opacification. The type of presentation varies according to the patient's age and the underlying anomaly. Ultrasound is a fast, non-invasive method that does not use radiation or contrast material, does not require anesthesia, and provides valuable information. Conclussion: In the presence of visual acuity loss, whether or not associated with lens opacification, the radiologist's essential role is to complement the clinical and ophthalmological examination. The findings in different lens anomalies are characteristic. Ultrasound is the method of choice for their diagnosis and monitoring. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Joulia Vulekovich Lara, Musso Marcos, Montalvetti Pablo

Keywords: Crystalline lens, Orbit, Ultrasonography

Case Presentation A 27-year-old female patient, primigravida, with no pathological clinical history, and a low risk first-trimester screening for aneuploidy and preeclampsia. Morphological ultrasound was performed at 21 weeks of gestational age, revealing a cystic structure at the lumbosacral spine with bone alteration. Myelomeningocele was suspected, but no associated Chiari type II anomaly was observed. Additional Fetal Magnetic Resonance Imaging (Fetal MRI) was requested. Findings At 24 weeks, an obstetric ultrasound was made identifying a cystic image at the lumbosacral level with the absence of a placode. An osseous spur protruding into the medullary canal was observed, dividing the medullary cone in two. Suspicious fatty tissue suggestive of a lipoma was also noted. Fetal MRI confirmed the ultrasound findings, consistent with diastematomyelia (DM) associated with closed meningocele, lipoma, and medullary canal ectasia. Discussion Dysraphism are congenital malformations of the spinal canal, with a prevalence of 1 to 3 per 1000 live births, and the lumbosacral spine being the most commonly affected site. DM is a closed-type dysraphia in which there is a splitting of the spinal cord into two halves separated by a fibrous, cartilaginous, or bony septum. Clinical manifestations are variable and are typically related to orthopedic problems, urinary or fecal incontinence, and characteristic cutaneous abnormalities. When isolated, DM tends to have a favorable prognosis, but approximately one-third of affected patients have an accompanying dysraphism. Current recommendations include early postnatal surgery to prevent further complications. Conclusion DM is a rare disorder of spinal development that can be diagnosed prenatally through imaging. Precise identification of the lesion and the exclusion of other associated structural malformations are crucial for prognosis. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Montalvetti Pablo, Joulia Vulekovich Lara, Ledesma Ricardo

Keywords: diastematomyelia, Fetal MRI, Ultrasonography

OBJECTIVES The objective of this study is to describe and classify the different types of aplasia cutis using dermatological Doppler ultrasound, in an imaging diagnostics service. To demonstrate the ultrasound signs and different presentations of the pathology. ABSTRACT Aplasia cutis is a congenital anomaly characterized by the focal absence of one or more layers of the skin and, at times, underlying tissues such as bone or dura mater. It has an incidence of 3 in every 10,000 live births, and its etiology is unknown. Its most frequent location is the scalp, although it can affect other parts of the body and be multifocal. Ultrasound and Doppler examination, using high-frequency probes, objectively assess the anatomical involvement and potential complications. CONCLUSION Given the clinical suspicion of aplasia cutis, ultrasound and Doppler imaging are valuable for diagnosis and monitoring complications. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Montalvetti Pablo, Joulia Vulekovich Lara, Musso Marcos

Keywords: aplasia cutis, Doppler, Ultrasonography

Case Presentation: We will show two cases, of patients aged 16 and 24 years, at 24 and 30 weeks of gestation, who were referred for a second-trimester ultrasound. Findings: The ultrasound revealed an enlarged lateral ventricle associated with an increased size of the ipsilateral cerebral hemisphere. A fetal MRI was performed revealing subependymal gray matter nodules, pachygyria, and areas of gliosis in the white matter. Discussion: Hemimegalencephaly is a rare congenital malformation initially described by Sims in 1835. It involves the partial or total overgrowth of a cerebral hemisphere with varying degrees of pachygyria, polymicrogyria, neuronal heterotopia, and white matter gliosis due to a disorder in germ cell proliferation, migration, and differentiation. Its etiology remains unknown, and it does not exhibit a gender preference. Clinically, 90% of patients present with focal or generalized epileptic seizures. They may also exhibit hemiparesis and mental retardation. Hemimegalencephaly can present in an isolated manner or be associated with various syndromes, including hypertrophy of the ipsilateral hemibody or total involvement, which affects the cerebellum and brainstem. Prenatal diagnosis is suspected through ultrasound, identifying ventricular asymmetry and unilateral ventricular dilation. Fetal MRI confirms these findings and allows the assessment of gray and white matter disorders. Conclusion: Hemimegalencephaly is a rare and severe condition that should be considered in prenatal assessment by ultrasound. Its diagnosis is facilitated by advances in fetal MRI, where the findings and their severity correlate with the clinical presentation. Read More

Meeting name: SPR 2024 Annual Meeting & Postgraduate Course , 2024

Authors: Pelizzari Mario, Ledesma Ricardo, Musso Marcos, Perez Ricardo, Montalvetti Pablo, Joulia Vulekovich Lara

Keywords: hemimeningencephaly, Fetal MRI, Ultrasonography