Barbara S. Hertzberg

A Histopathologic Study of 716 Unselected Eyes in Patients with Cancer at the Time of Death

To determine the frequency of ocular metastases in the general population, we conducted a prospective histopathologic study of 716 eyes obtained from patients who had malignant neoplasms at the time of death. Fifty-two patients had ocular metastases; all of these individuals had widespread metastases that contributed to their deaths. The overall incidence of ocular metastases among all fatal cases of cancer was 9.3%. Thirty-three of the 117 patients with various types of leukemia and four of the 60 patients dying with lymphoma had ocular involvement. The total incidence of ocular metastases in patients dying of all types of carcinoma was 4.0%. In the nine patients dying of sarcoma, no ocular metastases were detected. We estimate that about 22,000 patients who will die of cancer in the United States during 1983 will have ocular metastases.

Ovarian cyst rupture causing hemoperitoneum: imaging features and the potential for misdiagnosis

AbstractBackground: To describe the spectrum of imaging findings and clinical presentations produced after rupture and hemorrhage of an ovarian cyst. Methods: Imaging studies and hospital records of nine patients who were ultimately diagnosed with hemoperitoneum from a ruptured ovarian cyst were reviewed and categorized. Results: Hemoperitoneum from a ruptured ovarian cyst presented a range of imaging findings. Although the imaging findings were dominated by hemoperitoneum, at least a vestige of the cyst could be identified in seven patients. The diagnosis of hemoperitoneum from a ruptured ovarian cyst was favored in only four of nine patients after the initial imaging study. Conclusions: A ruptured ovarian cyst can produce massive hemoperitoneum, with clinical symptomatology and sonographic features that closely mimic those of other disorders, in particular ectopic pregnancy. Considering the likelihood of both clinical and radiologic misdiagnosis, the radiologist should consider and pursue the diagnosis of a ruptured hemorrhagic ovarian cyst in a woman of child-bearing age who presents with pelvic pain and a large amount of complicated intraperitoneal fluid.

Ultrasound of the postpartum uterus. Prediction of retained placental tissue.

We reviewed ultrasound images an 53 postpartum patients referred for possible retained products of conception and correlated specific ultrasound patterns with clinical and pathologic follow‐up. The most common finding in patients with retained placental tissue was an echogenic mass in the uterine cavity, seen in 9 of 11 patients with pathologically proven retained placental tissue. In the remaining 2 patients with pathologically confirmed retained placenta, a heterogeneous mass was seen in the uterine cavity at some point during the course of serial sonography. Retained placental tissue was unlikely when ultrasound demonstrated a normal uterine stripe (n = 18), endometrial fluid (n = 6), or hyperechoic foci in the uterine cavity without an associated mass (n = 17). The latter finding was often associated with recent uterine instrumentation. The sonographic appearance of retained placental tissue is variable, but detection of an echogenic mass in the uterus strongly supports the diagnosis. A heterogeneous mass is sometimes caused by retained placenta, but can also be secondary to blood clots or infected or necrotic material in the absence of placental tissue. Sonographic evaluation for retained products of conception is best done before uterine instrumentation to avoid confusion with iatrogenically introduced air.

Outcome in children with fetal mild ventriculomegaly : a case series

Mild enlargement of the lateral ventricles is associated with schizophrenia and other neurodevelopmental disorders. While it has been hypothesized that ventricle abnormalities associated with neurodevelopmental disorders arise during fetal brain development, there is little direct evidence to support this hypothesis. Using ultrasound, it is possible to image the fetal ventricles in utero. Fetal mild ventriculomegaly (MVM) has been associated with developmental delays in early childhood, though longer-term neurodevelopmental outcome has not been studied. Follow-up of five children (aged 4--9 years) with mild enlargement of the lateral ventricles on prenatal ultrasound and two unaffected co-twins is reported: one child had attention deficit hyperactivity disorder (ADHD), one had autism, and two had evidence of learning disorders. These cases suggest that the mild enlargement of the lateral ventricles associated with these neurodevelopmental disorders arises during fetal brain development and can be detected with prenatal ultrasound. In addition, the presence of mildly enlarged, asymmetric ventricles in two children on prenatal ultrasound and on follow-up MRI at age 6 years indicates that ventricle structure present in utero can persist well into childhood brain development. The study of fetal ventricle development with ultrasound may provide important insights into neurodevelopmental disorders and allow the identification of children at high risk.

Prenatal Mild Ventriculomegaly Predicts Abnormal Development of the Neonatal Brain

BACKGROUND Many psychiatric and neurodevelopmental disorders are associated with mild enlargement of the lateral ventricles thought to have origins in prenatal brain development. Little is known about development of the lateral ventricles and the relationship of prenatal lateral ventricle enlargement with postnatal brain development. METHODS We performed neonatal magnetic resonance imaging on 34 children with isolated mild ventriculomegaly (MVM; width of the atrium of the lateral ventricle >/= 1.0 cm) on prenatal ultrasound and 34 age- and sex-matched control subjects with normal prenatal ventricle size. Lateral ventricle and cortical gray and white matter volumes were assessed. Fractional anisotropy (FA) and mean diffusivity (MD) in corpus callosum and corticospinal white matter tracts were determined obtained using quantitative tractography. RESULTS Neonates with prenatal MVM had significantly larger lateral ventricle volumes than matched control subjects (286.4%; p < .0001). Neonates with MVM also had significantly larger intracranial volumes (ICV; 7.1%, p = .0063) and cortical gray matter volumes (10.9%, p = .0004) compared with control subjects. Diffusion tensor imaging tractography revealed a significantly greater MD in the corpus callosum and corticospinal tracts, whereas FA was significantly smaller in several white matter tract regions. CONCLUSIONS Prenatal enlargement of the lateral ventricle is associated with enlargement of the lateral ventricles after birth, as well as greater gray matter volumes and delayed or abnormal maturation of white matter. It is suggested that prenatal ventricle volume is an early structural marker of altered development of the cerebral cortex and may be a marker of risk for neuropsychiatric disorders associated with ventricle enlargement.

Mild ventriculomegaly detected in utero with ultrasound : clinical associations and implications for schizophrenia

The most consistent structural abnormality of the brain associated with schizophrenia is that of mild enlargement of the lateral cerebral ventricles. Mild ventriculomegaly (MVM) of the fetal brain detected in utero with ultrasound is associated with developmental delays similar to those described in children at high risk of schizophrenia. Fetal mild ventriculomegaly may be a marker for increased risk of schizophrenia and other neurodevelopmental abnormalities. Given the association between schizophrenia and obstetrical complications, pre- and perinatal complications and pregnancy outcomes were retrospectively reviewed in 51 pregnancies in which the fetus exhibited mild ventriculomegaly on routine ultrasonography and 49 control pregnancies. Mothers of children with MVM were older than controls and had shorter gestations. There were no significant between-group differences in numbers of pregnancy complications or pregnancy outcomes as reflected in gestational age at birth, birthweight, or Apgar scores. Children with isolated mild ventriculomegaly tended to be male. This study indicates that isolated mild ventriculomegaly detected in utero is not associated with pregnancy complications and suggests that isolated mild ventriculomegaly of the fetus is genetically determined or caused by environmental events not routinely considered pregnancy complications.

Pseudoaneurysm of the Uterine Artery After an Uncomplicated Spontaneous Vaginal Delivery

Apseudoaneurysm is a pulsatile hematoma that communicates with the lumen of a damaged parent artery via a small neck. Pseudoaneurysms of the uterine artery are rare causes of delayed postpartum hemorrhage. In this setting, accurate diagnosis using pelvic sonography with Doppler imaging is critical to allow for proper treatment with either surgical arterial ligation or transcatheter embolization because curettage may cause life-threatening uterine bleeding. 1 Reports in the literature regarding uterine artery pseudoaneurysms as etiologic factors in postpartum hemorrhage mainly involve patients with a history of uterine trauma and include cases after both vaginal 2-4 and cesarean 4-8 deliveries. We report a case of a uterine artery pseudoaneurysm after an uncomplicated spontaneous vaginal delivery in a patient with no surgical history.

Fetal choroid plexus lesions: relationship of antenatal sonographic appearance to clinical outcome

The sonograms and clinical outcomes of 31 fetuses with antenatally detected choroid plexus lesions were retrospectively reviewed. Lesions were classified as simple cysts in 22 cases (71%) and complex lesions in 9 (29%). Simple cysts tended to be smaller in size than the complex lesions and no adverse sequelae were attributed to the sonographic detection of simple cysts. Although complex choroid plexus lesions appeared to be an incidental finding in seven of nine cases (78%), one of the remaining fetuses developed ventriculomegaly with focal cerebral cortical thinning and in utero viral infection was suspected in the other. Amniocentesis was performed in nine patients (five with simple cysts and four with complex lesions) and no chromosomal abnormalities were detected during the study period, although after these data were collected we encountered a fetus in which bilateral large complex choroid plexus lesions were associated with trisomy 18. These findings suggest that antenatally detected choroid plexus lesions are more variable in appearance than previously recognized. We consider fetuses with small simple cysts and otherwise normal sonograms to be at relatively low risk for developing adverse sequelae and recommend repeat sonography in 1 to 2 months to confirm the benign nature of the process. The presence of large and/or complicated lesions is of more concern, although the majority of these lesions (78%) also represented an incidental finding. We suggest consideration of amniocentesis, TORCH titers, and close sonographic follow‐up of pregnancies with large or complex choroid plexus lesions.

First trimester fetal cardiac activity. Sonographic documentation of a progressive early rise in heart rate.

The heart rates of 124 first trimester fetuses were determined with real‐time sonography and were analyzed with regard to gestational age. The mean embryonic heart rate increased from 101 beats per minute (bpm) at 5 to 5.95 menstrual weeks to 143 bpm at 8 to 8.95 weeks. After nine weeks, the rate reached a plateau, ranging from 137 to 144 bpm. Slower heart rates are normal early in the first trimester and should not be misinterpreted as an abnormal finding or mistaken for maternal pulsations.

Ultrasonographically guided manual compression of femoral artery injuries.

To determine the success and complication rates of ultrasonographically guided manual compression in patients with femoral arterial injuries after femoral arterial catheterization, we performed 53 sonographically guided compression repairs in 51 patients. Ultrasonographically guided compression repair was performed on 40 pseudoaneurysms in non‐anticoagulated patients, seven pseudoaneurysms in anticoagulated patients, four arteriovenous fistulas on non‐anticoagulated patients, and one pseudoaneurysm combined with an arteriovenous fistula. One pseudoaneurysm underwent two separate ultrasonographically guided compression repairs: once when the patient was anticoagulated and once after anticoagulants were withheld. Ultrasonographically guided compression repair was successful in 37 of 48 pseudoaneurysms (77%). Of the 40 pseudoaneurysms in non‐anticoagulated patients, ultrasonographically guided compression repair was successful in 36 (90%). This repair technique failed in all seven pseudoaneurysms in anticoagulated patients. Ultrasonographically guided compression repair was successful in 13 of 16 (81%) multilobulated pseudoaneurysms but failed in all arteriovenous fistulas and the one case of pseudoaneurysm combined with an arteriovenous fistula. Ultrasonographically guided compression repair is a safe and effective alternative to surgery for the repair of pseudoaneurysms, including multilobulated pseudoaneurysms. The procedure does not appear to be effective in the anticoagulated patient or in patients with an arteriovenous fistula.