Sebastião Marques Zanforlin Filho

Sonoembryology by three-dimensional ultrasonography: pictorial essay.

ContextThree-dimensional ultrasonography in obstetrics has evolved in the last years, and nowadays it is a methodology that greatly helps prenatal diagnosis. Through its rendering mode it allows the careful evaluation of fetal face and limbs, and in multiplanar mode it allows the assessment of the anatomy through the many possible planes. In the first trimester of gestation, three-dimensional ultrasonography permits the detailed evaluation of embryonic development. Its main advantages over two-dimensional ultrasonography are shorter examination time and the possibility of storage of the volumes for later processing and analysis.AimWe present a pictorial essay with normal embryo development in the first trimester of pregnancy by three-dimensional ultrasonography, from the fifth to ninth week.

Three-dimensional transvaginal sonographic diagnosis of early and asymptomatic interstitial pregnancy

ContextThe interstitial gestation is a rare form of tubal pregnancy which is associated with high morbidity. The diagnosis of an interstitial gestation can be reached through a bidimensional transvaginal ultrasonography (2D-TVUS), however, sometimes when making use of this technique it is not possible to appropriately evaluate the position of the gestational sac in relation to the uterine cavity. The three-dimensional transvaginal ultrasonography (3D-TVUS) allows accessibility to plans that the bidimensional does not, thus it makes it possible to reach a more accurate diagnosis and it also allows for an appropriate therapeutic planning.Case reportWe present a case of interstitial gestation diagnosed in the sixth week in an asymptomatic woman, who had a previous diagnosis of primary infertility. The 2D-TVUS revealed the presence of a gestational sac outside of the uterine cavity; moreover the colored Doppler and the power Doppler indicated a thriving vascular ring. The 3D-TVUS in the surface and transparency mode demonstrated that the gestational sac was located in the interstitial region of the uterine tube, and the niche mode accurately evaluated the relationship between the gestational sac and the uterine cavity. The patient was successfully treated with a local injection of methotrexate guided by a transvaginal ultrasonography. The 3D-TVUS was of great importance to confirm the diagnosis, to allow appropriate therapeutic choices and to decrease the morbidity.

Diagnosis of Pentalogy of Cantrell by Three-Dimensional Ultrasound in Third Trimester of Pregnancy

The Pentalogy of Cantrell is a rare congenital anomaly characterized by defects in the closing of the supraumbilical abdominal wall, in the anterior portion of the diaphragm, in the diaphragmatic pericardium, ectopia cordis, and intracardiac defects. It may be associated to other anomalies determining the variants of this syndrome. The prenatal ultrasound diagnosis is extremely important for detecting structural malformations and for postnatal surgical planning, when possible. We present a case of Pentalogy of Cantrell diagnosed in the 34th week of gestation, showing the main findings by two-dimensional ultrasound and emphasizing the importance of three-dimensional ultrasound on the assessment of structural malformations and on the better understanding of the origins of the pathology.

Reference charts of fetal biometric parameters in 31,476 Brazilian singleton pregnancies.

The purpose of this study was to establish reference charts of fetal biometric parameters measured by 2‐dimensional sonography in a large Brazilian population.

Prenatal diagnosis of the 13q-syndrome through three-dimensional ultrasonography: a case report

Context: The deletion of the short arm of the chromosome 13, also known as 13q syndrome, is an extremely rare chromosomal disorder. Clinical manifestations include retinoblastoma, brain anomalies, mental and growth retardation, as well as renal, cardiac, gastrointestinal, facial, lip and digital defects. Antenatal diagnosis is suspected when the presence of anomalies is detected and it is confirmed through chromosome analysis. Case report: We reported a case of the 13q syndrome which was diagnosed in the 23rd week of gestation in a fetus with holoprosencephaly and we discussed the two and three-dimensional ultrasonography main findings. This is the first case reported in MEDLINE involving the use of three-dimensional ultrasonography in the structural anomalies evaluation of this syndrome.

Sirenomelia sequence: early prenatal diagnosis of one rare case associated with acardiac malformation

Sirenomelia sequence is a very rare congenital malformation, with incidence of around 1.5–4.2 per 100,000 births. Prenatal diagnosis of sirenomelia in the first trimester is rare; there are only five cases reported for the present, and the association of sirenomelia with acardiac malformation is even rarer. We present a rare case of sirenomelia associated with acardiac malformation detected in the first trimester through combined two-dimensional, three-dimensional and color Doppler sonographies.

Diagnosis of ovarian torsion by three‐dimensional power Doppler in first trimester of pregnancy

Three‐dimensional ultrasonography in power Doppler mode (3D power Doppler) allows the appropriate quantitative assessment of the ovarian tissue vascularization. The present case is of an ovarian torsion in a pregnant woman at 6.5 weeks with ovarian hyperstimulation syndrome due to in vitro fertilization. Gray‐scale images of endovaginal two‐dimensional ultrasonography revealed enlargement of the right ovary and multiple peripheral follicles. Two‐dimensional ultrasonography in color Doppler mode revealed the absence of venous flow and reduction in arterial flow to the impaired ovary. 3D power Doppler allowed the appropriate quantitative assessment of tissue vessel density of the impaired ovary, which greatly influenced the decision for conservative surgical treatment. The 3D power Doppler assessment performed after the surgery confirmed the integrity of the ovarian tissue. 3D power Doppler can help in the selection of patients with ovarian torsion for conservative surgical treatment.

Diagnosis of uteroperitoneal fistula through color Doppler hysterosonography.

IntroductionUterine fistulas are infrequent pathologic entities characterized by abnormal communication of the uterus with any other organ or structure through a perforation formed due to traumatic and infectious conditions among others. The use of hysterosonography as method of diagnosis for that pathologic entity has few descriptions in medical literature. MEDLINE search resulted in only two cases reporting the use of HS in the diagnosis of uterine fistula.ObjectiveOur objective is to report a case of uteroperitoneal fistula caused by uterine trauma during curettage, diagnosed by color Doppler hysterosonogrphy. The importance of our report lies on HS as a simple, safe and low cost method, which can be used for the diagnosis of fistulous processes involving the uterus.

Occult Spinal Dysraphism in the Presence of Rare Cutaneous Stigma in a Neonate: Importance of Ultrasound and Magnetic Resonance Imaging

Occult spinal dysraphism is defined as a group of dystrophic conditions below an intact cover of dermis and epidermis. Ultrasonography using linear transducers is a fast, inexpensive, and effective method that makes it possible to view the content of the vertebral canal and bone structures. Magnetic resonance imaging (MRI) is reserved for elucidating the type of dysraphism and for planning corrective surgery. We present a case of a five-day-old female neonate who presented cutaneous stigmas (in the lumbar region, hands, and feet), in whom ultrasonography demonstrated dysraphism in the lumbar region. MRI confirmed the type of dysraphism and enabled surgical planning.

Spatio-temporal image correlation (STIC): nova técnica para avaliação do coração fetal

As malformacoes cardiacas sao as mais frequentes anomalias congenitas ao nascimento, entretanto, a sua deteccao pre-natal pela ultra-sonografia convencional permanece baixa. As ultra-sonografias de terceira e quarta dimensoes surgiram no inicio da decada de 90, apresentando grandes aplicacoes em obstetricia, principalmente nos casos de diagnosticos duvidosos a ultra-sonografia bidimensional. O spatio-temporal image correlation (STIC) representa grande avanco na area de ultra-som de quarta dimensao; constitui-se em um software acoplado ao aparelho Voluson 730 Expert, que permite a aquisicao volumetrica do coracao fetal e suas conexoes vasculares. As analises volumetricas sao realizadas nos modos multiplanar e de renderizacao, podendo-se tambem utilizar o Doppler. Apresenta, como grandes vantagens, a aquisicao rapida e a possibilidade de analise posterior por especialistas em ecocardiografia fetal. Pode ser aplicada para a pesquisa de quaisquer cardiopatias congenitas, pois permite a aquisicao de qualquer plano, diferentemente do ultra-som bidimensional. Sua principal desvantagem esta relacionada aos movimentos fetais. A maior difusao do metodo pode permitir um aumento na deteccao de malformacoes cardiacas, pois possibilita ao ultra-sonografista geral encaminhar, via Internet, os volumes para a analise por especialistas em ecocardiografia fetal.