Y. Goldberg

Doppler and gray‐scale sonographic classification of adnexal torsion

To propose, in cases with coiling of the ovarian vessels, a classification of severity of torsion based on Doppler and gray‐scale ultrasound findings and to suggest a treatment strategy for each situation.

Starry sky pattern of fetal liver sonogram as first sign of twin–twin transfusion syndrome

‘Starry sky’ liver is one of the most common sonographic patterns in diffuse liver disease. It is characterized by clearly identified portal venules due to diminished parenchymal echogenicity. In advanced cases of twin‐to‐twin transfusion syndrome (TTTS), volume overload is considered the key factor in the pathogenesis of cardiac dysfunction of the recipient twin. When right‐sided failure occurs, the liver might show signs of edema and, as in acute hepatitis, the appearance of starry sky might develop. We present a case in which the sonographic appearance of starry sky liver, along with right‐sided cardiac failure (tricuspid regurgitation), were the first signs of TTTS in monochorionic twins at 20 weeks. A short time later, at 21 weeks, other signs of overload and signs of worsening heart failure were noted, as the typical triphasic waves in the inferior vena cava were replaced by a biphasic flow profile. Twin 2 at that time had relative oligohydramnios. A few days later, relative polyhydramnios and edema of the placental domain of the recipient twin were also noted. To the best of our knowledge, this is the first case report describing this hepatic sonographic pattern as an early sonographic sign of TTTS. Copyright

Imaging of an atypical large perineal cyst diagnosed during pregnancy

Perineal cysts are quite frequent, almost 2% of women developing symptoms related to Bartholin or Gartner cysts. In most cases these cysts derive from embryological remnants or ectopic tissue, or form as epithelial inclusion cysts. These structures are usually asymptomatic unless they are complicated by infection. We report the sonographic and magnetic resonance imaging characteristics of a large perineal cyst diagnosed during the first trimester of an uncomplicated pregnancy, followed by conservative management during pregnancy and surgical excision in the puerperium. Copyright

EP18.02: Diffuse pelvic actinomycosis mimicking advanced stage cervical carcinoma: a case report: Electronic Poster Abstracts

Actinomycosis of the female pelvis is a rare disease often related to an indwelling IUD. Actinomycosis-related pelvic abscesses were formerly describes as causing tumour-like structures resulting in bowel and urinary obstruction, and mimicking ovarian and uterine cancers. We describe a case of a 52 year old woman admitted due to intermittent vaginal discharge and bleeding and occasional abdominal discomfort. She had carried an IUD for over 15 years. On admission she had a swollen tender abdomen, an irregular stiff cervix with no exophytic lesions, and a frozen pelvis. Transvaginal ultrasound revealed a highly vascularised 3 cm mass on the posterior lip of the cervix penetrating the posterior fornix, rectovaginal septum, rectal serosa and the parametria bilaterally. There was a cystic lesion in the right ovary measuring 91,1,*cm with hypoechoic fluid, thick avascular septa and no solid elements. The exam was summarised as an advanced malignant lesion arising from the uterine cervix with parametrial and pelvic lymph node involvement. CT scans were consistent with the sonographic findings. Blood tests showed leukocytosis with neutrophilia and a CRP of 34. The patient was admitted and treated with broad-spectrum antibiotics. Multiple cervical biopsies and an endocervical curettage were performed. Pathologic reports demonstrated fragments of severely inflamed cervical mucosa and bacterial colonies surrounded by granulocytes consistent with an Actynomyces infection. During her hospitalisation, the patient also suffered a massive rectal bleeding and her hemoglobin dropped to 4.3 gr/dl. Surgical exploration revealed a diffuse inflammatory process involving the pelvic organs with a large purulent tubo-ovarian abscess. Total abdominal hysterectomy, bilateral salpingo-oophorectomy and a sigmoidectomy were performed. Pathologic specimens noted massive inflammation of the pelvic structures consistent with the primary biopsies and no malignant features.

OP24.03: 2-dimentions sonographic evaluation of benign and malignant endometrial lesions: simple and handy tool for the clinician

indication was increased NT. We excluded 24 cases of failed of cell culture or loss of follow up. Of these 174 procedures, a complete follow-up was obtained by a review of medical records and phonecall. Addition to fetal karyotyping these patients were managed with follow-up scans at 20–22 weeks, fetal echocardiography and in selected cases by infection screening. Especially our data set substantiates that additional MLPA analyses for further genetic syndrome. Results: Overall 69 (69/174, 39.66%) cases of chromosomal abnormalities were detected. In 105 (60.34%) with the normal karyotyping results, there were 8 (7.61%) abortions or FUID and 6 (5.71%) terminations of pregnancy. In the 91 (86.66%) survivors, 9 (8.57%) had abnormalities requiring medical or surgical treatment. The chance of a live-birth with no defects in the group with normal ultrasonographic findings was 71 (67.62%), for those with abnormal or suspicious ultrasonographic findings was 11 (10.48%). Moreover, microdeletions rate is 1.90%(2/105), all cases terminated of pregnancy. Conclusions: Grossly 47.13% (82/174) of cases with increased NT had a live-birth with no defects and chromosomal abnormality. Offering the parents the option for fetal karyotyping, the finding of increased translucency should stimulate the search for other fetal defects by detailed ultrasonography and special microdeletions study. If these results are normal features, physicians give a relief to parents and postnatal pediatric follow up should be arranged.

OC19.01: Conservative ultrasonographic follow up of asymptomatic endometrial lesions in postmenopausal women is a safe alternative to surgical procedures

C. C. Much1, E. Solano2, N. D. Forkert3, J. Sedlacik4, P. Arck2, G. Adam1, U. Wedegaertner1 1Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Experimental Feto-Maternal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 3Computational Neurosience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 4Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

P33.06: Prenatal diagnosis of nevus lipomatosus cutaneous superficialis of labia major in a female fetus: a case report

bladder. Severe dilatation of the left renal pelvis was noted with significant caliectasis, thinning of the renal cortex, and hydroureter. Case 2 was an 18 year old G4 P1021 who presented for assessment of fetal growth in the third trimester and was found to have a mass containing echogenic debris in the midline of the lower fetal abdomen. Follow up ultrasounds demonstrated persistence of the mass with progressive bilateral renal and ureteral dilatation. In both cases, postnatal evaluation confirmed the prenatal findings and revealed a diagnosis of imperforate hymen. Both fetuses underwent hymenostomy with subsequent resolution of the mass and improvement in hydronephrosis. Conclusion: Imperforate hymen should be considered as the etiology of renal obstructive disease in female fetuses presenting with a pelvic mass. Postnatal management and hymenostomy resulted in resolution of hydronephrosis.

P16.06: Doppler artery parameters are not useful for the clinical management of retain product of conception

A. Pexsters1, A. Daemen2, C. Bottomley3, Y. Abdallah4, O. Naji4, N. Raine-Fenning5, B. De Moor2, T. D’Hooghe1, D. Timmerman1, T. Bourne1,4 1Department of Obsterics and Gynecology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium; 2Department of Electrical Engineering, Katholieke Universiteit Leuven, University Hospitals, Leuven, Belgium; 3Chelsea and Westminster Hospital, London, United Kingdom; 4Imperial College London, Hammersmith Campus, London, United Kingdom; 5Nottingham University Treament Unit in Reproduction (NURTURE), University of Nottingham, London, United Kingdom

P18.09: Antenatal diagnosis and treatment of fetal goiter with a single intra‐amniotic injection of L‐thyroxine—a case report

This case highlights the need to consider diagnoses of rare conditions not normally associated with a particular population. A hydropic fetus presented at 29 + 1 weeks with extensive ascites, pericardial fluid, enlarged heart and hyperkinetic circulation. Maximum velocity in the middle cerebral artery was 76 cm/s. The etiology of the fetal anemia was unknown. Both parents were of Nordic origin. The family history revealed that the father was born with anemia, in need of neonatal transfusions. No conclusive explanation for his anemia was found. His physical and neurological development was normal, although the microcytic anemia persisted. The family history made us consider a hereditary anemia in the fetus. The first cordocentesis revealed a microcytic anemia with Hb 5.8 g/dl, Hct 0.19, MCV 91 fl. Six intrauterine transfusions, until 34 completed weeks, were performed. The female infant was delivered by Cesarean section at 36 weeks. Her initial Hb level (transfused) was 14.1 g/dl; at one month of age her Hb was 8.8 g/dl, MCV 78 fl. She was transfused at this stage and again at about 2 months; since then her Hb has been stable at about 9 g/dl. She is healthy and her physical and neurological development has been normal. In the father, a deletion of the 5′ end of the β globin gene cluster was characterised, the breakpoints sequenced and a new type of εγγδβ thalassemia identified. Analysis of the daughter’s DNA by MPLA and Southern blotting confirmed that she had inherited the deletion chromosome from her father. The clinical presentation of εγγδβ thalassemia may vary but neonatal transfusions are frequently required due to marked neonatal anemia. A thorough family history may provide the suspicion of the potential diagnosis. Intrauterine transfusions should always be considered while further investigation takes place. A correct diagnosis provides a probable prognosis and also allows early prenatal diagnosis and optimal surveillance in future pregnancies.

OP24.07: Ultrasonographic characteristics of borderline ovarian tumors - 5-year experience of a single institution

Results: Median age of the patients was 43 years (range 23–76 yrs); at final pathology according to pTNM classification 4 pts were at stage pT1A1, 20 pts pT1B1 (4 pN1), 2 pts pT1B2, one patient was pT2A pN1 and 4 pts pT2B, no residual tumor was found in 3 patients. TVUS accuracy for tumor detection was 82,4% even in ten cases of small tumour (less than 1 cm), compared to 80% of MRI. 3 pts were not correctly identified, but received prior neoadjuvant chemotherapy and 1 pts was a pT1A1. Comparing tumour maximum diameter at TVUS and final pathology the exact concordance (millimeters + 20%) was 58,8% in tumours sized more than 20 mm. Parametrial involvement was correctly detected by TVUS with an accuracy of the 95,7%. Tumor intensity of vascularization well correlated to vascular space involvement (73,7%), depth of infiltration (> 13, 5 mm) and positive lymph node (75%). Conclusions: These results confirm the accuracy of TVUS in presurgical evaluation of small cervical cancers and a possible aid of TVUS in identification of patients at risk who can require an adjuvant treatment. Evaluation of post-cone residual disease is very helpful in conservative treatment programs.