FREE LANCE RADIOLOGY

Fetal sonogram with Herniated anterior abdominal mass ( MEDIAN) with liver and small bowel as contents of herniation. The herniated contents are covered with membrane ( contained ) . These findings are s/o OMPHALOCELE( extra corporeal liver)

DEFINITION PATHOGENESIS

Extrusion of the fetal abdominal contents into the base of the cord .

Herniated mass is covered with parietal peritoneum and amniotic membrane with wharton’s jelly in between peritoneum and amniotic membrane.

Intracorporeal Liver ( only bowel herniates , No liver in the herniated contents) . This type of omphalocele is diagnosed after 12wks ( physiological herniation of bowel is a d/d before 12 wks ) . The etiology for this type of omphalocele is Persistence of primitive body stalk and failure of the bowel to return to abdomen after 12wks .

Extra corporeal liver ( only liver is herniated ) . This type of omphalocele can be diagnosed before 12 wks also . This type of omphalocele is sequel to defective growth of the lateral abdominal folds .

ASSOCIATIONS

Trisomy 18, 13, 21 Turners Klinfelter CNS anomalies GI anomalies GU anomalies Cardiac anomalies ( 50

%). Beckwith wiedmen

syndrome . Cloacal exstophy .

The extent of the Association with anomalies is high when herniated contents have smll bowel with oligohydramnios / polyhydramnios .

DIAGNOSISRADIOLOGICAL

FINDINGS

MSAFP Acetylcholinesterase

positive .

Anterior abdominal mass is appreciated in median plane

Define the site of cord insertion ( in omphalocele cord insertion is on the apex of the herniated mass).

Define the covering membranes with associated ascites .

In ompahloccele hernaited visera is contained ( c/f gastroschisis where herniated viscera is free floating and paramedian : Rt sided ) . Due to presence of the protective memberanes : Bowel thickening or dilation is not usually seen in omphalocele ( c/f gastroschisis)

THE RADIOLOGICAL RESPONSIBILITY SUGGESTIVE …………….

Define the appearance of the omphalocele .

Look for covering memberanes / ascites .

Define the presence / absence of the liver . ( intra / extra corporeal ) .

Ratio of the herniated mass to transverse diameter of the abdomen ( >60 % in omphalocele )

Fetal echocardiography

Karyotype . Delivery in tertiary

care Genetic counselling .

Anterior abdominal mass with covering membranes . Note is made of herniation of the liver .

ANTERIOR ABDOMINAL WALL WITH ECHOGENIC BOWEL AS HERNIATED

CONTENT .

MEDIAN HERNIATION OF THE ABDOMINAL CONTENTS INTO THE BASE OF THE UMBILICAL CORD WITH CORD INSERTION ON THE TOP OF THE HERNIATED CONTENTS

CORD INSERTION ON THE TOP OF HERNIATION ( GREY SCALE)

CORD INSERTION ON THE TOP OF HERNIATION ( COLOR DOPPLER)