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Biomedical subjects

E F Avni

Publications and source records attributed to E F Avni.

At least 37 records · Page 2Linked to original sources
PubMed1995

Atypical and equivocal sonographic features of the spinal cord in neonates.

Thanks to the wider use of sonography to examine the spinal content in the neonate, normal anatomy and anomalies may be detected easily. Yet, unusual sonographic patterns are also observed. These must be differentiated from true pathologies. During a prospective study of 103 neurologically asymptomatic neonates, atypical sonographic patterns were found in 16 patients, corresponding to normal variants in 13. Nine of these 13 patients presented with a widening of the distal part of the central echo complex (one had a dilated ventriculus terminalis). Nerve roots of the cauda equina were disposed asymmetrically in three patients; the spinal cord movements were still present. In two of these babies, this distribution was associated with thin arachnoid pseudocysts. One patient presented with transitorily hyperechoic and narrow subdural spaces, probably related to neonatal dehydration. None of the 13 patients showing normal variants required any treatment. The other 3 patients (of 16) presented with equivocal entities of unknown evolution: sonographic tethered cord, fibrolipoma of the filum terminale and epidural varices. Sonography is highly accurate in evaluating the spinal cord content and aids differentiation of normal and normal variants from equivocal or pathological entities.

Diagnosis, Differential↗
PubMed1995

Mid-portion agenesis of corpus callosum in a presumed Baller-Gerold syndrome.

We report an association of trigonocephaly and thumb hypoplasia in a 6.5-year-old boy, diagnosed as Baller-Gerold syndrome. In addition to craniosynostosis and radial limb defect, which are constant in this syndrome, our patient presents two unusual features: the first is an epidermal nevus and the second is an agenesis of the middle portion of corpus callosum. This unique type of callosal agenesis in the context of a polymalformative disorder supports the hypothesis that partial agenesis of corpus callosum may be due to an event occurring before the 12th week gestation with continued development of the midline structures.

Abnormalities, Multiple↗
PubMed1995

Areas of increased echogenicity in the fetal abdomen: diagnosis and significance.

Areas of increased echogenicity in the fetal abdomen are defined as abnormally bright areas with an echogenicity similar to that of surrounding bones. Such areas are encountered in various normal and abnormal processes. When increased echogenicity is discovered in the fetal abdomen, a careful search should be made for a potential cause. The causes to be considered depend on the location of the areas of increased echogenicity, which can be classified as intestinal, peritoneal, hepatic, retroperitoneal, and parietal. In each case, vascular, ischemic, infectious, tumoral, metabolic, and chromosomal abnormalities should be included in the differential diagnosis before considering the finding a normal variant. Therefore, in utero detection of fetal abdominal areas of increased echogenicity requires a complete sonographic survey of the fetus and placenta along with close sonographic follow-up, evaluation of familial factors, and testing for possible associated cystic fibrosis, infection, or a chromosomal anomaly. The prognosis depends more on the underlying disease than on the extent of the increased echogenicity.

Abdomen↗
PubMed1994

Hyperechoic thickened ependyma: sonographic demonstration and significance in neonates.

In the neonate, hyperechoic thickening of the ependyma is believed to be related to ventriculitis. Yet, in our experience, this sign is much more often observed in association with subacute intraventricular hemorrhage (IVH), without infection. Sixty premature neonates were prospectively studied. The observations of transfontanellar sonograms (intracranial hemorrhage, ependymal echogenicity, and ventriculomegaly) were correlated with the results of MRI, lumbar punctures and clinical work-up. Intracranial hemorrhage was detected in 28 patients, and hyperechoic thickening of the ependyma was observed in 21 of them, all of whom had IVH. In 9 of these 21 patients IVH was diagnosed retrospectively thanks to the visualization of the hyperechoic ependyma. In all but one, this sign persisted for at least 2 months after disappearance of other signs of IVH. MRI demonstrated the presence of hemosiderin and ferritin in ependymal or subependymal location only in patients with hyperechoic ependyma. One of our patients had in utero diagnosis of IVH owing to the visualization of the same hyperechoic aspect of the ependyma. Nine of the neonates with hyperechoic ependyma developed ventriculomegaly, and three underwent surgery. Hyperechoic thickening of the ependyma in prematures often results from a subacute IVH. It is related to hemoglobin catabolites which can be detected by MRI. It does not require immediate potentially harmful diagnostic punctures. The presence of this hyperechoic rim allows a retrospective diagnosis of IVH and indicates a clinical and sonographic follow-up in newborns at risk for secondary hydrocephalus.

Cerebral Hemorrhage↗
PubMed1994

Hepatic cysts and hyperechogenicities: perinatal assessment and unifying theory on their origin.

The authors report their experience with the perinatal diagnosis of six cases of hepatic cyst and six of liver hyperchogenicities. The in utero diagnosis of hepatic cysts was difficult when the cysts were large or subhepatic. A precise diagnosis was sometimes achieved only after surgery. Small intraparenchymal cysts tended to regress spontaneously. Liver hyperechogenicities were diffuse or localized. They were unrelated to liver infection, tumors, meconium peritonitis or biliary tract anomaly. Both entities could be related to vascular disruption phenomenon (VDP) in which structural anomalies result from damage to normal development of embryonic or fetal vessels with anomalies of perfusion to the developing organs. The consequences of VDP to the liver are variable depending on the time and duration of the phenomenon. Localized infarct or ischemia can fibrose or calcify leading to segmental hyperechogenicities. Necrosis with tissue reabsorption can be the origin of some (sub)hepatic cysts. When such anomalies are detected there should be a careful study of the placentation, and a search for potential associated anomalies should be undertaken.

Cysts↗
PubMed1994

Fetal esophagus: normal sonographic appearance.

Our objective was to describe the sonographic appearance of the normal fetal esophagus and to determine the rate of its visualization. The fetal esophagus has a tubular echogenic appearance. Two patterns of the tubular structure were observed: two parallel echogenic lines or several parallel echogenic lines (the so-called "multilayered pattern"). A cannula was placed in the stomach of three stillborns and removed under ultrasonographic monitoring, confirming its location. In 155 consecutive pregnancies examined, the thoracic part of the fetal esophagus was easy to visualize (about 90% of cases); the cervical and abdominal segments were more difficult to visualize (19 and 30%, respectively). The multilayered pattern was observed in 49% of cases before and in 87% of cases after 26 weeks' gestation. A direct sonographic demonstration of the fetal esophagus is possible and could help to exclude esophageal malformations.

Embryonic and Fetal Development↗
PubMed1993

Sonographic demonstration of congenital adrenal hyperplasia in the neonate: the cerebriform pattern.

Sonographic examination of the adrenal glands of three newborns with congenital adrenal hyperplasia demonstrated a cerebriform pattern. This is introduced as a sonographic feature specific to the disease. This finding in patients with ambiguous genitalia should suggest the diagnosis even if the adrenals are not significantly enlarged, and should prompt appropriate biochemical analysis and treatment.

Adrenal Glands↗
PubMed1993

Large solitary non-parasitic cyst of the liver.

Non-parasitic solitary liver cysts are rare in children. Yet they should be included in the differential diagnosis of superior abdominal masses. We report one case in a 7-year-old boy that illustrates the difficulties of the diagnosis.

Carcinoma, Hepatocellular↗
PubMed1992

A hypothesis for the higher incidence of vesico-ureteral reflux and primary megaureters in male babies.

The authors propose a new explanation for the male preponderance in cases with prenatally diagnosed vesico-ureteral reflux and primary megaureters. The theory is based on conclusions drawn from the characteristics of 4 patients (3 perinatal cases and 1 occurring in a 14-year-old boy) presenting with unusual anomalies of the lower urinary tract. In this hypothesis, the male preponderance could be related to an abnormal dilatation of the posterior urethra occurring during the embryological development of the male urethra. The dilatation leads to a flap valve mechanism and to a functional obstruction of the bladder outlet and finally to secondary dilatation of the upper urinary tract. This obstruction may be transitory; reflux and megaureters found in utero or after birth could be considered as sequellae of this phenomenon.

Adolescent↗
PubMed1992

Detection and evaluation of fetal goitre by ultrasound.

Antenatal diagnosis of fetal goitre has been reported rarely. Once detected, however, it is important to evaluate fetal thyroid function so early treatment can be initiated if necessary. In reporting three new cases, the authors analyse the various methods of evaluation. The normal sequence of appearance of the various epiphyseal ossification centres is an indirect illustration of thyroid function and can be followed by ultrasound. Direct evaluation of hormone levels through cord blood sampling under sonographic guidance is a complementary method in doubtful cases. The mechanisms predisposing to the development of fetal goitres and the possible implications of these findings are also discussed.

Diseases in Twins↗
PubMed1992

The ureterovesical junction in children: sonographic findings after surgical or endoscopic treatment.

We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.

Adolescent↗
PubMed1991

Peri-cholecystic hyper-echogenicities in necrotizing enterocolitis: a specific sonographic sign?

The authors report a new sonographic pattern found in association with neonatal necrotizing enterocolitis in 5 newborns: hyperechogenicities around the gallbladder. The pattern probably corresponds to extension of the disease to the perivesicular space. The most probable hypothesis for that extension is diffusion by contiguity through the lesser sac and/or the right gutter. The hyperechogenicities could be related to the foamy infiltrate typical of NEC. Air within the pericholecystic vascular system similar to portal air could be another (less probable) explanation.

Enterocolitis, Pseudomembranous↗
PubMed1991

Pulmonary sequestration-like anomaly presenting as a spontaneously resolving mass.

A premature baby boy presented at birth with respiratory distress. A right lower lobe opacity was found on chest X-ray. Pulmonary sequestration was the diagnosis suggested by ultrasound. The size of the mass decreased on subsequent examinations. 4 months later X-rays and sonography failed to demonstrate any remaining mass. This case illustrates another example of involutive pathology and suggests that not all pulmonary sequestration-like anomalies should be operated on.

Bronchopulmonary Sequestration↗
PubMed1991

Renal duplications: the impact of perinatal ultrasound on diagnosis and management.

Perinatal urology is a rapidly expanding field in pediatric urology bringing significant changes in the diagnosis and management of congenital uropathies. Renal duplication was detected by antenatal and perinatal ultrasound in 19 cases (22 duplicated systems). In most cases, no precise diagnosis could be established in utero (4 of 13), but this lack of accuracy is of little clinical significance since all newborns with suspected uropathies undergo complete urological investigations in the perinatal period. Voiding cystogram demonstrated reflux in 11 of 22 cases. On postnatal urography a functioning upper pole was demonstrated in 11 of 22 kidneys. There were 12 ureteroceles: in 8 a nonfunctioning upper pole was removed, while 3 were endoscopically incised with good functional improvement and 1 was reimplanted. Early recognition of congenital uropathies in association with duplication by prenatal ultrasound significantly improves patient care allowing early postnatal relief of obstruction by less invasive methods and before infection or persistent obstruction worsens the prognosis.

Congenital Abnormalities↗
PubMed1991

[Neonatal pilonidal sinuses and screening by medullary ultrasonography: preliminary results].

The authors report on their preliminary experience with ultrasound as a screening examination in neonates presenting pilonidal sinuses. Of the 100 patients examined over the 2 previous years, three pathological cases were found (1 tethered cord, 1 lipoma of the filum terminale and one localized hydromelia). Abnormal or doubtful cases were confirmed or further investigated by magnetic resonance. Ultrasound seems to be an accurate technique for the detection of malformation of spinal canal content in neonates under one month of age.

Humans↗
PubMed1990

Hyaline membrane disease in the newborn: diagnosis by ultrasound.

The authors report a new method of diagnosing hyaline membrane disease (HMD) in newborns: ultrasound. Babies with HMD display a specific pattern with retrohepatic hyperechogenicity on abdominal ultrasound. The specificity of the pattern was verified in 40 prematures with respiratory distress syndrome. The sign was present in 24, and in 22 of these the final diagnosis was moderate or marked HMD. In the last 2, mild HMD was suggested. The pattern was absent in the 16 others, none of whom had HMD. The pattern probably results from an ultrasound artifact: summation of multiple aerated airways surrounded by collapsed alveoli. Follow-up examinations were possible in 13 babies with HMD. Hyperechogenicity disappeared in 8 of these patients within 6-9 days and in 3 within 10-20 days; it persisted for 60 and 70 days in 2 with bronchopulmonary dysplasia. In conclusion, retrohepatic hyperechogenicity in newborns is pathognomonic for HMD and allows an instant diagnosis. The persistence of the pattern could be a useful criterion for evaluation of the prognosis.

Diagnosis, Differential↗
PubMed1990

Perinatal renal vein thrombosis. Sonographic demonstration.

The use of ultrasound (US) in the diagnosis of renal vein thrombosis (RVT) remains ill defined because the classical features lack specificity. The authors report three cases of renal vein thrombosis with a common US pattern: hyperechoic streaks in the interlobulary spaces confirming previous reports with the same pattern. The pattern has been observed in neonates as well as in utero. Associated vena cava thrombosis was present in two cases. This sign might be a specific sign of RVT.

Female↗