Re: Multiple hypoechoic areas in the placenta
From: Daniel Margulies (danymarg@movi.com.ar)
Mon Apr 30 23:55:05 2001
Hi Terry.
Furthermore, If any of You have seen those placental lakes typical to
accreta, use a hi frequency transducer and You are going to see a lot of
blood flow. and this flow changes its direcction. Color doppler does not
help a lot cause these is a very slow flow.
-----Mensaje original-----
De: DuboseTerryJ@uams.edu <DuboseTerryJ@uams.edu>
Para: Multiple recipients of list ULTRASOUND
<ultrasound@mail.medispecialty.com>
Fecha: Miércoles, 25 de Abril de 2001 11:53 a.m.
Asunto: RE: Multiple hypoechoic areas in the placenta
>Dear Udayakumar, Yes, all you say about "Placenta Accreta would present
with
>obliteration of the subplacental hypoechoic/sonolucent space. " is true.
>However, there are reports of obvious abnormal numbers "maternal lakes" and
>placental textural changes in the placenta in the area of Accreta. These
>are not always present, but if abnormal lakes are found in an area near or
>under a prior C Section, then I think Accreta should be considered. See
>number 4 below:
>
>"There have been four distinct sonographic appearances and associations
with
>placenta accreta:
>1) Placenta previa or low lying placenta in association with previous
>Cesarean section(s) or other uterine scaring.
>2) Loss of the hypoechoic retroplacental zone (vascular bed).
>3) Thinning or disruption of the hyperechoic uterine serosa-bladder
>interface.
>4) Presence of unusually numerous intraplacental lakes, venous channels or
>lacunae in the region of the accreta."
>
>See: DuBose, Fetal Sonography, W. B. Saunders 1996, p. 359... also:
>
> . Tabsh KMA, Brinkman CR, and King W; "Ultrasound Diagnosis of Placenta
>Increta"; J Clin Ultrasound, 1982; 10:288-290.
> . Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic Findings in
>Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . ibid 62. Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic
>Findings in Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . Finberg HJ and Williams JW; "Placenta Accreta: Prospective Sonographic
>Diagnosis in Patients with Placenta Previa and Prior Cesarean Section"; J
>Ultrasound Med, 1992; 11:333-343.
> . op cite 61. Tabsh KMA, Brinkman CR, and King W; "Ultrasound Diagnosis
>of Placenta Increta"; J Clin Ultrasound, 1982; 10:288-290.
> . op cite 62. Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic
>Findings in Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . Guy GP, Peisner DB, Timor-Tritsch IE; "Ultrasonographic evaluation of
>uteroplacental blood flow patterns of abnormally located and adherent
>placentas"; Am J Obstet Gynecol, 1990; 163:723.
> . op cite 64. Finberg HJ and Williams JW; "Placenta Accreta: Prospective
>Sonographic Diagnosis in Patients with Placenta Previa and Prior Cesarean
>Section"; J Ultrasound Med, 1992; 11:333-343.
> . Hoffman-Tretin JC, Koenigsberg M, Rabin A, et al; "Placenta Accreta:
>Additional Sonographic Observations"; J Ultrasound Med, 1992; 11:29-34.
> . Finberg HJ; "THE PLACENTA AND UMBILICAL CORD: RECENT OBSERVATIONS";
>Lecture and SDMS Official Proceedings: 10th Annual SDMS Conference,
Anaheim,
>California, Sept 16-19, 1993; p.243-244.
>
>Peace, Terry J. DuBose, M.S., RDMS, Assistant Professor
>Director, Diagnostic Medical Sonography Program
>CHRP, University of Arkansas for Medical Sciences
>Little Rock, Arkansas, USA
>501-686-6510
>http://www.io.com/~dubose/
>http://www.uams.edu/CHRP/dmshome.htm
>http://www.obgyn.net/us/panel/panel.htm
>
>-----Original Message-----
>From: udaya kumar [mailto:udaya@md2.vsnl.net.in]
>Sent: Tuesday, April 24, 2001 8:43 PM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Multiple hypoechoic areas in the placenta
>
>Dear Terry
>Placenta Accreta would present with obliteration of the subplacental
>hypoechoic/sonolucent
>space. (Maternal venous sinusus get obliterated due to the
>adherence/invasion.)
>I cant see how and why Hypoechoic areas within the placental substance
>should
>help diagnose or coexist with Placenta Accreta .
>I think the case in question is either areas of intervillous thrombi or
>Placental lakes.
>.Udayakumar
>
>DuboseTerryJ@uams.edu wrote:
>
>> With the hypoechoic areas also consider the possibility of Placenta
>Accreta.
>> Particularly in an anterior placenta with a prior C Section or other
>uterine
>> scaring in the anterior area.
>>
>> Terry J. DuBose, M.S., RDMS, Assistant Professor
>> Director, Diagnostic Medical Sonography Program
>> CHRP, University of Arkansas for Medical Sciences
>> Little Rock, Arkansas, USA
>> 501-686-6510
>> http://www.io.com/~dubose/
>> http://www.uams.edu/CHRP/dmshome.htm
>> http://www.obgyn.net/us/panel/panel.htm
>>
>> -----Original Message-----
>> From: Dr Fazeel uz Zaman [mailto:fazeel@atd.hazara.net.pk]
>> Sent: Monday, April 23, 2001 3:22 PM
>> To: Multiple recipients of list ULTRASOUND
>> Subject: Re: Multiple hypoechoic areas in the placenta
>>
>> Usually these are venous lakes and are considered normal........Dr.
Fazeel
>>
>> Dr Sarita Bhalerao wrote:
>>
>> > I`d like to know whether multiple hypoechoic areas in a placenta at 13
>> > weeks gestation is suggestive of an aneuploidy and hence warrants
>> > chorion villous biopsy.
>
