Re: Placental
From: Philippe Jeanty, MD,PHD (jeanty@TheFetus.net)
Fri Sep 21 12:46:03 2001
Well, I would not think that we can equate ultrasound-reflecting properties
with osmotic pressure. At least one of the case I have looks like a complete
cyst with only 20% contact between the sphere of the cyst and the amnion. I
also have all the transitions between the very flat ones and ht mostly
spherical ones. I think that with this pathology existing and being
well-known, it is tempting to assign your images to the same category.
-----Original Message-----
From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
Wolfgang Moroder, MD
Sent: Friday, September 21, 2001 12:18 PM
To: Multiple recipients of list ULTRASOUND
Subject: Re: Placental
I have seen cases of duplication of the membranes on the chorionic plate
which I thought as some sort of amniochorial detachment but now with
Jeanty I'd prefer to call "amnion duplication". Well, in those cases I
have not seen a cyst formation but they were with tapered ends. Scanning
this case with hi freq probes (7 MHz) I could distinctivly see a
difference in density with the amniotic fluid were the cysts were
completely clear while the amniotic fluid presented in contrast small
particles due to the Tyndall effect (see here:
http://www.svpvril.com/Tyndall.html). I do not know what this would
mean in terms of colloido-osmotic gradient - I 'd think that the cysts
would rather empty themselves, the opposite happened since the size
increased sensibly from 3 to 7-9 cm. in the course of the second
trimester.
Ciao
Wolfgang
At Fri, 21 Sep 2001, DuBose, Terry wrote:
>
>Dr. Jeanty, thanks for this discussion on:
>http://www.obgyn.net/us/us.asp?page=/us/present/0801/moroder
>
>I have never seen this type of "amniotic cysts" or whatever, and know of no
>examples in texts... so must be rare. Hopefully Dr. Moroder will have a
>path report for us soon.
>
>Thanks again.
>
>Peace, Terry J. DuBose, M.S., RDMS, APS
>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: Philippe Jeanty, MD,PHD [mailto:jeanty@TheFetus.net]
>Sent: Friday, September 21, 2001 10:35 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Placental
>
>I think that the pathology is not a fold in the amnion but a doubling (like
>duplication of gastrointestinal segments). So you could conceive this as
two
>pancakes (of amnion) fused at the edges with fluid in between. Now why
>should there be fluid in between is a little mysterious... in the old Ob
>textbooks one can read of membranes "producing" fluid. This is actually not
>true since the membranes do not actually "secrete" fluid but particulate
>matter in between could very well cause an osmotic pull of amniotic fluid
or
>extracelluar fluid which would explain the "round" aspect of the cyst.
>I have no images on http://www.TheFetus.net but I have several cases...
there are
>98 articles in medline under placental cyst (no all relevant of course), so
>if there is a brave sonographer out there who would like to write the
>definitive opus for http://www.TheFetus.net I would be glad to contribute
images. I
>am hesitant to just send the images here since I would have to edit the
>patient's identifications out of the images and this is a fair amount of
>work. I tried to embed a few images but they bounced...
>
> -----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>DuBose, Terry
>Sent: Friday, September 21, 2001 9:47 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Placental
>
>Dr. Jeanty, when you say "...doubling of the membrane with trapping of
fluid
>in between." Do you mean the amnion is folded on itself or there were two
>amnions as in a "disappearing twin"? These cysts appear to be so spherical
>I don't understand the process. I would think a folded amnion would have
>more tapered edges, rather than spheres... but since I have never observed
>either I am just trying to imagine what the process would be an how it
would
>appear.
>
>Are your "several such cases" on TheFetus? Do you have any histological
>images that would make this more clear for us? Could you give us URLs to
>them so we can compare them?
>
>Thanks for your participation.
>
>Peace, Terry J. DuBose, M.S., RDMS, APS
>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: Philippe Jeanty, MD,PHD [mailto:jeanty@TheFetus.net]
>Sent: Friday, September 21, 2001 9:09 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Placental
>
>I finally got a chance to look at the images on the link. These look to me
>like garden variety amniotic cyst. They are formed by a doubling of the
>membrane with trapping of fluid in between. They are not expected to cause
>any problems. I have several such cases.
>
> -----Original Message-----
>From: ultrasound@obgyn.net [mailto:ultrasound@obgyn.net] On Behalf Of
>Terry J DuBose
>Sent: Friday, September 21, 2001 9:03 AM
>To: Multiple recipients of list ULTRASOUND
>Subject: Re: Placental
>
>Dr. Moroder, very interesting... we will be anticipating the placental
>pathology on this case. I believe this is a rare case, what ever it
>represents.
>http://www.obgyn.net/us/us.asp?page=/us/present/0801/moroder
>
>Thanks again. Terry J DuBose, M.S., RDMS, APS
>
>----------------------------------------------
>
>----------------------------------------------
>At Thu, 20 Sep 2001, Dr. Wolfgang Moroder wrote:
>----------------------------------------------
>----------------------------------------------
>>
>----------------------------------------------
>--
>----------------------------------------------
>>Content-Type: text/plain; charset=us-ascii
>----------------------------------------------
>>Content-Transfer-Encoding: 7bit
>>
>>The patient delivered on September 17, 2001 at 33+2 w weeks a heavily
>growth restricted, anatomically normal, female baby, BW 1240 grams (the
inf
>2nd SD for 33 w is 1342 g.) . Apgar 7,8 pH umb. Artery 7.28. The placental
>weight was 400 g. The umbilical cord was inserted on top of the described
>cyst, one of which ruptured presubebly before delivery. The neonate is at
>present (3rd day) doing fine.
>>I will send addition information on the placental pathology.
>>
>>--
>>Wolfgang Moroder, M.D.
>>Prenatal Unit
>>General Hospital
>>Bolzano Italy
>>
>--
>Peace, Terry J DuBose
>Little Rock, Arkansas USA
>
--
Wolfgang Moroder, MD
Prenatal Unit
Bolzano General Hospital Italy
