R: Yolk sac
From: Andrea Corda (acord@tin.it)
Thu Jan 28 05:50:19 1999
Saw another "son of an enlarged yolk sac" today.She came to my attention
because of dilated cerebral ventricles and hyperechogenic bowel (17th
week).LMP 09/27/98,G2P1.Skipped nuchal translucency screening.A previous
scan performed on November the 10th by her doctor shows a 5 mmCRL with an
enlarged yolk sac (she did not measure it :judging by the picture must have
been 7 or 8 mm)next to the embryo.Findings:dilated cerebral ventricles (ex
vacuo:normal BPD),displaced and enlarged third ventricle,hyperechoic
bowel,hyperechoic renal parenchyma,small vertebral defect
(S3,4,5),hypoplastic 2nd falanx of the 5th digit,shorter femur.I suppose
trisomy 21.Will perform amnio next thursday.I'll let you know the results.
Regards,
Andrea
----Messa
ggio originale-----
Da: Dr.Andrea Corda <acord@tin.it>
A: Multiple recipients of list <ultrasound@talk.obgyn.net>
Data: mercoledì 27 gennaio 1999 22.32
Oggetto: Re: Yolk sac
>At Wed, 25 Nov 1998, Edward Lyons wrote:
>>
>>JSS, JW and others
>>The original paper we wrote on yolk sac size showed that a sac of 6 mm or
>>more, internal diameter, could be abnormal for fetuses LESS than 10 weeks
>>MA. For those over 10 weeks the sac can be normal at 6 mm or more. I too
am
>>unsure what prompted the concern in this case. Remember, our measurements
>>were all done on endovaginal scans, not transabdominal ones.
>>By the way, we measure the yolk sac in all cases under 10 weeks and find
it
>>to be a very useful sign. Is this the experience of others??
>>
>>E.A. Lyons MD
>>Professor of Radiology/ Obstetrics and Gynecology
>>Winnipeg
>>-----Original Message-----
>>From: James S Smeltzer MD <gaperina@mindspring.com>
>>To: Multiple recipients of list <ultrasound@talk.obgyn.net>
>>Date: Wednesday, November 25, 1998 6:06 AM
>>Subject: Re: Yolk sac
>>
>>>Joseph,
>>>
>>>I closed my eyes & imagined this scenario & can not identify anything to
>>>worry about. What am I missing? JSS
>>>
>>>At 07:00 PM 11/24/1998 -0600, you wrote:
>>>>What do folks have to say about a pregnancy of 10w4d, normal appearing
>>>>embryo/fetus, normal appearing placenta, no clinical problems, amnion
>>almost
>>>>completely fused, and a nice-looking, round thin-walled yolk sac of
5.9mm
>>>>inner diameter? Although I could only see amnion where it was orthogonal
>>to
>>>>the sound beam, (I did not see any amnion near this yolk sac), the yolk
>>sac
>>>>did not appear at all compressed.
>>>>
>>>>The heart rate is 167, the embryo/fetus is active, the midgut has not
>>>>returned to the abdomen.
>>>>
>>>>Joseph A Worrall MD RDMS
>>>>
>
>--
>Sir,
>I started measuring yolk sac size since 1993,when I heard a lecture you
took in Las Vegas' ISUOG .I've found that a yolk sac size of 7 mm or more
(outer-outer)before the end of the 7th week means almost certainly a
chromosomal abnormality (if the pregnancy goes further on,of
course;usually,it ends up with a spontaneous demise before the 10th
week.)Also,the (normal) yolk sac has a growth rate in the very early
pregnancy that is more or less the same of the embryo (i.e. :3 mm CRL,3 mm
yolk and so on up to the normal size of more or less 5 mm ,when the embryo
keeps on growing and the yolk sac stops.)So,if a find,say a yolk sac of 7 mm
and a crl of 3mm in a viable embryo and the pregnancy goes on over the 12th
week,I should perform a CVS or an amnio because almost certainly that fetus
has some chromosomal anomaly.Almost certainly as well I'll be able to find
an increased nuchal translucency,but this (the yolk sac)goes regardless of
that and is a far more precocious sign.On the bas!
>is of yolk sac size I performed a series of kariotypes either on fresh
abortive material,CVS or amniocentesis and ALL of them showed a chromosomal
anomaly of different varieties.Up to now I've collected almost 50 cases
thanks to a few colleagues who helped me.Do you agree with these findings?
>As for hyperechoic yolk sac,I saw one today with a missed abortion.I saw
the pregnancy two weeks ago and embryo was alive,5.2 mm yolk sac (normal
appearance,round,even ),7 mm CRL,128 bpm.Today:16 mm CRL with what looked
like a hole in the thorax (?)(you should see the picture),5.3 hyperechoic
yolk sac ,no EHR,no blood clots between chorion and decidua (early
loss).Mother had flu 1 week ago.Could this be the result of a viral insult ?
I'm quite convinced that the yolk sac could tell us a lot of stories about
early pregnancy.Do you agree with me?Could we find out a way to collect our
data in order to prove this hypothesis?
>I'm sure this should not be a difficult task.
>Please answer me
>Regards,
>Dr.Andrea Corda acord@tin.it
|
|
