ULTRASOUND Messages for May, 1999: Re: enlarged umb. vein

Re: enlarged umb. vein

From: James S Smeltzer MD

gaperina@mindspring.com

Wed May 5 20:15:34 1999

The name of the entity is umbilical vein varix. It has been reported to be a severe problem in the eyes of some, and less consequential in the experience of others. The few I have seen have done well when it was isolated. The earlier it is apparent, the worse the prognosis? Please see these articles for help:

TITLE: Fetal prognosis in varix of the intrafetal umbilical vein. AUTHORS:Sepulveda W; Mackenna A; Sanchez J; Corral E; Carstens E AUTHOR AFFILIATION:Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Casilla, Santiago, Chile. SOURCE: J Ultrasound Med 1998 Mar;17(3):171-5 CITATION IDS:PMID: 9514169 UI: 98173103 ABSTRACT: To assess the clinical significance of varix of the intraabdominal portion of the umbilical vein, we reviewed 10 cases diagnosed prenatally by ultrasonography at a median gestational age of 27 weeks. A comprehensive anatomic survey and serial follow-up scans were performed in each case. All three fetuses with associated anomalies died in utero, and prenatal karyotyping revealed that two of them had a chromosomal abnormality. In six of the seven cases with structurally normal fetuses the pregnancy proceeded uneventfully, and no neonatal complications were attributed to the umbilical vein varix. Our experience and the review of the literature revealed 42 cases with information on fetal outcome. Overall, 24% of the fetuses died, 12% had a chromosomal abnormality, and 5% developed hydrops. We conclude that fetuses with varix of the intrafetal umbilical vein should be considered at risk for poor outcome. However, if no other anomalies are present, the prognosis is generally good.

TITLE: Fetal umbilical vein varix: sonographic appearance and postnatal outcome. AUTHORS: Estroff JA; Benacerraf BR AUTHOR AFFILIATION: Department of Radiology, Children's Hospital, Boston, Massachusetts. SOURCE: J Ultrasound Med 1992 Mar;11(3):69-73 CITATION IDS: PMID: 1608075 UI: 92300820 ABSTRACT: We describe five cases of dilation or varix of the umbilical portion of the left portal vein appearing as a fetal intra-abdominal cyst. Doppler or color flow examination, or both, indicated umbilical venous flow within the cystic area in each case. Only one fetus exhibited transient cardiomegaly, which resolved before birth. This fetus was the only one discovered to have the varix as early as the second trimester. All five infants were delivered at term without sequelae.

TITLE: Varix of the fetal intra-abdominal umbilical vein: comparison with normal. AUTHORS: Mahony BS; McGahan JP; Nyberg DA; Reisner DP AUTHOR AFFILIATION: Division of Ultrasound Medicine, Swedish Hospital Medical Center, Seattle, Washington. SOURCE: J Ultrasound Med 1992 Feb;11(2):73-6 CITATION IDS: PMID: 1560496 UI: 92219316 ABSTRACT: To compare the normal extrahepatic portion of the fetal intra-abdominal umbilical vein (FIUV) with varix of the FIUX, we prospectively measured the diameter of the FIUV in 150 uncomplicated second and third trimester pregnancies and compared these results with retrospective review of nine fetuses with varix of the FIUV as an isolated prenatal sonographic finding. The diameter of the normal FIUV increases linearly from approximately 3 mm at 15 menstrual weeks to approximately 8 mm at term (R = 0.92). The nine fetuses with FIUV varix had a FIUV diameter 6 to 12 standard deviations above the mean for age. Four (44%) of the nine fetuses with FIUV varix subsequently died, including one with trisomy 21. One of the remaining fetuses developed severe hydrops 2 weeks after the initial detection of the FIUV varix. FIUV varix appears to carry an increased risk of adverse fetal outcome, including fetal demise.

TITLE: Thrombotic occlusion of an umbilical vein varix causing fetal death. AUTHORS: Schrocksnadel H; Holbock E; Mitterschiffthaler G; Totsch M; Dapunt AUTHOR AFFILIATION: Department of Obstetrics and Gynecology, University of Innsbruck, Austria. SOURCE: Arch Gynecol Obstet 1991;248(4):213-5 CITATION IDS: PMID: 1898126 UI: 91378636 ABSTRACT: Acute thrombosis of an umbilical vein varix in combination with a single umbilical artery is a rare cause of fetal death. We now report such a case.

TITLE: Ultrasound case of the day. Herniating paraumbilical vein varix. AUTHORS: Stallard DJ; Pozniak MA; Paulson BA AUTHOR AFFILIATION: Department of Radiology, University Hospital and Clinics, Madison, WI 53792-3252. SOURCE: Radiographics 1993 Mar;13(2):480-2 CITATION IDS: PMID: 8460233 UI: 93212086

At 11:05 PM 4/30/1999 -0500, you wrote: >I did a 26 week old fetus today and found an enlarged umb. vein. Just
under the abdominal wall it measures 1.3 cm. it tapers in a teardrop shape ending where the curve is in a normal exam. The vein in the cord is prominant and measures .7 cm. I have been unable to find any info on normal measurements of the umbilical vein but know that these are much larger than I normally see. I did doppler on the umb. arteries and they appear to be normal. AFV appeared normal. There was a very full stomach that did not empty during the exam, I checked repeatedly over 45 min. All size measurements were consistant with age. Anyone have any experience with this, or know of any articles concerning this?

Look for other problems. If none, will PROBABLY do OK but is a high risk pregnancy. Jim Smeltzer, MD

>
>Thanks for any help you can give me.
>
>Sally Casagrande, RDMS
>Paradise, CA
>
>Download Neoplanet at http://www.neoplanet.com
>

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