Fetal Diagnosis Imaging: Fetal Genitourinary Disease 2015

Amnioinfusion is needed if the patient is a candidate for a shunt in order to place the shunt properly

A karyotype can usually be obtained from a washing of the amniotic sac by doing amnioinfusion

Amnioinfusion allows visualization of the uncompressed chest to look at chest size and compare it to norms, which can help predict pulmonary hypoplasia

Heart size ratios are very critical in prognosis for fetal bladder outlet obstruction

Associated anomalies of the heart are not common in fetal genitourinary disease

After intervention, if fluid volume drops off again because of end-stage fetal renal disease, amnioinfusions can be repeated through several different techniques

Bladder outlet obstruction diagnosis was made in the mid-trimester to early 3rd trimester in the past, but is now diagnosed just outside of the first trimester

The keyhole configuration of the bladder is seen commonly with posterior urethral valves or other obstructive neuropathies

When evaluating kidneys, echogenicity of the parenchyma and orientation of renal cysts allow better assessment of postnatal renal function

Early in the disease process, renal cysts can be distributed around the outer pole of the kidney, and as the process progresses, things become more disoriented and distorted

With oligohydramnios, the problem really comes back to pulmonary hypoplasia

If pulmonary hypoplasia is in place, it is very difficult to correct

A bell-shaped thorax with lower ribs being pushed out indicates the pulmonary circuit is not developing normally

If kidneys are high enough or big enough that they are impairing diaphragmatic excursion, there is a bigger problem and more likely diagnosis of pulmonary hypoplasia

Big kidneys can cause the diaphragm to stop moving and create the same crisis for pulmonary development as phrenic nerve dissection

MRI provides a visual image that parents can better get a handle on the diagnosis compared to ultrasound alone

For renal abnormalities, MRI is a very important discriminator because it gives a big picture of the baby and the images are clear for parents to see