The Diagnostic Value Of Color Doppler Sonography In Common Thoracic Malformation Of Fetus

Objective Thoracic malformation of fetus are a common type of fetal malformation.Early diagnosis is of great significance for family decision-making and clinical treatment.However,sometimes the gray-scale images of such lesions are similar,which makes it difficult to differentiate diagnosis.Color Doppler flow imaging(CDFI)provides abundant blood flow information to aid diagnosis.This study focused on the value of color Doppler ultrasound in the diagnosis and differential diagnosis of fetal thoracic malformation.Methods A retrospective analysis was performed on the diagnosis of 54 cases of common thoracic malformations diagnosed by the Department of Prenatal Ultrasound Screening of the First Affiliated Hospital of Anhui Medical University between 2016.10 and 2018.01 and all cases were pathologically anatomized after labor induction,postnatal surgery,X ray or CT or MRI.The characteristics of sonographic gray imaging and color Doppler flow imaging were summarized,the diagnostic and differential diagnostic skills of prenatal ultrasound screening for common thoracic malformations were concluded.Results A total of 54 cases of common thoracic malformations with complete data between 2016.10 and 2018.01 were detected by prenatal ultrasound screening in our hospital.Of the 54 cases,8 cases with congenital diaphragmatic hernia(CDH)were all left ones,of which 2 cases with stomach in the abdominal cavity and 6 cases in the thoracic cavity.The common grey-scale images of the 2 cases showed heterogeneoussolid masses in the left thoracic cavity,the urinary bladder were detected in the abdominal cavity.Color Doppler flow imaging showed that nourishing vessels of masses could all be detected in 8 cases,which were going throughout abdominal and thoracic cavity and continued with the mesenteric vessels.28 cases were congenital cystic adenomatoid malformation(CCAM),of which type Ⅰ、Ⅱ、Ⅲ were 10,11,7cases,respectively.The common grey-scale images of CCAM showed cystic echoes,solid-cystic echoes or solid masses of slight strong echo in thoracic cavity,diameters of cysts varied,24 cases were accompanied by varying degrees of mediastinal shift.Color Doppler flow imaging revealed that nourishing vessels drived from the pulmonary artery can be detected in 6,8 and 6 cases in type Ⅰ、Ⅱ and Ⅲ,respectively.18 cases were pulmonary sequestration(PS),of which combined with CCAM in 1 case.The common grey-scale images of 17 cases showed leafy or triangular strong echo masses with clear boundaries and uniform internal echoes in fetals’ lungs,color Doppler flow imaging revealed that nourishing vessels drived from the descending aorta can be detected in 15 cases;the common grey-scale images of PS combined with CCAM showed solid-cystic mass with slight strong echo in thoracic cavity,which also with regular shape,clear boundaries,a number of good-sound-transmission small cystic echoes on the basis of strong echo and mediastinal shift,could be detected its nourishing vessels derived from the thoracic aorta in Color Doppler flow imaging.The common grey-scale images of thoracic malformation were abnormal echo in thoracic cavity,displacement of heart or reduction of cardiothoracic ratio,etc.Color Doppler flow imaging can validate the nourishing vessels of masses in thoracic cavity,the upturned mesenteric vessels,pulmonary artery branches and the descending aorta branches in masses indicated CDH,CCAM and PS,respectively.The tracing of the nourishing vessels originating from the mesenteric vessels was extremely important for diagnosing left CDH of the fetus,especially when the fetal’s stomach did not enter into the left side of thoracic cavity but still remaining in the abdominal cavity.Conclusions CDH,CCAM and PS are three common fetal thoracic malformation.It is sometimes difficult to accurately identify the three diseases just by grayscale image.Color Doppler flow imaging can provide a wealth information of hemodynamics,the characteristics of masses in fetals’ thoracic cavity could be further clarified by tracing their nourishing vessels.Color Doppler ultrasonography has important value in the diagnosis and differential diagnosis of fetal common thoracic malformation.