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Fetal Genito-Urinary Abnormalities, image, image, image, image - Coggle…
Fetal Genito-Urinary Abnormalities
AGENESIS
UNILATERAL
DDx
NWS too early (<18wks)
renal ectopia (pelvic kidney)
Manifestations depend on the other kidney (if abnormal >> oligo, bladder not seen, poor outcome)
BILATERAL
POTTER'S $
Amniotic fluid (oligo/anhydramnious)
Bladder (not seen)
Outcome (fatal)
Associated anomalies (pulm hypoplasia, contracted clubbed limbs, potter's face)
SIRENOMELIA
Sporadic ,rare, lethal
Single fused lower limb
Bilateral renal agenesis
Mermaid syndrome
DILATION
(Pyelectasis) No obst
No obstruction
Renal pelvis prominent
Normal pressure
Not pathologic (
SOFT MARKER
)
AP renal pelvis
≥5-≤10mm
(HYDRONEPHROSIS) Obst
UNILATERAL
UPJ OBST
UVJ OBST
BILATERAL
BLADDER OUTLET OBST
Prune Belly Syndrome
Males
only
Posterior urethral valve obstruction
Lax abdominal musculature
Cryptorchidism
US
↑↑↑Bladder (
Keyhole
:lock: shape)
Bilateral hydronephrosis/hydroureter
Oligo/Anhydramnios
Complications
Bladder Rupture
Urinary ascites
vs
other ascites
3 more items...
Hydronephrosis resolved
Renal Failure
Pulmonary Hypoplasia
bilat UPJ OBST
bilat UVJ OBST
Obstruction
Renal pelvis enlarged
↑pressure in kidney
Pathologic
AP renal pelvis
>10mm
CYSTIC
MCDK
UNILATERAL 80% (normal AFI, bladder seen)
BILATERAL (oligo, bladder not seen)
large cysts, don't join together (
vs hydronephrosis
)
A Recessive (fatal)
Meckel-Gruber $
Polycystic
Kidneys
Occipital
encephalocele
Polydactyly
ARPCKD
Always Bilateral, Bladder not seet, oligo/anhydramnious)
US
Large kidneys
Echogenic
++ Microcysts, not visible
INTRO
EMBRYOLOGY
kidneys start to function by 12 wks
seen by 18 wks (best when spine up)
Important questions to ask
Is
amniotic fluid
normal?
Is anomaly
unilateral
or
bilateral
?
Can you identify fetal
bladder
?
Are the
ureters
involved?
Pitfall
Adrenals mistaken for kidneys
identify renal pelvis
Adrenals usually flat, but can be rounded in case of agenesis
Renal pelvis
Normal
AP renal pelvis value
<5mm 14w1d-22w6d
Cloacal/ Bladder Exstrophy
Cloaca (Bladder, rectum)
Exstrophy (eversion of bladder and/or bowel mucosa)
Failure of closure lower anterior abdowall
US
No bladder
seen
Soft tissue
mass
below CI
Bifid genitalia males
Cystic mass in the pelvis
Urinary Bladder (
dynamic
,
fills and empties
)
UrachalCyst
Ovarian Cyst
GI Duplication Cyst
Mesenteric cyst
