Scans

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Chapter 8. Scans
More recently, the availability of high quality magnetic resonance imaging (MRI) has increased, and the detail possible with this technique may be invaluable in the assessment of infants with congenital neurological abnormalities or those who have suffered an episode of perinatal asphyxia.
This chapter contains ultrasound, CT and MRI scans along with relevant clinical histories. As with x-rays, interpretation is required as well as proposed management in some. In others you will be asked to comment upon the possible long-term significance of the abnormality that has been detected. There are many textbooks available for reference. 123 and 4

QUESTIONS

1. A term baby presents in heart failure shortly after birth. The fontanelle is noted to be bulging outward and a bruit is audible over the fontanelle. A further investigation is performed.

B9780443070709000082/gr1.jpg is missing
Figure 8.1.
a. What type of scan is this?
b. What does it show?
2. The same infant had the following chest x-ray taken.

a. Describe the chest x-ray.
b. What is the diagnosis from the chest x-ray?
c. How is this image linked with the MRI scan?

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Figure 8.2.
3. A term baby is born following a difficult vaginal delivery. No resuscitation is required and he is returned to his mother. Paediatricians are asked to review him at 18 hours of age as it is thought that he may have made some abnormal movements. He appears well on examination and an MRI scan is performed.

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Figure 8.3.
a. Describe the scan.
b. What is this likely to be due to?
c. What clinical signs would this infant demonstrate, if any?
d. What is the most likely underlying cause?
e. What one other investigation would you consider to give more information about prognosis?
4. A preterm baby, born at 28 weeks’ gestation has a follow-up scan carried out at 34 weeks corrected gestational age.

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Figure 8.4.
a. What type of scan is this?
b. What does it show?
c. Why has this happened?
d. What is the outlook for this baby?
5. This scan was carried out on a 25 week gestation infant, who is now 72 hours old. He had a very stormy first two days, requiring maximal inotropic support and high ventilatory pressures. He is now requiring no blood pressure support and is on minimal ventilation.

B9780443070709000082/gr5.jpg is missing
Figure 8.5.
a. Describe the scan.
b. What has happened?
c. What is the outlook for this baby?
6. A 27 week gestation baby has a routine head scan performed at 2 days of age.

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Figure 8.6.
a. Describe the scan.
b. Will this affect the baby’s long-term outcome?
7. A routine head scan is performed in a 29 week gestation infant. Parents want to know what it shows and whether it means that their baby is going to be normal or not.

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Figure 8.7.
a. Describe the scan.
b. What is the likely outcome for this baby?
8. A baby is known to have a congenital abnormality of the head antenatally. This scan is carried out after birth.

a. Describe the scan.
b. What is the diagnosis?
c. What are the associations?
d. What is the long-term outlook for this condition?

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Figure 8.8.

9. This scan was carried out on day 7 in an ex-26 week gestation infant.

a. Describe the scan.
b. What is the most likely cause?
c. What is your management?

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Figure 8.9.
10. A 25 week gestation infant has a scan performed at the age of 10 days.

B9780443070709000082/gr10.jpg is missing
Figure 8.10.

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Figure 8.11.
a. What do these images show?
b. What is your management?

11. This is a routine scan carried out on a baby born at 30 weeks’ gestation who requires no ventilatory support and is tolerating full milk feeds by 5 days of life.

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Figure 8.12.
a. Describe the scan.
b. What is the diagnosis?
c. What is the outcome for this baby?
12. Examine the scan below.

B9780443070709000082/gr13.jpg is missing
Figure 8.13.
a. What type of scan is this?
b. What does it show?
c. What would the management of this baby be?
13. A 29 week infant has a routine cranial ultrasound scan performed.

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Figure 8.14.
a. Describe the scan.
b. Why has this happened?
c. What is the outlook for this baby?
14. A baby is born at term through meconium-stained liquor and requires full resuscitation. She has seizures noted at 1 hour of age and is given a loading dose of phenobarbitone. She is ventilated for the first 12 hours and then copes without respiratory support. She has established feeding by day 7 and is discharged at day 10. An MRI is carried out the day before discharge.

B9780443070709000082/gr15.jpg is missing
Figure 8.15.
a. What does the MRI show?
b. Why has this occurred?
15. A baby girl is delivered by caesarean section for failure to progress. She has a large abdomen at birth with masses palpable bilaterally.

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Figure 8.16.
a. Describe the scan.
b. What is the likely diagnosis?
c. What problems might the baby have?
d. What are the known associations?
16. A routine cranial ultrasound scan is carried out on a 31 week gestation infant.

B9780443070709000082/gr17.jpg is missing
Figure 8.17.
a. Describe the scan.
b. What is the diagnosis?
c. What is the outlook for this baby?
17. A baby born at 36 weeks gestation has severe RDS with a history of prolonged rupture of membranes for 5 days. He is treated with antibiotics and is transferred for high frequency oscillation ventilation. He was initially hypotensive requiring maximal inotropic support. A scan is carried out on day 3 after transfer.

a. Describe the scan.

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Figure 8.18a.
A few days later, a further scan was obtained.
b. Describe the changes.

B9780443070709000082/gr18b.jpg is missing
Figure 8.18b.

18. Following an abnormal cranial ultrasound scan, further imaging is carried out.

B9780443070709000082/gr19.jpg is missing
Figure 8.19.
a. Describe the scan.
b. What might this be associated with?
c. What is the long-term outlook for this baby?
19. A woman is scanned antenatally at 30 weeks.

B9780443070709000082/gr20.jpg is missing
Figure 8.20.
a. What does the scan show?
b. What will be your management of the baby at birth?
c. What are the baby’s chances of survival?
20. Examine the scan below.

B9780443070709000082/gr21.jpg is missing
Figure 8.21.
a. Describe the antenatal scan of the fetus’s renal tract.
b. What would your postnatal management of this infant be if any?
21. A woman is referred for a detailed fetal scan and has been found to have a raised alphafetoprotein.

a. What is the abnormality on this scan?
b. What other investigations would you carry out postnatally?
c. What conditions is this anomaly associated with?

B9780443070709000082/gr22.jpg is missing
Figure 8.22.
22. A term infant is born vaginally following a rapid delivery. At 24 hours of age she is noted to be irritable and feeding is poor. A cranial ultrasound is performed and raises some concerns. Another investigation is performed.

B9780443070709000082/gr23.jpg is missing
Figure 8.23.
a. What type of scan is this?
b. What does it show?
c. What is the outcome for this baby?
23. An infant is noted on postnatal examination to have a large head circumference, with a bulging fontanelle. He is asymptomatic and feeding well by bottle. An MRI scan is performed.

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Figure 8.24.
a. Is this a T1 or T2 weighted MRI?
b. What does it show?
24. A CT scan has been performed on a growth retarded baby born at 38 weeks gestation. There is mixed hyperbilirubinaemia and a petechial rash.

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Figure 8.25.
a. What does the scan show?
b. What is the diagnosis?
c. What other investigations must be performed?
25. An MRI scan is carried out on a six month old infant.

a. Describe two abnormalities with this scan.
b. What is the likely cause?

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Figure 8.26.
26. A term baby is delivered with a growth at the back of the skull. She has an MRI scan as shown below.

a. Describe the scan.
b. What is the likely diagnosis?

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Figure 8.27.

27. A cranial ultrasound scan is carried out in a 25 week infant. She has been transferred in for intensive care from a level 2 unit. She seemed to be relatively stable for the first 24 hours after birth but at the age of 26 hours becomes acidotic and pale and required fluid resuscitation and increasing ventilation. A scan is carried out and is shown. Describe the scan.

B9780443070709000082/gr28.jpg is missing
Figure 8.28.

ANSWERS

1.

a. This is an MRI scan of the brain.
b. It shows a loss of cortex in the centre of the brain with an area filled with fluid. There is also increased extra-axial fluid around the brain. Blood vessels are tortuous and highlighted on the scan above the area filled with fluid.
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