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Radiology
Cord Varix
Built from Obstetric Imaging
What’s inside
7 sections · 53 slides
Overview
- What you will learn here
The cord, the vein, and the bulge
Start with the anatomy the scan is looking at
- Inside the umbilical cord
- The cord and placenta after birth
- Where the umbilical vein runs inside the fetus
- What a varix actually is
- “
- Two places the bulge can sit
- Inside the abdomen there are two sub-spots
- How often does it turn up?
- ~4%
Why the vein balloons
Two theories, neither of them proven
- The honest answer: nobody knows
- Theory one: pressure finds the weak point
- Theory two: the wall was weak to begin with
What it means for the baby
Early reports were frightening; later ones are much calmer
- Why the finding worries people
- The early series painted a dark picture
- More of the early evidence
- The largest of the early collections
- Newer series are far more reassuring
- The biggest recent numbers
- Reported outcomes across the published series
- How the picture changed
- What aneuploidy looks like
- Isolated or not — the question that decides everything
Finding it on the scan
A black circle first, then Doppler to prove it is a vessel
- When does it show up?
- What it looks like on the screen
- A black oval in the fetal abdomen
- Black does not mean blood — prove it
- Working through a black space on the scan
- Colour fills the bulge and the trace confirms venous flow
- Intraabdominal varix in grayscale, colour and pulsed Doppler
- Measuring the widened segment
- The venous waveform from the widened segment
- Extraabdominal varix on colour and pulsed Doppler
- Doppler also spots a clot
- How wide is too wide?
- Three ways people define it, none of them agreed
- What else makes a black blob there?
- The three groups to think through
What happens next
No treatment exists, so everything rests on searching and watching
- There is nothing to treat it with
- The path after the varix is seen
- Step one: search the whole fetus
- Step two: think about the chromosomes
- Step three: watch the fetus
- No consensus on how to watch
- The case against delivering early
- Deliver early, or wait for term?
Taking it away
What the referring doctor needs, and the points to keep
- What the referring physician needs to know
- Key points
- One-minute recap
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition