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Radiology
Precordial Venous System
Built from Obstetric Imaging
What’s inside
8 sections · 91 slides
Overview
- Definition of the precordial venous system
- Vessels of the precordial venous system
- Abbreviations used for the precordial veins
- Difficulties in imaging the precordial veins
- Advances that improved fetal venous imaging
Embryology of the fetal venous system
How three pairs of embryonic veins become the adult plan
- Three pairs of veins in the fourth embryonic week
- Rightward shift of the sinus venosus
- Effect of the growing liver on the embryonic veins
- Fate of the two umbilical veins
- Formation of the ductus venosus
- Sequence of venous development
- Three venous systems inside the fetal liver
Normal anatomy of the precordial veins
Where each vessel runs and what it carries
- 70-80%
- Umbilical vein blood flow and fetal growth
- Ductus venosus shunting in reduced oxygen supply
- Ductus venosus shunting in maternal diabetes
- Course of the umbilical vein in the abdomen
- Umbilicoportal venous system in the upper abdomen
- Cross-section scheme of the umbilicoportal system
- Anatomy of the left portal vein
- Origin and course of the main portal vein
- Branches of the left and right portal veins
- Left portal vein branches and ductus venosus on colour Doppler
- Blood supply of the fetal liver lobes
- Relative size of the hepatic lobes before and after birth
- Precordial venous system before and after birth
- Prenatal pattern of umbilical and portal flow
- Postnatal pattern after the umbilical vein closes
- Changes in the venous system shortly after birth
- Structure and function of the ductus venosus
- Parasagittal course of the umbilical vein, ductus venosus and hepatic veins
- Route of oxygen-rich blood from placenta to heart
- The efferent hepatic venous system
- The subdiaphragmatic vestibulum
- Efferent venous system of the upper liver
- Trident pattern of the hepatic veins on colour Doppler
- Course and tributaries of the inferior vena cava
Ultrasound of the normal precordial venous system
Planes, landmarks and flow directions to look for
- Imaging tools for the fetal venous system
- Imaging the umbilicoportal system
- Landmarks in the axial upper abdominal plane
- Scanning the main portal vein
- Connection patterns between main portal vein and portal sinus
- 68%
- Subtypes of the main portal vein to portal sinus junction
- Direction of flow in the fetal portal branches
- Imaging the hepatic veins
- Imaging the ductus venosus
- Ductus venosus velocimetry in first-trimester screening
- Imaging the inferior vena cava
- Parasagittal view of the inferior vena cava
- Inlet of the inferior and superior vena cava into the right atrium
Anatomical variants
Persistent right umbilical vein and umbilical vein varix
- Persistent right umbilical vein
- Sonographic detection of persistent right umbilical vein
- Significance and follow-up of persistent right umbilical vein
- Persistent right umbilical vein in an axial abdominal plane
- Varix of the umbilical vein
- Outcome and monitoring of umbilical vein varix
- Practical approach to an isolated umbilical vein varix
- Umbilical vein varix in a sagittal abdominal plane
Congenital venous anomalies
Agenesis of the ductus venosus and of the portal venous system
- Range of congenital precordial venous anomalies
- Detection rate of venous anomalies
- Agenesis of the ductus venosus
- Drainage routes when the ductus venosus is absent
- Intrahepatic and extrahepatic shunt compared
- Sites of extrahepatic drainage
- Loss of preferential oxygenated flow
- Ultrasound approach to suspected ductus venosus agenesis
- Intrahepatic drainage on ultrasound
- Agenesis of the ductus venosus with intrahepatic drainage
- Extrahepatic drainage on ultrasound
- Agenesis of the ductus venosus with extrahepatic drainage
- Prognosis of agenesis of the ductus venosus
- Development of heart failure in ductus venosus agenesis
- Prognosis in isolated cases
- Link between ductus venosus flow and portal system development
Agenesis of the portal venous system
Abernethy malformation and its classifications
- Total or partial agenesis of the portal venous system
- Morgan and Superina classification
- Subtypes of Abernethy malformation
- Subdivisions of Type I and Type II
- Kobayashi classification by shunt site
- Shared embryonic origin with ductus venosus agenesis
- Pulsed Doppler in detecting a portosystemic shunt
Summary and key points
What to carry away into the scan room
- Key points on normal anatomy
- Key points on ultrasound technique
- Key points on variants and anomalies
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition