Torch Infections and Prenatal Ultrasound Findings

August 9, 2011

TORCH INFECTIONS AND PRENATAL ULTRASOUND FINDINGS Eran Casiff M.D. Department of Obstetrics and Gynecology Kaplan Medical Center Rehovot 76100, Israel Limitations • Most infected fetuses are sonographically normal • Ultrasound findings may change with time • no correlation with infant outcome Cerebral Ventriculomegaly • Measured at the posterior aspect of the choroid plexus • Almost always symmetric • 5% of cases can be attributed to fetal infection Intracranial Calcifications • Intrauterine infection • Periventricular hyperechoic foci - the hallmark • May be located in the thalami and basal ganglia • Small with no acoustic shadowing • Most frequently seen with CMV and Toxoplasmosis Hydranencephaly • Most severe manifestation of the destructive process • Cerebral hemispheres replaced by fluid, brain stem preserved, falx present, absent or deviated, posterior fossa structures can be identified • Reported in Herpes simplex, Toxoplasmosis and CMV Microcephaly • Often associated with other CNS anomalies • Diagnosed as three SD below the mean for gestational age • Abnormal HC/AC and HC/FL ratios • Isolated microcephaly documented in CMV, Rubella and Herpes simplex Cardiac Abnormalities • Cardiomegaly, mostly in CMV • Cardiothoracic ratio • VSD, ASD, Pulmonic stenosis and coarctation of the aorta in Rubella Hepatosplenomegaly • Documented in all TORCH infection • Often a transient finding • Normograms are available   Intra-abdominal Calcifications • Typical appearance: echogenic foci with acoustic shadowing • Peritoneum, intestinal lumen, organ parenchyma, biliary tree and vascular structures • Echogenic bowel in CMV and Toxoplasmosis Hydrops, Placenta and Amniotic Fluid • Hydrops reported in most TORCH but may be transient • Placentomegaly is usually associated with intrauterine infection, but small placentae have also been reported • Hydramnios and oligohydramnios have been reported with similar frequency Fetal Growth Restriction • Estimated weight below the 10th percentile • Common feature with CMV, Rubella, Herpes simplex and Varicella • Usually not seen with Toxoplasmosis and Syphilis TOXOPLASMOSIS • Ventriculomegaly is the most frequently documented finding Intracranial calcifications, placentomegaly, liver calcifications and ascites Hyperechoic bowel have been reported Microcephaly never been reported in utero SYPHILIS • Hepatomegaly and Placentomegaly are the most frequent sonographic manifestations • Ascites, Hydrops and Hydramnios are less commonly reported • Resolution of sonographic signs have been reported with maternal antibiotic therapy RUBELLA • Incidence less than 1:100,000 live birth • Prenatal diagnosis by sonographic findings have never been reported • Potential detected abnormalities include: cardiac anomalies, microcephaly, hepatosplenomegaly, FGR, microphtalmia and cataract CMV • The most common congenital infection affecting 1% of all live births • 10% of infected neonates demonstrate clinical manifestations that potentially could be identified by prenatal sonography • Ventriculomegaly, FGR, Intracranial calcifications and oligohydramnios are the most frequently reported findings HERPES SIMPLEX • HSV are usually acquired at birth Intrauterine infections resulting in clinical signs has been reported in 100 cases worldwide • Hydranencephaly is the only sonographic sign reported antenatally • Microcephaly, interracial calcifications and FGR are potentially detectable VARICELLA ZOSTER • The most common finding is Hydramnios • Also reported: liver calcifications, hepatomegaly, hydrops, limb deformities, ventriculomegaly and FGR SUMMARY • Sonography is not a sensitive test for fetal infection • Normal fetal anatomy survey cannot predict a favorable outcome • Multiple organ systems are affected in 50% of cases THANK YOU

TORCH INFECTIONS AND PRENATAL ULTRASOUND FINDINGS Eran Casiff M.D.
Department of Obstetrics and Gynecology
Kaplan Medical Center Rehovot 76100, Israel

Limitations
• Most infected fetuses are sonographically normal
• Ultrasound findings may change with time
• no correlation with infant outcome

Cerebral Ventriculomegaly
• Measured at the posterior aspect of the choroid plexus
• Almost always symmetric
• 5% of cases can be attributed to fetal infection

Intracranial Calcifications
• Intrauterine infection
• Periventricular hyperechoic foci - the hallmark
• May be located in the thalami and basal ganglia
• Small with no acoustic shadowing
• Most frequently seen with CMV and Toxoplasmosis

Hydranencephaly
• Most severe manifestation of the destructive process
• Cerebral hemispheres replaced by fluid, brain stem preserved, falx present, absent or deviated, posterior fossa structures can be identified
• Reported in Herpes simplex, Toxoplasmosis and CMV

Microcephaly
• Often associated with other CNS anomalies
• Diagnosed as three SD below the mean for gestational age
• Abnormal HC/AC and HC/FL ratios
• Isolated microcephaly documented in CMV, Rubella and Herpes simplex

Cardiac Abnormalities
• Cardiomegaly, mostly in CMV
• Cardiothoracic ratio
• VSD, ASD, Pulmonic stenosis and coarctation of the aorta in Rubella

Hepatosplenomegaly
• Documented in all TORCH infection
• Often a transient finding
• Normograms are available

  Intra-abdominal Calcifications
• Typical appearance: echogenic foci with acoustic shadowing
• Peritoneum, intestinal lumen, organ parenchyma, biliary tree and vascular structures
• Echogenic bowel in CMV and Toxoplasmosis

Hydrops, Placenta and Amniotic Fluid
• Hydrops reported in most TORCH but may be transient
• Placentomegaly is usually associated with intrauterine infection, but small placentae have also been reported
• Hydramnios and oligohydramnios have been reported with similar frequency

Fetal Growth Restriction
• Estimated weight below the 10th percentile
• Common feature with CMV, Rubella, Herpes simplex and Varicella
• Usually not seen with Toxoplasmosis and Syphilis

TOXOPLASMOSIS
• Ventriculomegaly is the most frequently documented finding
Intracranial calcifications, placentomegaly, liver calcifications and ascites
Hyperechoic bowel have been reported
Microcephaly never been reported in utero

SYPHILIS
• Hepatomegaly and Placentomegaly are the most frequent sonographic manifestations
• Ascites, Hydrops and Hydramnios are less commonly reported
• Resolution of sonographic signs have been reported with maternal antibiotic therapy

RUBELLA
• Incidence less than 1:100,000 live birth
• Prenatal diagnosis by sonographic findings have never been reported
• Potential detected abnormalities include: cardiac anomalies, microcephaly, hepatosplenomegaly, FGR, microphtalmia and cataract


CMV

• The most common congenital infection affecting 1% of all live births
• 10% of infected neonates demonstrate clinical manifestations that potentially could be identified by prenatal sonography
• Ventriculomegaly, FGR, Intracranial calcifications and oligohydramnios are the most frequently reported findings

HERPES SIMPLEX
• HSV are usually acquired at birth Intrauterine infections resulting in clinical signs has been reported in 100 cases worldwide
• Hydranencephaly is the only sonographic sign reported antenatally
• Microcephaly, interracial calcifications and FGR are potentially detectable

VARICELLA ZOSTER
• The most common finding is Hydramnios
• Also reported: liver calcifications, hepatomegaly, hydrops, limb deformities, ventriculomegaly and FGR

SUMMARY
• Sonography is not a sensitive test for fetal infection
• Normal fetal anatomy survey cannot predict a favorable outcome
• Multiple organ systems are affected in 50% of cases

THANK YOU