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Radiology
Cloacal Abnormalities
Built from Obstetric Imaging
What’s inside
10 sections · 88 slides
Overview
- What this topic covers
What a cloaca is
One chamber, three tracts - the word, the anatomy, and the range of severity
- The word behind the diagnosis
- Normal in birds, abnormal in people
- The definition, in one line
- From mild to extreme
- The severity ladder
- OEIS: the four letters of the worst form
- The four parts of the OEIS complex
- Three hundred years of a hard problem
How common, and in whom
Prevalence figures that keep rising, an even sex split, and an odd excess of twins
- Prevalence: the numbers have moved
- 1:200,000
- Boys and girls are affected equally
- Not inherited, and no risk factor found
- The twin excess
- What the published series show
- Incidence of Cloacal Abnormalities
- The pooled incidence data as printed
Why it happens
A normal embryonic stage that fails to finish, and the signals that may drive it
- Every embryo starts with a cloaca
- The cloacal membrane
- How the chamber normally splits
- The normal partition, step by step
- Three ways the split can fail
- What triggers the failure is unknown
- The genetic clues so far
- Why twins may be at extra risk
How it presents
A pelvic mass, ambiguous genitalia, or unexplained ascites - and why most cases are missed
- Most cases show something - few are named
- The usual reason for referral
- Why fluid collects inside
- What a proven series looked like
- But only half will show it
- A mild cloaca in the second trimester
- Two other ways it announces itself
- The urinary tract is almost always involved
- Cloacal exstrophy arrives as a cluster
- The spine is very often abnormal
- Legs and mobility
- Genital anomalies and sex assignment
- The anomalies that travel with cloacal exstrophy
- Anomalies Associated with Cloacal Exstrophy (Listed by Frequency)
- The associated anomalies as printed
Imaging
What ultrasound sees trimester by trimester, and where MRI earns its place
- Why naming it before birth matters
- Ultrasound: where it started
- The first trimester: rarely, but not never
- The second trimester: the main window
- Two more clues on the same scan
- Cloacal exstrophy with a prominent omphalocele at 14 weeks
- What changes as pregnancy goes on
- MRI: not for the obvious cases
- Meconium is the MRI signature
- Telling the two apart on MRI
- What else MRI adds
- The two classic signs
- Find the pair, then hunt for the third
- Proposed major criteria
- Proposed minor criteria
- The subtle end of the spectrum
- Prenatal ultrasound series of a fetus with OEIS
- Colour Doppler at the cord insertion
- Three-dimensional view of the lower body
What else it could be
The look-alikes, and the trap of naming only one part of the complex
- The commonest error: naming only one piece
- Named syndromes in the differential
- Simpler things it also mimics
Care before birth
Genetic testing, the options offered, and how the pregnancy is followed
- Genetic testing: what it can and cannot do
- Options and choices
- Following the pregnancy
- Where the baby should be born
Life after birth
Staged surgery, survival that has transformed, and the function that remains
- Survival: then and now
- The two ends of the outcome range
- The first operation, in the first week
- What that first repair does
- The definitive repair
- The staged surgical plan
- Newborn appearance through staged surgical repair
- What the newborn photographs show
- Growth and nutrition later on
- Continence: the honest picture
- What predicts function best
- The psychological load
- Pregnancy in women born with a cloaca
Take it away
The short list a referring clinician and a student both need
- What the referring physician needs to know
- Key points, part one
- Key points, part two
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition