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Radiology
Congenital Syphilis
Built from Obstetric Imaging
What’s inside
7 sections · 81 slides
Overview
- Topics covered
The disease
What causes congenital syphilis, how common it is, and how it reaches the fetus
- Definition of congenital syphilis
- Syphilis within the TORCH group
- Treponema pallidum: the organism
- Route of infection from mother to fetus
- Timing of fetal infection
- up to 23%
- 32.4%
- 52.3%
- Missed opportunities for testing and treatment
- Risk factors for syphilis in pregnancy
- 14%
- Immune evasion by Treponema pallidum
- Stages of maternal infection
Manifestations of disease
What congenital syphilis does before birth, in the newborn, and years later
- Limits of prenatal diagnosis
- Prenatal consequences of congenital syphilis
- 2 in 3
- Two patterns of neonatal and childhood disease
- Early congenital syphilis: commonest findings
- Early congenital syphilis: further findings
- Early congenital syphilis: less frequent findings
- Liver, pancreas and gut involvement
- Skin and mucous membrane lesions
- Nervous system, kidney and eye involvement
- 40%
- Late congenital syphilis: face, palate and teeth
- Late congenital syphilis: bone and joint
- Late congenital syphilis: eye and ear
- Late neurosyphilis in congenital infection
Imaging technique and findings
What high-resolution ultrasound shows, how often, and what it means
- When ultrasound findings appear
- Ultrasound findings of congenital syphilis
- Hepatomegaly as the leading sign
- Fetal hepatomegaly in the coronal plane
- Fetal hepatomegaly in the transverse plane
- Placental thickening on ultrasound
- Thickened placenta on prenatal ultrasound
- Placental depth measured in the sagittal plane
- Nonimmune hydrops on ultrasound
- Fetal hydrops in the sagittal plane
- Fetal ascites and skin edema in the transverse plane
- Long bone abnormalities on ultrasound
- Bowed fetal long bone on prenatal ultrasound
- Bowing of the fetal femur
- Middle cerebral artery Doppler and fetal anemia
- Frequency of ultrasound findings in congenital syphilis
- Sequence of fetal involvement
- Mechanisms of fetal hepatomegaly
- Placentomegaly: underlying pathology
- Resolution of ultrasound findings after maternal treatment
- 12%
Differential diagnosis from imaging findings
The scan findings are shared with many other conditions
- Overlap with other congenital infections
- Fetal hepatomegaly: infectious causes
- Fetal hepatomegaly: non-infectious causes
- Placental thickening: definition
- Differential diagnosis of placental thickening
- Fetal nonimmune hydrops: definition and compartments
- Immune versus nonimmune hydrops
- Causes of nonimmune hydrops
Treatment
Penicillin for the mother, and what happens to the newborn afterwards
- 3x
- Benzathine penicillin G in pregnancy
- Number of penicillin doses by stage of maternal syphilis
- Jarisch-Herxheimer reaction
- Penicillin allergy in pregnancy
- 95-100%
- Nontreponemal titers and the fourfold change
- Infant who needs no treatment or evaluation
- Infant of a mother treated late in pregnancy
- Components of the neonatal workup
- Evaluation of the infant with signs of congenital syphilis
- Ten-day penicillin regimen for the neonate
- Serologic follow-up of the infant
- Further follow-up in neurosyphilis and HIV testing
What the referring physician needs to know
Screening, the reasons cases persist, and the take-home points
- Universal prenatal syphilis screening
- Reasons congenital syphilis cases persist
- Benefits and harms of universal screening
- Key points: epidemiology and imaging
- Key points: outcomes and treatment
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition