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Radiology
Cytomegalovirus, Rubella, Toxoplasmosis, Herpes Simplex Virus, and Varicella
Built from Obstetric Imaging
What’s inside
7 sections · 187 slides
Overview
- Topics covered
- The TORCH group of congenital infections
- Relative frequency of the congenital infections
- Congenital Infections
Cytomegalovirus
The commonest infection a fetus catches in the womb
- Cytomegalovirus as an organism
- Prevalence and epidemiology of congenital cytomegalovirus
- Routes of cytomegalovirus transmission between people
- Primary versus recurrent maternal cytomegalovirus infection
- Vertical transmission risk by type of maternal infection
- Maternal-fetal cytomegalovirus transmission after primary infection
- Outcomes after primary maternal cytomegalovirus infection
- Maternal-fetal cytomegalovirus transmission after recurrent infection
- Outcomes after recurrent maternal cytomegalovirus infection
- Effect of gestational age on infection risk and disease severity
- Neonatal outcome of congenital cytomegalovirus
- Sensorineural hearing loss in congenital cytomegalovirus
- Placental replication and placental insufficiency
- Doppler signs of increased placental resistance
- Middle cerebral artery Doppler in fetal hypoxia
- Maternal illness with cytomegalovirus
- Clinical spectrum of congenital cytomegalovirus
- Determinants of fetal disease severity
- Serologic diagnosis of maternal cytomegalovirus infection
- Immunoglobulin G avidity testing
- Indications and timing of amniocentesis for cytomegalovirus
- Why the six-week interval before amniocentesis matters
- Rules for a reliable amniocentesis result
- Polymerase chain reaction and viral load in amniotic fluid
- Placental thickness in maternal cytomegalovirus infection
- Placentomegaly and fetal ascites
- Chronic placentitis with microcalcifications
- Cerebral damage in congenital cytomegalovirus
- Reported ultrasound markers of congenital cytomegalovirus
- Ultrasound Findings Associated With Congenital Cytomegalovirus
- Ultrasound Findings Associated With Congenital Cytomegalovirus (continued)
- Ultrasound Findings Associated With Congenital Cytomegalovirus (continued)
- Ultrasound Findings Associated With Congenital Cytomegalovirus (continued)
- Ultrasound findings associated with congenital cytomegalovirus, as printed
- Central nervous system manifestations of congenital cytomegalovirus
- Ventriculomegaly
- Periventricular halo
- Cysts and the sequence of white matter injury
- Cerebellar calcifications and hypoplasia
- Neuronal formation and migration in the fetal brain
- Distribution of intracranial calcifications
- Lenticulostriate vasculitis
- Dating fetal infection from brain malformations
- Frequency and pattern of ultrasound findings in infected fetuses
- Echogenic fetal bowel and cytomegalovirus
- Liver and spleen findings in congenital cytomegalovirus
- Hepatomegaly and splenomegaly
- Nonimmune hydrops in congenital cytomegalovirus
- Nonimmune hydrops with cardiomegaly and pericardial effusion
- Growth, renal and ocular involvement
- Why serial ultrasound examinations are needed
- Factors Affecting Ultrasound Detection of Congenital Cytomegalovirus
- Factors affecting ultrasound detection of congenital cytomegalovirus, as printed
- Diagnostic performance of ultrasound for congenital cytomegalovirus
- Gestational age at which findings become visible
- Prognostic value of ultrasound findings
- Magnetic resonance imaging in congenital cytomegalovirus
- Timing fetal infection from magnetic resonance imaging findings
- Classic signs and differential diagnosis
- Prenatal treatment options for cytomegalovirus
- Safety signal and postnatal treatment
- Key points on congenital cytomegalovirus
- Practice points on congenital cytomegalovirus
Rubella
German measles: nearly eliminated, still devastating when it strikes
- History of rubella and congenital rubella syndrome
- Definitions: congenital rubella infection and congenital rubella syndrome
- Prevalence and elimination of rubella
- Global rubella immunisation
- Rubella virus and its transmission
- Course of maternal rubella infection
- Infectivity and route to the fetus
- Mechanisms of rubella-mediated cytopathology
- Clinical features of congenital rubella syndrome
- Gestational age and the risk of congenital infection
- Ultrasound findings in congenital rubella
- Congenital bilateral cataracts on fetal ultrasound
- Fetal microcephaly
- Less common findings in congenital rubella
- Imaging approach in suspected congenital rubella
- Differential diagnosis of the rubella findings
- Prevention and prenatal management of rubella
- Referral, delivery and postnatal care in rubella
- Key points on congenital rubella
Toxoplasmosis
A parasite from cats and undercooked meat that reaches the fetal brain
- Toxoplasma gondii and its geography
- Prevalence and epidemiology of congenital toxoplasmosis
- Life cycle and routes of human infection
- Recognition of maternal risk factors
- Vertical transmission across gestation
- Fetal Infection After Maternal Toxoplasmosis Infection
- Clinical presentation in the mother
- Outcome in congenitally infected children
- Features of the symptomatic neonate
- Serologic and fetal diagnosis of toxoplasmosis
- Ultrasound findings with congenital toxoplasmosis
- Ultrasound Findings With Congenital Toxoplasmosis
- Ultrasound Findings With Congenital Toxoplasmosis (continued)
- Ultrasound findings with congenital toxoplasmosis, as printed
- Bilateral ventriculomegaly with dangling choroids
- Magnetic resonance imaging and classic signs in toxoplasmosis
- Differential diagnosis in suspected toxoplasmosis
- Prenatal treatment of toxoplasmosis
- Fetal Infection After Maternal Toxoplasmosis Infection
- Postnatal treatment and practice points in toxoplasmosis
Herpes Simplex Virus
Mostly caught during birth; rarely, and severely, in the womb
- Neonatal herpes simplex virus infection
- Maternal history and viral type in neonatal herpes
- Categories of herpes simplex virus infection
- Herpes simplex virus and routes to the fetus
- Maternal symptoms of genital herpes
- Latency, reactivation and viral shedding
- Spread of herpes simplex virus and effect of antivirals
- 45%
- Transplacental and ascending infection
- Maternal serum and amniotic fluid markers
- 94%
- Central nervous system damage from herpes simplex virus
- Ultrasound findings with in utero herpes simplex virus
- Ultrasound Findings With In Utero Herpes Simplex Virus
- Ultrasound Findings With In Utero Herpes Simplex Virus (continued)
- Ultrasound findings with in utero herpes simplex virus, as printed
- Porencephalic cyst
- Intracerebral clot
- Cerebellar hypoplasia
- Unilateral microphthalmia
- Placental effects of herpes simplex virus
- Bilateral pleural effusions with a normal heart circumference
- Ascites and placentomegaly in nonimmune hydrops
- Magnetic resonance imaging and differential diagnosis in herpes
- Treatment and outcome in neonatal herpes
- Key points on neonatal herpes simplex virus
Varicella
Chickenpox in pregnancy, and the limb damage that can follow
- Varicella zoster virus in pregnancy
- Latency and reactivation of varicella zoster virus
- Incidence of varicella in pregnancy
- Documenting maternal immunity and transmission
- Maternal consequences of varicella in pregnancy
- Risk of congenital varicella syndrome
- Features of congenital varicella syndrome
- Maternal herpes zoster and fetal risk
- Clinical presentation of chickenpox and shingles
- Prenatal diagnosis of fetal varicella
- Ultrasound findings in congenital varicella
- Ultrasound Findings With Congenital Varicella
- Ultrasound Findings With Congenital Varicella (continued)
- Ultrasound Findings With Congenital Varicella (continued)
- Ultrasound findings with congenital varicella, as printed
- Prognosis with limb and brain involvement
- Right leg atrophy and clubbed foot
- Lower-limb clubbing and atrophy in a pathologic specimen
- Upper limb atrophy and contracture
- Contracture of the arm
- Ascites associated with hydrops
- Detection of varicella embryopathy on prenatal ultrasound
- Reassurance from neurodevelopmental follow-up
- Invasive testing after confirmed maternal varicella
- Timing rules for amniocentesis in varicella
- Severity of fetal effects and the limits of prediction
- Magnetic resonance imaging and differential diagnosis in varicella
- Prevention and treatment of varicella in pregnancy
- Key points on congenital varicella syndrome
- Preconception prevention of varicella
Comparing the Five Infections
What overlaps, what separates them, and what to do next
- Ultrasound findings shared across the congenital infections
- Features that point towards one infection
- Common principles of prenatal diagnosis
- Common principles of prevention and treatment
- Take-home messages
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- Suggested reading
- Suggested reading (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition