Department of Medical Ultrasound, West China Hospital, Sichuan University, No.37, Guo Xue Xiang, Chengdu, 610041, China.
Department of Pediatric Surgery, West China Hospital, Sichuan University, No.37, Guo Xue Xiang, Chengdu, 610041, China.
BMC Pediatr. 2020 Oct 19;20(1):483. doi: 10.1186/s12887-020-02389-y.
Fetus in fetu (FIF) is a rare congenital anomaly. The preoperative diagnosis of FIF and differentiating it from teratoma and other abdominal tumors can be challenging for radiologists. Clarification of the blood supply and the relationship with the surrounding vessels is especially helpful for successful surgery; however, multimode ultrasound (US) performed for FIF has rarely been explored. Here, we first report a "humanoid" FIF case diagnosed by multimode US examinations, with the use of contrast-enhanced ultrasound (CEUS) for clarifying the blood supply features.
A 25-day-old preterm male infant was referred to our hospital for surgery. The US and computed tomography (CT) examinations led to a diagnosis of teratoma at the local hospital. The laboratory workup at our hospital revealed an elevation of total bilirubin, direct bilirubin, indirect bilirubin, alpha-fetoprotein, and neuron-specific enolase levels. A precise diagnosis and differentiation from teratoma, hepatoblastoma, neuroblastoma and other abdominal tumors were needed. In addition, the blood supply and the relationship with the surrounding vessels needed clarification prior to surgery. Multimode US examinations were performed and the features of a "humanoid" FIF as well as the blood supply for the abdominal lesion of the infant were suggested by grayscale US, color Doppler flow imaging (CDFI), and CEUS. Furthermore, CDFI and CEUS revealed an aorta-like structure and umbilical cord-like blood vessels in the "humanoid" FIF, and the CEUS helped with marking the surface of the infant's abdominal wall. To the best of our knowledge, this is the first case report of CEUS in FIF, and the blood supply was clearly demonstrated in the FIF. The intraoperative findings confirmed our multimode US findings and revealed a "humanoid" FIF. The infant quickly recovered after the operation and had no positive findings at the 2-year follow-up visit.
Multimode US was helpful in diagnosing the rare FIF without radiation exposure. Specifically, CEUS clearly demonstrated the limb branch vessel-like structures, the abdominal aorta-like structure and the blood supply, which was useful for the FIF diagnosis and for avoiding damage to important vessels during the operation.
胎儿内生畸形（FIF）是一种罕见的先天性异常。对于放射科医生来说，FIF 的术前诊断以及将其与畸胎瘤和其他腹部肿瘤区分开来具有一定挑战性。明确其血供并与周围血管的关系对于成功手术尤其有帮助；然而，针对 FIF 进行的多模态超声（US）检查很少被探索。在这里，我们首次报告了一例通过多模式 US 检查诊断的“人形”FIF 病例，并使用对比增强超声（CEUS）来明确其血供特征。
一名 25 天大的早产儿男婴因手术被转至我院。当地医院的 US 和计算机断层扫描（CT）检查提示畸胎瘤的诊断。我院的实验室检查结果显示总胆红素、直接胆红素、间接胆红素、甲胎蛋白和神经元特异性烯醇化酶水平升高。需要明确诊断并与畸胎瘤、肝母细胞瘤、神经母细胞瘤和其他腹部肿瘤区分开来。此外，还需要在手术前明确其血供并与周围血管的关系。多模式 US 检查显示，婴儿腹部病变的灰阶 US、彩色多普勒血流成像（CDFI）和 CEUS 均提示“人形”FIF 的特征以及其血供。此外，CDFI 和 CEUS 显示“人形”FIF 中存在类似主动脉的结构和类似脐带的血管，CEUS 有助于标记婴儿腹壁的表面。据我们所知，这是首例关于 FIF 的 CEUS 病例报告，FIF 中的血供得到了清晰显示。术中所见证实了我们的多模式 US 发现，并揭示了一个“人形”FIF。术后患儿迅速康复，在 2 年随访时无阳性发现。
多模式 US 有助于在无辐射暴露的情况下诊断罕见的 FIF。具体而言，CEUS 可清晰显示肢体分支血管样结构、类似腹主动脉的结构和血供，这对于 FIF 的诊断以及避免在手术中损伤重要血管非常有用。
