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Additional resources for Smart Alec
1998b; Favre et al. 2004). MRI has high sensitivity for demonstrating the meconial character of ascitic ﬂuid (Fig. 49). A large mass, with slightly echodense content and calciﬁed wall is characteristic of meconium pseudo cyst (Fig. 50). When it is echofree at US, it appears meconial on MRI (Fig. 51) (Veyrac et al. 2004; Wong et al. 2006). Imaging provides decisive arguments for predicting neonatal surgery: persistent ascitis, large meconial pseudo cyst, dilated small bowel proximal-to a mechanical obstruction.
When the risk is known (heterozygous CFTR mutation) an enzymatic proﬁ le of bowel obstruction is correlated with increased viscosity of intestinal secretions. A normal proﬁ le excludes cystic ﬁbrosis. However, there is a narrow diagnostic window (from 17 to 21 weeks). In case of hyperechogenic fetal bowel, assessment of the amniotic ﬂuid has poor interest, because the abnormal sonographic ﬁndings are infrequently observed before 22 weeks. At last, before 22 weeks, the enzymatic proﬁ le is not speciﬁc of cystic ﬁbrosis (it may be seen in low intestinal occlusion, trisomy 21).
A 35-week-fetus. Distal small bowel atresia. The dilatation did not involve the proximal bowel, especially the jejunal loops of left abdomen that kept a normal high T2 ﬂuid signal (circle) 40 A. Couture a b Fig. 37a,b. A 34-week-fetus with 24-h disappearance of fetal motion. a Some loops was dilated (arrow) (16 mm), hyperperistaltic. b Distally, there was a spiral aperistaltic avascular intestinal mass. Suspicion of volvulus. Urgent caesarean delivery: volvulus with necrosis and resection of 40 cm small bowel (Dr.