Objectives

BackgroundTheoretically, a cross-sectional image of any cardiac planes can be obtained from a STIC fetal heart volume dataset. We described a method to display 11 fetal echocardiographic planes from STIC volumes.MethodsFetal heart volume datasets were acquired by transverse acquisition from 200 normal fetuses at 15 to 40 weeks of gestation. Analysis of the volume datasets using the described technique to display 11 echocardiographic planes in the multiplanar display mode were performed offline.ResultsVolume datasets from 18 fetuses were excluded due to poor image resolution. The mean visualization rates for all echocardiographic planes at 15-17, 18-22, 23-27, 28-32 and 33-40 weeks of gestation fetuses were 85.6% (range 45.2-96.8%, N = 31), 92.9% (range 64.0-100%, N = 64), 93.4% (range 51.4-100%, N = 37), 88.7%(range 54.5-100%, N = 33) and 81.8% (range 23.5-100%, N = 17) respectively.ConclusionsOverall, the applied technique can favorably display the pertinent echocardiographic planes. Description of the presented method provides a logical approach to explore the fetal heart volumes.

Cystic teratomas can produce a wide spectrum of sonographic appearances, which depends on their major content 1 . Teratomas may be predominantly cystic, of complex mass, or even of solid appearance if the intracystic fat tissue, epithelial debris and hairs are conglomerated and produce hyperechogenic features filling the entire cyst 2 . Many specific ultrasonographic appearances of cystic teratoma have been reported including the tip of the iceberg sign, fat-fluid level, dermoid mesh and Rokitansky's protuberance (dermoid plug) 3 -6 . We present a case of another distinct ultrasonographic feature, namely multiple, discrete, uniform globules floating within the cyst. On examination of the gross specimen these globules were fat balls composed of cheese-like sebum material and hairs. This unique finding was discovered when a 33-year-old woman presented with abdominal distension and discomfort that she had experienced for 1 year. Physical examination showed that her abdomen was slightly distended with a midline, tense cystic mass of about 20 cm diameter in her lower abdomen. On pelvic examination, a large cystic mass of 20 cm diameter occupying most of the lower abdomen was noted. It had a smooth external wall and was slightly mobile but not tender. A normal-size uterus was palpated just posterior to this cyst. Transabdominal sonography revealed a large cystic mass of 20 cm diameter occupying the whole pelvic cavity extending up to the level of the umbilicus. This cyst had a striking ultrasound appearance with multiple, distinct, round, bright, echogenic, uniform globules of about 2 cm diameter floating in hypoechogenic fluid (Figure 1). A broad hyperechogenic area with multiple bright linear echoes and spots that were characteristic of cystic teratoma (dermoid plug) was also noted in the upper part of the cyst. Because the uterus and normal ovaries could not be depicted, transvaginal sonography was suggested but the patient refused the procedure. A preoperative ultrasonographic diagnosis of dermoid cyst was made. On exploratory laparotomy the week following ultrasound examination, a 16-cm unilocular left ovarian cyst was found. It contained serous fluid and numerous small, soft, cheese-like sebum balls of about 2 cm diameter with hairs in many of them (Figure 2). A broad, thick mass of cheese-like sebum tissue and hairs that represented a dermoid plug was also noted. The right ovary and the uterus were normal. Left salpingo-oophorectomy was performed