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VACTERL Association

Paul MP - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: VACTERL Association

History: 44 y/o G2P1001 at 36+3 weeks EGA with uncomplicated gestation of twin girls presents to clinic for routine check-up. Growth US shows Twin A at 2921g (44% on growth curve), Twin B at 2487g (15% on growth curve), and both twins breech with polyhydramnios. In addition, Twin B has a single umbilical artery. Mother is taken to OR for primary low transverse caesarian-section. Apgar scores at 1 and 5 minutes are 6 and 9 for Twin A; 6 and 8 for Twin B. Both twins taken to NICU.

Findings: •Chest AP Portable shows an orogastric tube terminating at t4-5, normal stomach bubble position and bowel gas pattern, and multiple skeletal anomalies, including hemivertebra, butterfly vertebra, and fused ribs. •Skeletal survey shows a hypoplastic right 1st metacarpal. •Echocardiogram showed a 6mm ASD. EKG was normal. •US of head is normal. •Renal/bladder US is normal. •Barium Enema shows a colon that is patent and normal in caliber.

Ddx: •VACTERL Association •DiGeorge Syndrome •Fanconi's anemia

Dxhow: 5 criteria satisfied: Vertebral anomalies Anal abnormality Cardiac defect Tracheoesophageal Fistula with Esophageal Atresia Limb abnormality

Exam: Twin B OG-tube not properly placed due to inability to advance adequately. 2/6 systolic murmur heard best at the LLSB with fixed S2. Small anteriorly placed anus. Small right thenar eminence.

No MeSH data available.


OG-tube terminates at T4-5. Presence of stomach bubble and normal bowel gas.  There are 13 ribs bilaterally.  Right ribs 1-3 are fused laterally. Right ribs 6 and 7 are fused posteriorly. Multiple vertebral abnormalities are present including butterfly vertebrae and hemivertbrae.  Slight scoliosis.
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MPX1163_synpic28917: OG-tube terminates at T4-5. Presence of stomach bubble and normal bowel gas. There are 13 ribs bilaterally. Right ribs 1-3 are fused laterally. Right ribs 6 and 7 are fused posteriorly. Multiple vertebral abnormalities are present including butterfly vertebrae and hemivertbrae. Slight scoliosis.


VACTERL Association

Paul MP - MedPix (2007)

OG-tube terminates at T4-5. Presence of stomach bubble and normal bowel gas.  There are 13 ribs bilaterally.  Right ribs 1-3 are fused laterally. Right ribs 6 and 7 are fused posteriorly. Multiple vertebral abnormalities are present including butterfly vertebrae and hemivertbrae.  Slight scoliosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1163&req=5

MPX1163_synpic28917: OG-tube terminates at T4-5. Presence of stomach bubble and normal bowel gas. There are 13 ribs bilaterally. Right ribs 1-3 are fused laterally. Right ribs 6 and 7 are fused posteriorly. Multiple vertebral abnormalities are present including butterfly vertebrae and hemivertbrae. Slight scoliosis.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: VACTERL Association

History: 44 y/o G2P1001 at 36+3 weeks EGA with uncomplicated gestation of twin girls presents to clinic for routine check-up. Growth US shows Twin A at 2921g (44% on growth curve), Twin B at 2487g (15% on growth curve), and both twins breech with polyhydramnios. In addition, Twin B has a single umbilical artery. Mother is taken to OR for primary low transverse caesarian-section. Apgar scores at 1 and 5 minutes are 6 and 9 for Twin A; 6 and 8 for Twin B. Both twins taken to NICU.

Findings: •Chest AP Portable shows an orogastric tube terminating at t4-5, normal stomach bubble position and bowel gas pattern, and multiple skeletal anomalies, including hemivertebra, butterfly vertebra, and fused ribs. •Skeletal survey shows a hypoplastic right 1st metacarpal. •Echocardiogram showed a 6mm ASD. EKG was normal. •US of head is normal. •Renal/bladder US is normal. •Barium Enema shows a colon that is patent and normal in caliber.

Ddx: •VACTERL Association •DiGeorge Syndrome •Fanconi's anemia

Dxhow: 5 criteria satisfied: Vertebral anomalies Anal abnormality Cardiac defect Tracheoesophageal Fistula with Esophageal Atresia Limb abnormality

Exam: Twin B OG-tube not properly placed due to inability to advance adequately. 2/6 systolic murmur heard best at the LLSB with fixed S2. Small anteriorly placed anus. Small right thenar eminence.

No MeSH data available.