DOI: 10.1148/rg.263055113
Obstetric US: Watch the Fetal Hands1
Françoise Rypens, MD,
Josée Dubois, MD,
Laurent Garel, MD,
Jean-Christophe Fournet, MD,
Jacques L. Michaud, MD and
Andrée Grignon, MD
1 From the Department of Radiology (F.R., J.D., L.G., A.G.), Department of Pathology (J.-C.F.), and Division of Medical Genetics (J.L.M.), Hôpital Ste-Justine and Université de Montréal, 3175 Côte Ste-Catherine, Montreal, Quebec, Canada H3T 1C5. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received May 6, 2005; revision requested June 3 and received June 24; accepted July 20. All authors have no financial relationships to disclose.
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Figure 1. US image shows a normal fetal hand at 18 weeks of gestation.
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Figure 2a. Fetal US images obtained at 25 weeks of gestation show a normal relaxed hand (a) and the same hand 1 second later (b).
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Figure 2b. Fetal US images obtained at 25 weeks of gestation show a normal relaxed hand (a) and the same hand 1 second later (b).
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Figure 3. Schematic representation of a clenched hand.
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Figure 4a. (a) US image shows a typical clenched hand of a fetus with trisomy 18 at 18 weeks of gestation. (b) US image shows ulnar deviation of the index finger, which overlaps the other digits.
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Figure 4b. (a) US image shows a typical clenched hand of a fetus with trisomy 18 at 18 weeks of gestation. (b) US image shows ulnar deviation of the index finger, which overlaps the other digits.
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Figure 5a. Focal akinesia. (a) Schematic representation of the anomalies observed at US in a fetus at 30 weeks of gestation. (b) US image shows camptodactyly, with permanent flexion of the proximal phalanges of the third and fourth fingers (arrows) and with flexion deformities of the distal interphalangeal articulations of the second and fifth fingers, which are extended. (c) US image, which shows the palmar aspect of the same hand, helps confirm the proximal flexion of the third and fourth fingers (arrows).
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Figure 5b. Focal akinesia. (a) Schematic representation of the anomalies observed at US in a fetus at 30 weeks of gestation. (b) US image shows camptodactyly, with permanent flexion of the proximal phalanges of the third and fourth fingers (arrows) and with flexion deformities of the distal interphalangeal articulations of the second and fifth fingers, which are extended. (c) US image, which shows the palmar aspect of the same hand, helps confirm the proximal flexion of the third and fourth fingers (arrows).
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Figure 5c. Focal akinesia. (a) Schematic representation of the anomalies observed at US in a fetus at 30 weeks of gestation. (b) US image shows camptodactyly, with permanent flexion of the proximal phalanges of the third and fourth fingers (arrows) and with flexion deformities of the distal interphalangeal articulations of the second and fifth fingers, which are extended. (c) US image, which shows the palmar aspect of the same hand, helps confirm the proximal flexion of the third and fourth fingers (arrows).
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Figure 6. Clinodactyly. US image shows clinodactyly of the fifth finger in a normal fetus (arrow) at 18 weeks of gestation.
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Figure 7a. Diffuse akinesia. (a) US image in a fetus at 23 weeks of gestation shows the left wrist flexed, the hand closed, and the elbow extended, a position that remained unchanged during two successive examinations. (b) Corresponding radiograph of the left upper limb of the same fetus shows a clubhand and a normal radius and ulna. The other three limbs (not shown) also manifested fixed deformities.
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Figure 7b. Diffuse akinesia. (a) US image in a fetus at 23 weeks of gestation shows the left wrist flexed, the hand closed, and the elbow extended, a position that remained unchanged during two successive examinations. (b) Corresponding radiograph of the left upper limb of the same fetus shows a clubhand and a normal radius and ulna. The other three limbs (not shown) also manifested fixed deformities.
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Figure 8a. Radial clubhand. (a) US image shows severe constant malposition of the hand, secondary to the absence of one forearm bone. (b) Corresponding radiograph helps confirm the radial clubhand deformation secondary to radial aplasia.
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Figure 8b. Radial clubhand. (a) US image shows severe constant malposition of the hand, secondary to the absence of one forearm bone. (b) Corresponding radiograph helps confirm the radial clubhand deformation secondary to radial aplasia.
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Figure 9a. Ulnar clubhand. (a) US image shows fixed deformation of the elbow (arrow) with hand malposition. (b) Corresponding radiograph shows a fixed deformation, with the hand clenched and slightly deviated in the ulnar direction because of ulnar aplasia. The deformation of the elbow is secondary to radiohumeral synostosis.
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Figure 9b. Ulnar clubhand. (a) US image shows fixed deformation of the elbow (arrow) with hand malposition. (b) Corresponding radiograph shows a fixed deformation, with the hand clenched and slightly deviated in the ulnar direction because of ulnar aplasia. The deformation of the elbow is secondary to radiohumeral synostosis.
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Figure 10a. Phocomelia. (a) Coronal oblique US image of a fetal thorax at 20 weeks of gestation shows abnormal direct implantation of the hand (arrow) on the thorax. (b) Corresponding radiograph shows the bilateral anomaly.
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Figure 10b. Phocomelia. (a) Coronal oblique US image of a fetal thorax at 20 weeks of gestation shows abnormal direct implantation of the hand (arrow) on the thorax. (b) Corresponding radiograph shows the bilateral anomaly.
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Figure 11a. Thumb aplasia. (a) US image of a fetus at 19 weeks of gestation shows only four fingers that are well formed. (b) Corresponding radiograph shows the bilateral thumb anomaly.
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Figure 11b. Thumb aplasia. (a) US image of a fetus at 19 weeks of gestation shows only four fingers that are well formed. (b) Corresponding radiograph shows the bilateral thumb anomaly.
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Figure 12a. Hitchhiker thumb deformation in diastrophic dysplasia. (a) US image of a fetus of unknown gestational age shows abnormal abduction of the thumb (arrow) and foreshortening of the long bones (the ulna is visible between the calipers). (b) Corresponding radiograph of the same fetus shows the characteristic malposition of the thumbs.
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Figure 12b. Hitchhiker thumb deformation in diastrophic dysplasia. (a) US image of a fetus of unknown gestational age shows abnormal abduction of the thumb (arrow) and foreshortening of the long bones (the ulna is visible between the calipers). (b) Corresponding radiograph of the same fetus shows the characteristic malposition of the thumbs.
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Figure 13a. Broad thumb in Pfeiffer syndrome. (a) US image at 20 weeks of gestation shows a thickened thumb. This finding, associated with a cranial deformation, allowed a precise prenatal diagnosis of the type of acrocephalo-syndactyly. (b) Corresponding radiograph helps confirm the hand abnormality.
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Figure 13b. Broad thumb in Pfeiffer syndrome. (a) US image at 20 weeks of gestation shows a thickened thumb. This finding, associated with a cranial deformation, allowed a precise prenatal diagnosis of the type of acrocephalo-syndactyly. (b) Corresponding radiograph helps confirm the hand abnormality.
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Figure 14a. Macrodactyly in Proteus syndrome. (a) US image at 23 weeks of gestation shows a disproportionately long third left finger (arrow). Massive axillary lymphangioma also was observed at US. (b) Corresponding radiograph shows tumefaction of the axillary soft tissues, in association with subtle macrodactyly of the third and fourth fingers.
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Figure 14b. Macrodactyly in Proteus syndrome. (a) US image at 23 weeks of gestation shows a disproportionately long third left finger (arrow). Massive axillary lymphangioma also was observed at US. (b) Corresponding radiograph shows tumefaction of the axillary soft tissues, in association with subtle macrodactyly of the third and fourth fingers.
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Figure 15a. Thanatophoric dysplasia and trident hand. (a) US image at 20 weeks of gestation shows four fingers with the same length (arrows). (b) Corresponding radiograph helps confirm the hand abnormality.
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Figure 15b. Thanatophoric dysplasia and trident hand. (a) US image at 20 weeks of gestation shows four fingers with the same length (arrows). (b) Corresponding radiograph helps confirm the hand abnormality.
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Figure 16a. Chondrodysplasia punctata. (a) US image of a fetus at 24 weeks of gestation shows abnormal hyperechogenicity of the carpus (arrows). (b) Radiograph of the hand of the 1-day-old neonate shows multiple punctate carpal calcifications.
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Figure 16b. Chondrodysplasia punctata. (a) US image of a fetus at 24 weeks of gestation shows abnormal hyperechogenicity of the carpus (arrows). (b) Radiograph of the hand of the 1-day-old neonate shows multiple punctate carpal calcifications.
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Figure 17a. Postaxial polydactyly in trisomy 13. (a) US image of a fetus of unknown gestational age shows a small incomplete supernumerary digit (arrow) along the fifth finger. (b) Corresponding radiograph shows bilateral postaxial polydactyly.
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Figure 17b. Postaxial polydactyly in trisomy 13. (a) US image of a fetus of unknown gestational age shows a small incomplete supernumerary digit (arrow) along the fifth finger. (b) Corresponding radiograph shows bilateral postaxial polydactyly.
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Figure 18a. Short ribs–polydactyly syndrome. (a) US image shows lack of ossification of the hand, with six barely visible digits (arrows). (b) Corresponding radiograph, which shows the unossified digits, helps confirm the diagnosis.
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Figure 18b. Short ribs–polydactyly syndrome. (a) US image shows lack of ossification of the hand, with six barely visible digits (arrows). (b) Corresponding radiograph, which shows the unossified digits, helps confirm the diagnosis.
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Figure 19. Polydactyly of the central type. US image of a fetus at 20 weeks of gestation shows six clearly identifiable fingers.
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Figure 20. Soft-tissue syndactyly. US image of a fetus at 18 weeks of gestation shows soft-tissue syndactyly of the fourth and fifth fingers, which remained linked throughout the US examination, while the other fingers moved independently.
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Figure 21a. Complex syndactyly. (a) US image of a fetus at 34 weeks of gestation shows the last four digits stuck together, with a mittenlike appearance of the hand. (b) US image shows that the thumb (arrow) is independent; the fetus is able to grip. (c) Corresponding radiograph of the hand at 4 months of age.
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Figure 21b. Complex syndactyly. (a) US image of a fetus at 34 weeks of gestation shows the last four digits stuck together, with a mittenlike appearance of the hand. (b) US image shows that the thumb (arrow) is independent; the fetus is able to grip. (c) Corresponding radiograph of the hand at 4 months of age.
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Figure 21c. Complex syndactyly. (a) US image of a fetus at 34 weeks of gestation shows the last four digits stuck together, with a mittenlike appearance of the hand. (b) US image shows that the thumb (arrow) is independent; the fetus is able to grip. (c) Corresponding radiograph of the hand at 4 months of age.
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Figure 22. Ectrodactyly in split-hand and -foot syndrome. US image at 20 weeks of gestation shows a deep central V-shaped cleft in the hand.
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Figure 23a. Ectrodactyly. (a) US image of a fetus at 19 weeks of gestation shows a wide gap between the thumb (arrow) and the last two fingers of the left hand, which are malformed. (b) US image of the same fetus shows the right hand, which also is affected by wide ectrodactyly (the arrow indicates the thumb) in association with syndactyly of the last two digits. The fetus also manifested cleft lip, cleft palate, and micrognathia. (c) Corresponding fetal radiograph shows ectrodactyly of the four extremities.
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Figure 23b. Ectrodactyly. (a) US image of a fetus at 19 weeks of gestation shows a wide gap between the thumb (arrow) and the last two fingers of the left hand, which are malformed. (b) US image of the same fetus shows the right hand, which also is affected by wide ectrodactyly (the arrow indicates the thumb) in association with syndactyly of the last two digits. The fetus also manifested cleft lip, cleft palate, and micrognathia. (c) Corresponding fetal radiograph shows ectrodactyly of the four extremities.
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Figure 23c. Ectrodactyly. (a) US image of a fetus at 19 weeks of gestation shows a wide gap between the thumb (arrow) and the last two fingers of the left hand, which are malformed. (b) US image of the same fetus shows the right hand, which also is affected by wide ectrodactyly (the arrow indicates the thumb) in association with syndactyly of the last two digits. The fetus also manifested cleft lip, cleft palate, and micrognathia. (c) Corresponding fetal radiograph shows ectrodactyly of the four extremities.
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Figure 24a. Oligodactyly. (a) US image at 21 weeks of gestation shows only three fingers (arrows). (b) Corresponding radiograph after birth shows the absence of the fourth and fifth fingers.
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Figure 24b. Oligodactyly. (a) US image at 21 weeks of gestation shows only three fingers (arrows). (b) Corresponding radiograph after birth shows the absence of the fourth and fifth fingers.
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Figure 25a. Congenital constriction band sequence. (a) US image of a fetus at 18 weeks of gestation shows constrictive rings (arrows) of the right forearm, with distal soft-tissue edema. (b) Corresponding fetal radiograph helps confirm the presence of a constrictive ring of the right forearm and shows distal amputation and syndactyly on the left side.
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Figure 25b. Congenital constriction band sequence. (a) US image of a fetus at 18 weeks of gestation shows constrictive rings (arrows) of the right forearm, with distal soft-tissue edema. (b) Corresponding fetal radiograph helps confirm the presence of a constrictive ring of the right forearm and shows distal amputation and syndactyly on the left side.
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Figure 26a. Congenital constriction band sequence. (a) US image of a fetus at 19 weeks of gestation shows distal amputation at the level of the left wrist. (b) Corresponding fetal radiograph confirms amputation.
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Figure 26b. Congenital constriction band sequence. (a) US image of a fetus at 19 weeks of gestation shows distal amputation at the level of the left wrist. (b) Corresponding fetal radiograph confirms amputation.
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Copyright © 2006 by the Radiological Society of North America.
