产前超声诊断胎儿食管后左头臂静脉

目的 观察产前超声诊断胎儿食管后左头臂静脉（RELBCV）的价值。方法 回顾性分析10胎产前超声诊断RELBCV胎儿,观察其超声表现、伴发畸形、染色体异常及妊娠结局等;结合产后随访结果分析产前超声诊断RELBCV的效能。结果 产前超声检出单纯RELBCV 5胎,RELBCV伴心内畸形3胎,伴心外畸形2胎。9胎RELBCV超声三血管气管（3VT）切面图像见左头臂静脉（LBCV）走行于食管和气管后方,与扩张的奇静脉汇合后汇入上腔静脉而形成"U"形血管环;1胎RELBCV见LBCV分为2支,前支较纤细,走行于主动脉弓上方,后支走行于主动脉弓平面食管后方,均汇入上腔静脉。6胎接受羊膜腔穿刺染色体核型及基因组疾病检测,1胎致病性染色体微结构异常,1胎染色体缺失,4胎均未见明显异常。4胎接受无创DNA检测,结果均提示非整倍体异常风险较低。7胎正常出生后经超声心动图证实RELBCV。结论 胎儿RELBVC产前超声表现为LBCV走行于食管或气管后方,与奇静脉汇合后流入上腔静脉,形成"U"形血管环;产前超声检出胎儿RELBCV时,应全面筛查是否伴有其他系统异常,必要时行产前基因组疾病检测。

Prenatal ultrasonic diagnosis of fetal retroesophageal left brachiocephalic vein

Objective To observe the value of prenatal ultrasound for diagnosing fetal retroesophageal left brachiocephalic vein (RELBCV). Methods Totally 10 fetuses with RELBCV diagnosed with prenatal ultrasound were retrospectively analyzed. The ultrasonic findings, associated malformations, chromosomal abnormalities and pregnancy outcomes were observed to analyze the value of prenatal ultrasound for diagnosing fetal RELBCV combined with the postpartum follow-up outcomes. Results Among 10 fetuses of RELBCV, 5 were diagnosed as simple RELBCV, 3 were found RELBCV with intracardiac malformation and 2 with extracardiac malformations. Three-vessel and trachea (3VT) images showed that the left brachiocephalic vein (LBCV) went behind the esophagus and trachea, converged with azygos vein and flowed into superior vena cava to form a "U" shaped in 9 fetuses. LBCV divided into 2 branches of another fetus in the rest fetus, the thinner anterior branch went above the aortic arch and the posterior branch ran behind esophagus in the plane of the aortic arch, and these 2 branches flowed into superior vena cava finally. Six fetuses underwent amniocentesis for chromosomal karyotype and genomic examinations, and the results showed that 1 with abnormal chromosomal microstructure and 1 with chromosome deletion, while 4 fetuses were found without obvious abnormality. Noninvasive DNA testing results showed that the risk of aneuploidy was low in all 4 fetuses. RELBCV was confirmed by reexamination with echocardiography in 7 normal delivered infants. Conclusion Prenatal ultrasonic features of fetal RELBCV included LBCV went behind the esophagus or trachea, converged with azygos vein and flowed into superior vena cava to form a "U" shape. When RELBCV fetal was detected with prenatal ultrasound, the possible associated malformations should be screened, and prenatal detection of genomic diseases should be performed when necessary.