Hyperechoic thickened ependyma: Sonographic demonstration and significance in neonates (original) (raw)

Abstract

In the neonate, hyperechoic thickening of the ependyma is believed to be related to ventriculitis. Yet, in our experience, this sign is much more often observed in association with subacute intraventricular hemorrhage (IVH), without infection. Sixty premature neonates were prospectively studied. The observations of transfontanellar sonograms (intracranial hemorrhage, ependymal echogenicity, and ventriculomegaly) were correlated with the results of MRI, lumbar punctures and clinical work-up. Intracranial hemorrhage was detected in 28 patients, and hyperechoic thickening of the ependyma was observed in 21 of them, all of whom had IVH. In 9 of these 21 patients IVH was diagnosed retrospectively thanks to the visualization of the hyperechoic ependyma. In all but one, this sign persisted for at least 2 months after disappearance of other signs of IVH. MRI demonstrated the presence of hemosiderin and ferritin in ependymal or subependymal location only in patients with hyperechoic ependyma. One of our patients had in utero diagnosis of IVH owing to the visualization of the same hyperechoic aspect of the ependyma. Nine of the neonates with hyperechoic ependyma developed ventriculomegaly, and three underwent surgery. Hyperechoic thickening of the ependyma in prematures often results from a subacute IVH. It is related to hemoglobin catabolites which can be detected by MRI. It does not require immediate potentially harmful diagnostic punctures. The presence of this hyperechoic rim allows a retrospective diagnosis of IVH and indicates a clinical and sonographic follow-up in newborns at risk for secondary hydrocephalus.

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References

  1. Reeder JD, Sanders RC (1983) Ventriculitis in the neonate: recognition by sonography. AJNR 4: 37–41
    PubMed Google Scholar
  2. Kim Han B, Babcock DS, Mc Adams L (1985) Bacterial meningitis in infants: sonographic findings. Radiology 154: 645–650
    PubMed Google Scholar
  3. Couture A, Veyrac C, Baud C (1994) La pathologie infectieuse et les lésions hemorragiques cérébrales. In: Echographie cérébrale du foetus au nouveau-né. Sauramps, Montpellier, pp 133–166, 372–374
    Google Scholar
  4. Gaisie G, Roberts mS, Bouldin TW, Scatliff JH (1990) The echogenic ependymal wall in intraventricular hemorrhage: sonographic-pathologic correlation. Pediatr Radiol 20: 297–300
    PubMed Google Scholar
  5. Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights lessthan 1500 gm. J Pediatr 92: 529–534
    PubMed Google Scholar
  6. Kirks DR, Bowie JD (1986) Cranial ultrasonography of neonatal periventricular/intraventricular hemorrhage: who, how, why and when? Pediatr Radiol 16: 114–119
    PubMed Google Scholar
  7. Grant EG, Tessler F, Perrella R (1988) Infant cranial sonography. Radiol Clin North Am 26 (5): 1089–1110
    PubMed Google Scholar
  8. Lowe J, Papile LA (1990) Neurodevelopmental performance of very-low-birth-weight infants with mild periventricular, intraventricular hemorrhage. Outcome at 5 to 6 years of age. AJDC 144: 1242–1245
    PubMed Google Scholar
  9. Gomori JM, Grossman RI, Goldberg HI, Hacknay DB, Zimmerman RA, Bilaniuk LT (1987) High-field spin-echo MR imaging of superficial and subependymal siderosis secondary to neonatal intraventricular hemorrhage. Neuroradiology 29: 339–342
    Article PubMed Google Scholar
  10. Grant EG (1986) Sonography of the premature brain: intracranial hemorrhage and periventricular leukomalacia. Neuroradiology 28: 476–490
    Article PubMed Google Scholar

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Authors and Affiliations

  1. Department of Radiology, Hospital Erasme, Cliniques Universitaires de Bruxelles, 808 route de Lennik, B-1070, Brussels, Belgium
    F. Rypens, E. F. Avni, L. Dussaussois, P. David & C. Matos
  2. Department of Neonatology, Hospital Erasme, Cliniques, Universitaires de Bruxelles, 808 route de Lennik, B-1070, Brussels, Belgium
    P. Vermeylen
  3. Department of Pediatric Neurology, Hospital Erasme, Cliniques Universitaires de Bruxelles, 808 route de Lennik, B-1070, Brussels, Belgium
    P. Van Bogaert

Authors

  1. F. Rypens
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  2. E. F. Avni
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  3. L. Dussaussois
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  4. P. David
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  5. P. Vermeylen
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  6. P. Van Bogaert
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  7. C. Matos
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Rypens, F., Avni, E.F., Dussaussois, L. et al. Hyperechoic thickened ependyma: Sonographic demonstration and significance in neonates.Pediatr Radiol 24, 550–553 (1994). https://doi.org/10.1007/BF02012729

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