TORCH INFECTIONS AND

PRENATAL ULTRASOUND
FINDINGS

Eran Casiff M.D.

Department of Obstetrics and

Gynecology
Kaplan Medical Center
Rehovot 76100, Israel
 Limitations
• Most infected fetuses are
sonographically normal
• Ultrasound findings may
change with time
• no correlation with infant
outcome
 Cerebral Ventriculomegaly
• Measured at the posterior aspect
of the choroid plexus
• Almost always symmetric
• 5% of cases can be attributed to
fetal infection
 Intracranial Calcifications

• Intrauterine infection
• Periventricular hyperechoic foci - the
hallmark
• May be located in the thalami and basal
ganglia
• Small with no acoustic shadowing
• Most frequently seen with CMV and
Toxoplasmosis
 hydranencephaly
• Most severe manifestation of the
destructive process
• Cerebral hemispheres replaced by
fluid, brain stem preserved, falx
present, absent or deviated, posterior
fossa structures can be identified
• reported in Herpes simplex,
Toxoplasmosis and CMV
 Microcephaly
• Often associated with other CNS
anomalies
• Diagnosed as three SD below the mean
for gestational age
• Abnormal HC/AC and HC/FL ratios
• Isolated microcephaly documented in
CMV, Rubella and Herpes simplex
Cardiac abnormalities
• Cardiomegaly, mostly in CMV
• Cardiothoracic ratio
• VSD, ASD, Pulmonic stenosis
and coaractation of the aorta in
Rubella
 Hepatosplenomegaly

• Documented in all TORCH

infection
• Often a transient finding
• Normograms are available
Intra-abdominal Calcifications
• Typical appearance: echgenic foci
with acoustic shadowing
• Peritoneum, intestinal lumen,
organ parenchyma, biliary tree and
vascular structures
• Echogenic bowel in CMV and
Toxoplasmosis
 Hydrops, Placenta and
Amniotic fluid
• Hydrops reported in most TORCH but
may be transient
• Placentomegaly is usually associated
with intrauterine infection, but small
placentae have also been reported
• Hydramnios and oligohydramnios have
been reported with similar frequency
 Fetal growth restriction
• Estimated weight below the 10th
percentile
• common feature with CMV,
Rubella, Herpes simplex and
Varicella
• Usually not seen with
Toxoplasmosis and Syphylis
 TOXOPLASMOSIS
• Ventriculomegaly is the most
frequently documented finding
• Intracranial calcifications,
placentomegaly, liver calcifications
and ascites
• hyperechoic bowel have been reported
• microcephaly never been reported in
utero
 SYPHILIS
• Hepatomegaly and Placentomegaly are
the most frequent sonographic
manifestations
• Ascites, Hydrops and Hydramnios are
less commonly reported
• Resolution of sonographic signs have
been reported with maternal antibiotic
therapy
 RUBELLA
• Incidence less than 1:100,000 live birth
• Prenatal diagnosis by sonographic
findings have never been reported
• Potential detected abnormalities include:
cardiac anomalies, microcephaly,
hepatosplenomegaly, FGR,
microphtalmia and cataract
 CMV
• The most common congenital infection
affecting 1% of all live births
• 10% of infected neonates demonstrate
clinical manifestations that potentially could
be identified by prenatal sonography
• Ventriculomegaly, FGR, Intracranial
calcifications and oligohydramnios are the
most frequently reported findings
 HERPES SIMPLEX
• HSV are usually acquired at birth
• Intrauterine infections resulting in
clinical signs has been reported in 100
cases worldwide
• Hydranencephaly is the only
sonographic sign reported antenatally
• Microcephaly, intracranial
calcifications and FGR are potentially
detectable
VARICELLA ZOSTER
• The most common finding is
Hydramnios
• Also reported: liver
calcifications, hepatomegaly,
hydrops, limd deformities,
ventriculomegaly and FGR
 SUMMARY
• Sonography is not a sensetive test
for fetal infection
• Normal fetal anatomy survey
cannot predict a favorable outcome
• Multiple organ systems are
affected in 50% of cases
THANK YOU FOR
YOUR

ATTENTION