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ISSN 2070-8718 (Print)

2012, Number 3

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Rev Cub Gen 2012; 6 (3)

On the importance of fetal thymus ultrasound study

Martínez GLR

Language: Spanish
References: 37
Page: 5-9
PDF size: 627.47 Kb.


ABSTRACT

Fetal thymus is a lymphoid organ first visualized by ultrasound back in 1989. Its study has been gaining importance mainly in the last decade due to the ease of visualization provided by high resolution ultrasound equipment. The assessment of thyme dimensions by means of different methods, either by measuring its transverse diameter, its perimeter and more recently the thymus/thoracic ratio has made it possible to demonstrate how its absence or hypoplasia are related with different fetal alterations. These alterations include complex cardiopathies mainly cone-truncal and aortic arch ones, as well as fetus intrauterine growth retardation, maternal preeclampsia, and as a chorioamnionitis and prematurity early sign indicator. Also, related to CATCH-22 and different trisomies as the 21, 18 and 13 ones and also in the prediction of the immunologic status alter birth. This paper is aimed to provide prenatal diagnosis specialists with a review of the most recent results in fetal thymus evaluation, by means of the ultrasonographic measurement of the three vessels in an ultrasonographic image that can be achieved in more than 90 % of all cases, thus contributing a valuable element to prenatal fetus studies.


REFERENCES

  1. Felker RE, Cartier MS, Emerson DS, Brown DL. Ultrasound of the fetal thymus. J Ultrasound Med. Dec 1989;8(2):669-73. PubMed PMID: 2685344.

  2. Chaoui R. Fetal echocardiography: state of the art of the state of the heart. Ultrasound Obstet Gynecol [Internet]. 2001 [citado 2. 25 Oct 2012];17(4):[aprox. 8 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1046/j.1469-0705.2001.00413.x/pdf.

  3. Zalel Y, Gamzu R, Mashiach S, Achiron R. The development of the fetal thymus: an in utero sonographic evaluation. Prenat 3. Diagn [Internet]. 2002 [citado 25 Oct 2012];22(2):[aprox. 4 p.]. Disponible en: http://dx.doi.org/10.1002/pd.257.

  4. Li L, Bahtiyar MO, Buhimschi CS, Zou L, Zhou QC, Copel JA. Assessment of the fetal thymus by two- and three-4. dimensional ultrasound during normal human gestation and in fetuses with congenital heart defects. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 2012];37(4):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.8853/pdf.

  5. Paladini D. How to identify the thymus in the fetus: the thy-box. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 5. 2012];37(4):[aprox. 5 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.8854/pdf.

  6. Mohamed N, Eviston DP, Quinton AE, Benzie RJ, Kirby AC, Peek MJ, et al. Smaller fetal thymuses in pre-eclampsia: a 6. prospective cross-sectional study. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 2012];37(4):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.8953/pdf.

  7. Chaoui R, Heling KS, Sarut Lopez A, Thiel G, Karl K. The thymic–thoracic ratio in fetal heart defects: a simple way 7. to identify fetuses at high risk for microdeletion 22q11. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 2012];37(4):[aprox. 7 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.8952/pdf.

  8. Gamez F, De Leon-Luis J, Pintado P, Perez R, Robinson JN, Antolin E, et al. Fetal thymus size in uncomplicated twin and 8. singleton pregnancies. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 2012];36(3):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.7578/pdf.

  9. Cromi A, Ghezzi F, Raffaelli R, Bergamini V, Siesto G, Bolis P. Ultrasonographic measurement of thymus size in IUGR 9. fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol [Internet]. 2009 [citado 25 Oct 2012];33(4):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.6320/pdf.

  10. Yinon Y, Zalel Y, Weisz B, Mazaki-Tovi S, Sivan E, Schiff E, Achiron R. Fetal thymus size as a predictor of chorioamnionitis 10. in women with preterm premature rupture of membranes. Ultrasound Obstet Gynecol [Internet]. 2007 [citado 25 Oct 2012];29(6):[aprox. 5 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.4022/pdf.

  11. Di Naro E, Cromi A, Ghezzi F, Raio L, Uccella S, D’Addario V,Loverro G. Fetal thymic involution: a sonographicmarker 11. of the fetal inflammatory response syndrome. Am J Obstet Gynecol. Ene 2006;194(1):153-9. PubMed PMID: 16389025.

  12. Chaoui R. The examination of the normal fetal heart using two dimensional echocardiography. En: Yagel S, Gembruch U, 12. Silverman N, editores. Fetal Cardiology: Embryology, Genetics, Physiology, Echocardiographic Evaluation, Diagnosis and Perinatal Management of Cardiac Diseases. New York: Informa Healthcare; 2008. p. 173-84.

  13. Abuhamad A, Chaoui R. A Practical Guide to Fetal Echocardiography: Normal and Abnormal Hearts. Lippincott-13. WilliamsWilkins: Philadelphia; 2010.

  14. Tison BE, Nicholas SK, Abramson SL, Hanson IC, Paul ME, Seeborg FO, et al. Autoimmunity in a cohort of 130 pediatric 14. patients with partial DiGeorge syndrome. J Allergy Clin Immunol. Nov 2011; 128(5):1115-7. PubMed PMID: 21835443

  15. Kyburz A, Bauersfeld U, Schinzel A, Riegel M, HugM, Tomaske M, et al. The fate of children with microdeletion 22q11.2 15. syndrome and congenital heart defect: clinical course and cardiac outcome. Pediatr Cardiol [Internet]. 2008 [citado 25 Oct 2012];29:[aprox. 8 p.]. Disponible en: http://download.springer.com/static/pdf/888/art%253A10.1007%252Fs00246-007-9074-2.pdf?auth66=1353513312_56b0e7bc3be9d548edf48c3a283cfb6a&ext=.pdf.

  16. Chaoui R, Korner H, Bommer C, Kalache KD. Fetal thymus and the 22q11.2 deletion. Prenat Diagn [Internet]. 2008 [citado 16. 25 Oct 2012];22(9):[aprox. 2 p.]. Disponible en: http://dx.doi.org/10.1002/pd.422.

  17. Gottlieb C, Li Z, Uzel G, Nussenblatt RB, Sen HN. Uveitis in DiGeorge syndrome: a case of autoimmune ocular inflam17. mation in a patient with deletion 22q11.2. Ophthalmic Genet [Internet]. Mar 2010 [citado 25 Oct 2012];31(1):[aprox. 6 p.]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009586/pdf/nihms258413.pdf.

  18. De Leon-Luis J, Santolaya J, Gamez F, Pintado P, Perez R, Ortiz-Quintana L. Sonographic thymic measurements in Down 18. syndrome fetuses. Prenat Diagn [Internet]. 2011 [citado 25 Oct 2012];31(9):[aprox. 5 p.]. Disponible en: http://dx.doi.org/10.1002/pd.2783.

  19. Cromi A, Ghezzi F, Raffaelli R, Bergamini V, Siesto G, Bolis P. Ultrasonographic measurement of thymus size in IUGR 19. fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol [Internet]. 2009 [citado 25 Oct 2012];33(4):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.6320/pdf.

  20. 2012];24(1):[aprox. 4 p.]. Disponible en: http://www.jultrasoundmed.org/content/24/1/127.full.pdf+html.

  21. Karl K, Heling KS, Sarut Lopez A, Thiel G, Chaoui R. Thymic–thoracic ratio in fetuses with trisomy 21, 18 or 13. Ultrasound 21. Obstet Gynecol [Internet]. 2012 [citado 25 Oct 2012];40(4):[aprox. 6 p.]. Disponible en: http://dx.doi.org/10.1002/uog.11068.

  22. García Guevara C, Arencibia Faife J, Hernández Martínez Y, Crespo del Río A, García Morejón C, Savío Benavides A. 22. Valor de la vista ecocardiográfica de los tres vasos en el pesquisaje de cardiopatías congénitas. Rev Cubana Genet Comunit [Internet]. 2010 [citado 25 Oct 2012];4(1):[aprox. 5 p.]. Disponible en: http://bvs.sld.cu/revistas/rcgc/v4n1/rgc020110.pdf.

  23. Cho JY, Min Y, Lee H, McCrindle B, Hornberger L. Diameter of the normal fetal thymus on ultrasound. Ultrasound 23. Obtet Gynecol [Internet]. 2012 [citado 25 Oct 2012];29(6):[aprox. 5 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.3979/pdf.

  24. Hill M. Endocrine Development – Thymus [Internet]. Australia: The University of New South Wales; 2011 [citado 6 May 24. 2012]. Disponible en: http://embryology.med.unsw.edu.au/notes/endocrine13.htm#.

  25. Gennery AR. Immunological aspects of 22q11.2 deletion syndrome. Cell Mol Life Sci. Ene 2012;69(1):17-27. PubMed 25. PMID: 21984609.

  26. Kuvibidila S, Dardenne M, Savino W, Lepault F. Influence of iron-deficiency anemia on selected thymus functions in mice: 26. thymulin biological activity, T-cell subsets, and thymocyte proliferation. Am J Clin Nutr [Internet]. 1990 [citado 25 Oct 2012];51(2):[aprox. 5 p.]. Disponible en: http://ajcn.nutrition.org/content/51/2/228.full.pdf+html.

  27. Paladini D. How to identify the thymus in the fetus: the thy-box. Ultrasound Obstet Gynecol [Internet]. 2011 [citado 25 Oct 27. 2012];37(4):[aprox. 5 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.8854/pdf.

  28. Roat E, Prada N, Lugli E, Nasi M, Ferraresi R, Troiano L, et al. Homeostatic cytokines and expansion of regulatory T cells 28. accompany thymic impairment in children with Down syndrome. Rejuvenation Res. Jun 2008;11(3):573-83. PubMed PMID: 18386990.

  29. Lang U, Baker RS, Khoury J, Clark KE. Effects of chronic reduction in uterine blood flow on fetal and placental growth in 29. the sheep. Am J Physiol Regul Integr Comp Physiol [Internet]. 2000 [citado 25 Oct 2012];279(1):[aprox. 8 p.]. Disponible en: http://ajpregu.physiology.org/content/279/1/R53.full.pdf+html.

  30. Hartge R, Jenkins DM, Kohler HG. Low thymic weight in small-for-dates babies. Eur J Obstet Gynecol Reprod Biol. Jun 30. 1978;8(3):153-5. PubMed PMID: 264079.

  31. El-Haieg DO, Zidan AA, El-Nemr MM. The relationship between sonographic fetal thymus size and the components 31. of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes. BJOG [Internet]. 2000 [citado 25 Oct 2012];115(7):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01715.x/pdf.

  32. Yinon Y, Zalel Y, Weisz B, Mazaki-Tovi S, Sivan E, Schiff E, et al. Fetal thymus size as a predictor of chorioamnionitis 32. in women with preterm premature rupture of membranes. Ultrasound Obstet Gynecol [Internet]. 2007 [citado 25 Oct 2012];29(6):[aprox. 5 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.4022/pdf.

  33. McDade TW, Beck MA, Kuzawa CW, Adair LS. Prenatal undernutrition and postnatal growth are associated with adolescent 33. thymic function. J Nutr [Internet]. 2001 [citado 25 Oct 2012];131(4):[aprox. 7 p.]. Disponible en: http://jn.nutrition.org/content/131/4/1225.full.pdf+html.

  34. Cromi A, Ghezzi F, Raffaelli R, Bergamini V, Siesto G. Ultrasonographic measurement of thymus size in IUGR fetuses: a 34. marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol [Internet]. 2009 [citado 25 Oct 2012];33(4):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/uog.6320/pdf.

  35. Knutsen AP, Baker MW, Markert ML. Interpreting low T-cell receptor excision circles in newborns with DiGeorge 35. anomaly: importance of assessing naive T-cell markers. J Allergy Clin Immunol [Internet]. Dec 2011 [citado 25 Oct 2012];128(6):[aprox. 2 p.]. Disponible en: http://download.journals.elsevierhealth.com/pdfs/journals/0091-6749/PIIS0091674911013200.pdf.

  36. El-Haieg D, Zidan A, El-Nemr MM. The relationship between sonographic fetal thymus size and the components of 36. the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes. BJOG [Internet]. 2008 [citado 25 Oct 2012];115(7):[aprox. 6 p.]. Disponible en: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2008.01715.x/pdf.

  37. Santner Nanan B, Peek MJ, Khanam R, Richarts L, Zhu E, Fazekas de St Groth B, et al. Systemic increase in the ratio 37. between Foxp3+ and IL-17-producing CD4+ T cells in healthy pregnancy but not in preeclampsia. J Immunol [Internet]. 2009 [citado 25 Oct 2012];183(11):[aprox. 9 p.]. Disponible en: http://www.jimmunol.org/content/183/11/7023.full.pdf+html.




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