Spalding sign
- PDF / 574,204 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 36 Downloads / 243 Views
CLASSICS IN ABDOMINAL RADIOLOGY
Spalding sign Felipe Matsunaga1 · Sree Harsha Tirumani1 Received: 9 August 2020 / Revised: 3 September 2020 / Accepted: 10 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
The Spalding sign, an eponym indicative of intrauterine fetal demise which refers to overlapping fetal cranial bones at the sutures, was first described by the obstetrician Alfred Baker Spalding in a case series in 1922 based on the radiographic appearance of these osseous structures [1]. In addition to the detection of gas within the heart and great vessels, it remained one of the few specific radiographic signs of fetal demise prior to the use of ultrasonography for the detection of fetal heart rate. Though initially a radiographic finding, the sign is still nevertheless visualized sonographically.
The sign develops anywhere from 1 to 21 days following fetal demise but usually becomes apparent within 10 days (Fig. 1). Shrinkage of the underlying brain tissue is postulated to be the underlying mechanism. In contradistinction to fetal molding where overlapping or displacement of some skull bones occurs during the descent into the birth canal, overlapping at most of the sutures is visualized in all projections with a Spalding sign [2].
* Felipe Matsunaga [email protected] 1
Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
13
Vol.:(0123456789)
Abdominal Radiology
Fig. 1 A 28-year-old G4P1 woman at 13 weeks gestational age presented to the emergency department with vaginal bleeding. A pelvic ultrasound in the sagittal (a) and transverse (b) projections demonstrated intrauterine fetal demise as evidenced by fetal maceration (arrow) and lack of a fetal heart rate (not pictured). The cranium remained intact. The patient missed her scheduled outpatient dilatation and curettage procedure and subsequently presented to the emer-
gency department 9 days later with continued vaginal bleeding. Sonographic evaluation in the sagittal (c) and transverse projections (d) demonstrated brain parenchymal shrinkage with resultant overlapping cranial bones (arrows). An uneventful dilatation and evacuation of a male fetus were performed the next day with gross pathology revealing a shrunken skull with overlapping cranial bones and containing liquefied brain parenchyma
Compliance with ethical standards
References
Conflict of interest The authors declare that they have no conflict of interest.
1. Spalding, Alfred Baker. A pathognomonic sign of intra-uterine death. Surgery, Gynecology and Obstetrics. 1922;34:754. 2. Townsend L. Obstetrics for students. [2d ed. Carlton, Victoria]: Melbourne University Press; 1969. 722 p.
Research involving human and animal rights This article does not contain any studies with human participants or animals performed by any of the authors.
13
Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affili
Data Loading...
