Pattern Recognition of Abdominal Vasculature on Color Doppler in the Fetus as a Tool for Early Diagnosis of Bladder Exstrophy in the First and Early-Second Trimester: Initial Observations

Early prenatal diagnosis of bladder exstrophy is challenging because of its variable size and presentation. This article brings forth new signs on color Doppler (CD) to help establish the diagnosis in a suspected case. Two cases of omphalocele-exstrophy-imperforate anus-spinal defects complex presenting as a solid-cystic ventral mass at 11 weeks and a solid lower abdominal wall mass at 20 weeks, with nonvisualization of the urinary bladder, were studied by gray-scale and CD in sagittal and transverse-bladder views of the abdomen. The sagittal view on CD revealed an altered intrafetal course of umbilical artery (UA), widened UA-aorta angle (K angle), a break in the intersection of UA, and umbilical vein (UV) at the umbilicus—broken “X-sign” with distortion of the equilateral triangle normally formed by aorta, UA, and UV. The transverse-bladder view showed an altered divergent course of single-UA. Combination of these findings substantiated early diagnosis of bladder exstrophy, thus facilitating prenatal counseling. Key Messages: Early prenatal diagnosis of bladder exstrophy is possible by pattern recognition of abdominal vasculature on color Doppler. The new signs—“X” and “Y” derived on color Doppler, as a clue to early diagnosis of bladder exstrophy—have not been identified in the current literature that makes this article unique.