title: Counterclockwise barber-pole sign on prenatal three-dimensional power Doppler sonography in a case of duodenal obstruction without intestinal malrotation.
abstract: Three-dimensional (3D) power Doppler sonographic imaging provides a 3D view of the blood vessels. This technique reportedly has advantages over other forms of sonography in visualizing normal and abnormal fetal vascular anatomy. We report the case of a 36-year-old pregnant woman in whom 3D power Doppler sonography with simultaneous gray-scale imaging was performed at 32 weeks' gestational age to investigate an intestinal obstruction in the fetus that was suspected on the basis of 2-dimensional sonographic findings. The 3D sonograms revealed that the superior mesenteric artery and vein of the fetus were wound counterclockwise, forming the "barber-pole" sign. At 38 weeks' menstrual age, the female infant was delivered vaginally. Only duodenal atresia and annular pancreas, but not intestinal malrotation, were found postnatally. Surgical reconstruction of the duodenum was performed, with no major complications. Previous research suggests that the counterclockwise barber-pole sign is a normal finding. On the basis of our case, we believe that this "negative finding" might be used to exclude the diagnosis of midgut volvulus, a condition that would be expected to cause these vessels to wrap around in a clockwise direction.
authors.affiliation: Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92 Chung-Shan North Road, Section 2, Taipei 104, Taiwan.
authors.forename: Chin-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Chiba
authors.forename: On
authors.initials: O
authors.lastname: Fukui
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyashita
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging*; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging*; D017538:Mesenteric Artery, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal