HYPERECHOIC THICKENED EPENDYMA - SONOGRAPHIC DEMONSTRATION AND SIGNIFICANCE IN NEONATES

In the neonate, hyperechoic thickening of the ependyma is believed to be related to ventriculitis. Yet, in our experience, this sign is much more often observed in association with subacute intraventricular hem orrhage (IVH), without infection. Sixty premature neonates were prospe ctively studied. The observations of transfontanellar sonograms (intra cranial hemorrhage, ependymal echogenicity, and ventriculomegaly) were correlated with the results of MRI, lumbar punctures and clinical wor k-up. Intracranial hemorrhage was detected in 28 patients, and hyperec hoic thickening of the ependyma was observed in 21 of them, all of who m had IVH. In 9 of these 21 patients IVH was diagnosed retrospectively thanks to the visualization of the hyperechoic ependyma. In all but o ne, this sign persisted for at least 2 months after disappearance of o ther signs of IVH. MRI demonstrated the presence of hemosiderin and fe rritin in ependymal or subependymal location only in patients with hyp erechoic ependyma. One of our patients had in utero diagnosis of IVH o wing to the visualization of the same hyperechoic aspect of the ependy ma. Nine of the neonates with hyperechoic ependyma developed ventricul omegaly, and three underwent surgery. Hyperechoic thickening of the ep endyma in prematures often results from a subacute IVH. It is related to hemoglobin catabolites which can be detected by MRI. It does not re quire immediate potentially harmful diagnostic punctures. The presence of this hyperechoic rim allows a retrospective diagnosis of IVH and i ndicates a clinical and sonographic follow-up in newborns at risk for secondary hydrocephalus.