Ultrasound findings in early congenital syphilis: Two case reports and literature review

Abstract

Syphilis is caused by treponema pallidum. If untreated, or inadequately treated, during pregnancy, it can result in congenital syphilis (CS), which is classified as early and late. Early CS displays before 2 years of age. We herein describe 2 cases of early CS, whose clinical onset included liver failure, edema, organomegaly, and respiratory distress. We focus on liver, intestinal, and brain ultrasound (US) and other peculiar radiological findings. To date, there are no scientific data on intestinal and brain US findings in patients with early CS whereas data on abdominal US are scarce. Increasing knowledge about US findings in early CS could be useful to improve the diagnostic and therapeutic approach to these patients.

Keywords: Brain ultrasound; Congenital syphilis; Intestinal ultrasound; Neonatal ultrasound; Syphilis; Ultrasound.

Fig. 1

Abdominal ultrasound showing an enlarged liver, with a diffusely and modestly heterogeneous echo structure as a “geographical map” but without nodular organization (arrow); a marked thickening of the periportal-biliary spaces (arrowhead) more represented at the level of the central branches but also well detectable in the peripheral structures.

Fig. 2

Abdominal ultrasound showing an enlarged and hyperechoic spleen (*), with a homogeneous echo-structure; a markedly hyperechogenic kidney (arrow) and peri-splenic free fluid (arrowheads).

Fig. 3

Intestinal US showing a moderately thick-walled colon (arrow). The thickening is ``non-stratified'' with complete loss of stratification of bowel wall (*).

Fig. 4

Brain US showing a moderate flattening of the cerebral convolutions and thickening of the subcortical parenchyma that appeared faintly and diffusely hypoechoic (arrow). Resistance indexes (RI) increased at the level of the anterior cerebral artery (ACA) with a sampled value of 0.91.

Fig. 5

Abdominal ultrasound showing an enlarged liver, with a diffusely uneven echo-structure like a “geographical map” with the presence of hypoechoic and hyperechoic areas without nodular organization (arrow) and marked thickening of the biliary tract walls and the vascular structure walls (arrowhead).

Fig. 6

CT examination showing an enlarged liver with diffusely inhomogeneous densitometry with multiple coarse, tenuously hypodense areas of infiltrating character, scattered throughout the parenchyma, some with subcapsular extension, others arranged along the periportal spaces (arrows); intra-abdominal fluid effusion (arrowhead).