SONOWORLD : Intracranial arteriovenous malformation with cardiomegaly

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Obstetrics » Obstetrics 2nd And 3rd Trimester

Intracranial arteriovenous malformation with cardiomegaly

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Author(s) :

Chaitali Shah, FRCR

Oksana H. Baltarowich, MD

Presentation This is a routine asymptomatic third trimester ultrasound.

Caption: Scan of the fetal head

Description: A midline cystic mass is noted in the fetal head. There is no associated hydrocephalus or any other anomaly.

Caption: Color Doppler of the concerned area

Description: The cystic mass completely fills with color, indicating its vascular origin.

Caption: Four chamber view of the heart

Description: Ventricular hypertrophy is noted.

Differential Diagnosis The differential of cystic mass in the fetal head is: 1. Vein of Galen aneurysm 2. Arachnoid cyst 3. Agenesis of the corpus callosum [interhemispheric cyst] 4. Dorsal sac associated with holoprosencephaly 5. Arterio-venous malformation

Final Diagnosis Fetal intracranial arterio-venous malformation with associated cardiomegaly

Discussion On ultrasound, fetal intracranial arteriovenous malformation is seen as

A midline cystic [often tubular] structure posterior to the third ventricle and thalamus

Turbulent arterial and venous flow is observed on Doppler, depending on the area that is sampled.

Dilated blood vessels are seen in the vicinity.

The pathology is usually apparent after 30 weeks of gestation

Complications include:
1. Congestive heart failure [evidenced by cardiomegaly, hydrops and polyhydramnios]
2. Hydrocephalus and CNS ischemia
3.Coarctation of the aorta
4.Transposition of the great vessels.