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Obstetrics » Obstetrics 2nd And 3rd Trimester
Intracranial arteriovenous malformation with cardiomegaly
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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.
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