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2006-04-11-11 Case of the week © Auslander www.TheFetus.net


Answer to the case of the week #171

 July 7- 20, 2006

Ron Auslander, MD, Goldberg Yael, MD

Israel

This is a 30-year-old-woman, primigravida, referred to our unit at 22 weeks.  The first scan performed at 15 weeks was normal except for a cardiac hyperechogenic focus. The karyotype and viral test were negative. The scan performed in our unit revealed a pericardia fluid. A serial ultrasound examination performed at 25 weeks showed a severe pericardial effusion and a thickening of the myocardium. At 28 weeks, we noted an aneurysm located between the right atria and the right ventricle, located in the area correspondent to the right coronary artery. We could not see if the blood flow was coming from the right ventricle or from an aberrant branch of coronary artery.

The anatomical-pathological examination diagnosed:

  • single coronary artery with anomalous implantation
  • hemopericardium with blood clots filling the pericardium cavity
  • saccular aneurysmatic dilatation in the atrioventricular groove (probably of venous etiology)

As the only anomaly found in this heart was the anomalous coronary implantation it is possible that the aneurysm and the hemopericardium were secondary to this anomaly.

So, the final diagnosis was a fistula from an aneurysm to the pericardium from a single coronary artery with anomalous implantation. Moshe Bronstein suggested that this was part to the Kawasaki disease.

23 weeks and 3 days

25 weeks

28 weeks

 

Postnatal images. Note the saccular aneurysmatic dilatation

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