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2008-11-02-10 Answer to the case of the week #233 © Calvo

Answer to the case of the week #233

December 5 - 18, 2008

Antonio Calvo, MD; Guillermo Azumendi, MD; Jose Ramon Herrero, MD; Marisa Borenstein, MD.

Gutenberg Clinic, Ultrasound Unit, Malaga, Spain.

Case report

A 30-year-old woman (G2P1), with non-contributive history, presented to our unit at 32 weeks of her pregnancy due to excessive fetal mouth movements seen on ultrasound by her obstetrician. Her previous pregnancy was terminated by a caesarean section at term and a healthy neonate (3800 g) was delivered. 

Until this observation no fetal or maternal problems were detected and her first trimester screening for Down syndrome was negative (1/4500). Fetal growth was normal and so was the amniotic fluid volume. No structural abnormality or markers of chromosomal abnormality were detected. General fetal movements appeared normal, but we could observe quick and persistent fetal mouth movements during our 45 minutes scan.

Four days later the patient requested an amniocentesis due to her anxiety of Down syndrome, but the karyotype was normal (46,XY).  During the procedure the fetal mouth movements were not visible on sonography and they were not observed any more.

The neonate was delivered at 41st week of gestation. No anomalies were found and the healthy neonate (3650 g) was discharged with the mother two days after birth.

Abnormal movement of the tongue has been described in the literature as a possible sign of the medullary compression at the craniovertebral junction [1]. Our case demonstrates that this kind of fetal behavior can be just a normal variant of fetal facial expression.

Image 1 and video 1: 32 weeks; the image 1 shows fetal profile. No anomaly can be seen. The video shows permanent fetal mouth movements which persisted during the whole 45 minutes long examination.



1. Lee CH, Casey AT, Allibone JB, Chelvarajah R. Trombone tongue: a new clinical sign for significant medullary compression at the craniovertebral junction. Case report. J Neurosurg Spine. 2006 Dec;5(6):550-3.

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