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2008-12-29-10 Answer to the case of the week #240 © Srisantiroj www.TheFetus.net


Answer to the case of the week #240

March 19, 2009 - April 9, 2009

Nattinee Srisantiroj, MD; Prapat Wanitpongpan, MD; Vitaya Titapant, MD.

Fetal-maternal medicine division, Department of Obstetric and Gynecology, Siriraj Hospital, Mahidol university, Bangkok, Thailand.

Case report

A 27-year-old woman (G1P0), presented to our unit at 33 weeks of her pregnancy. She complained about an abnormal tension of her abdomen. Our ultrasound found a singleton pregnancy with marked polyhydramnios. Transverse scans of the fetal thorax at the level of the four-chamber view of the heart showed dextroposition of the heart. The left lung looked hyperechoic and we falsely considered the findings as a diaphragmatic hernia with polyhydramnios. The stomach was not observed during our examination. The neonate was delivered by cesarean section and tracheoesophageal fistula combined with severe right lung hypoplasia was revealed postnatally. The right lung hypoplasia explained the prenatal finding of the dextropositioned heart.

Images 1, 2: Transverse scans of the fetal thorax at the level of the four-chamber view showing the dextroposition of the heart.

 

Images 3, 4: The images show the "hyperechoic" part of the left lung. This is actually an artifact with normal lung echogenicity surrounded by areas with attenuation (ribs, scapula, spine)

 

Images 5, 6: The image 5 shows transverse scan of the fetal abdomen. The stomach can"t be seen and there is marked polyhydramnios present. The image 6 shows transverse scan of the fetal thorax at the level of the three-vessel view of the heart. This complex is shifted to the right due to the right lung hypoplasia.

  

Image 7: The image shows marked polyhydramnios.

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