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2009-07-29-10 Answer to the case of the week #249 © Cuillier www.TheFetus.net


Answer to the case of the week #249

August 6, 2009 - August 20, 2009

Fabrice Cuillier, MD*; J. F. Scemama, MD**; E. Lopez, MD***; P. Fossati, MD****.

*      Department of Gynecology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion’ Island, France;
**    Sonographer, Chaussee’ Street, 97400 Saint- Paul, Reunion Island, France;
***   Neurosurgeon, Saint-Pierre Hospital, France;
**** Department of Radiology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion Island, France.

Case report

A 30-year-old woman, G2P1, with non contributive history presented to our department at 22 weeks of her pregnancy. Her first trimester screening was reported to be normal (NT 1 mm; CRL 54 mm). The findings during our scanning were suggestive of a spina bifida occulta of the fetus. A hemivertebra was also present. No cerebral anomalies were seen and the rest of the fetal anatomy was normal.
At 26 weeks the ultrasound was repeated and a sacral dermal sinus was suspected. Prenatal MRI found diastematomyelia in thoracic region which was also seen during our ultrasonographic scan performed at 40 weeks.
Karyotype of the fetus was normal.
The neonate was delivered at 41st week. Its neurological examination was normal and the skin covering the spine was intact, but there was a palpable solid mass above the thoracic spine present.

Images 1, 2: The image 1 shows normal transverse scan of the fetal head. The image 2 shows sagittal scan of the fetal thoraco-lumbar spine. The fingers points to the region where spina bifida occulta was suspected.

 

Images 3, 4, 5, 6: The images shows sagittal scan of the fetal thoraco-lumbar spine. The fingers points to the region where spina bifida occulta was suspected.

 

 

Images 7, 8: Transverse scans of the thoracolumbar spine showing the diastematomyelia - fingers at the image 8 point at the two separate cords of the spinal cord.

 

Images 9, 10: Oblique coronal views of the fetal spine at two different levels - the left part of the images is taken higher in the thoracic region where just one spinal cord can be visible (finger on the image 9) and the right part of the images shows a plane obtained lower in the thoraco-lumbar region where two cords of the spinal cord can be seen (diastematomyelia).

 

Images 11, 12: Transverse scans of the thoraco-lumbar region of the fetal spine. A bony crest is visible lying in-between the two separate cords of the spinal cord.

 

Images 13, 14: The images show 3D scans of the fetal spine - a hemivertebra can be seen (arrow on the image 14).

 

Images 15, 16, 17, 18, 19, 20, and 21: The images show transverse and sagittal MRI scans of the fetal spine. The images 15 and 16 were taken in the thoracic region of the fetal spine, where just one spinal cord is visible (arrow on the image 16). The images 17-19 show thoraco-lumbar region of the fetal spine with two cords of the spinal cord (diastematomyelia). The image 21 shows sagittal scan of the fetal spine - not contributive to the diagnosis.

 

 

 

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