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2010-12-18-16 Answer to the case the week #264 © Aleong

 Answer to the case of the week #264 

 March 18, 2010 - April 2, 2010

Tibisay Guerrero Chin Aleong
, MD., Montserrat Alegre, MD., María Victoria Huerta Anaya, MD.

Hospital de Figueres, Fundacio Salut Emporda, Figueres, Girona, Spain. 


The following images represent an interesting case of congenital Cytomegalovirus infection.


Case report


A 33-year-old patient G0P0 was referred to our unit for the ultrasound examination at 20 weeks of the otherwise uncomplicated pregnancy. Patient underwent bariatric surgery for morbid obesity 5 years ago and has suffered from chronic anemia since. Her family history was negative. Her blood group was 0 Rhesus negative and her indirect Coombs test was negative.  No flu-like symptoms in the past months. The ultrasound screening at 12 weeks was normal.


During the ultrasound examination we revealed the following findings:

    • Ascites
    • Fluid collection, suspicious of hematoma, subsequent ventriculomegaly
    • Intestinal distention with echogenic bowel
    • Hepatomegaly with calcifications

The findings were suggestive of a fetal infection. We decided to perform a cordocentesis and amniocentesis to exclude parvovirus B19 and CMV (cytomegalovirus) infection.
Fetal MRI reported supratentorial tumor with ventriculomegaly which could be caused by intracranial bleeding.
Subsequent ultrasound performed in 2 weeks revealed worsening of the fetal condition, progression of ventriculomegaly and ascites.
The fetal blood results confirmed a congenital Cytomegalovirus infection.
The couple opted for the pregnancy termination due to an adverse prognosis for the fetus. The autopsy confirmed a severe systemic CMV infection.


Images 1,2,3: Images show fetal brain at 20 weeks, note echogenic lesion in the frontal lobe.





Images 3,4: Images show an axial plain view of the brain at 22 weeks, note the ventriculomegaly.




Images 5,6: Axial view of the brain, note apparent ventriculomegaly and echogenic round lesion in the frontal region.




Images 7,8: The images show the echogenic bowel and ascites, indicated by (*). 




Images 9, 10: The images show a transverse view of the fetal abdomen. Image 10 shows a hepatic calcification, indicated by arrow and the ascites, indicated by (*) . 




Images 11,12: Image 11 shows a transvers view of the abdomen with the apparent hepatomegaly indicated by the arrow. Image 12 shows a longitudinal view, hepatomegaly with calcification (indicated by arrows), ascites and the echogenic bowel.  




Images 13,14: Image 13 shows a cell infefcted by CMV, note intranuclear and intracytoplasmic inclusion and white halo around the nucleus. Image 14 shows a fetus after the pregnancy termination.




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