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2010-03-01-10 Answer to the case of the week #272 © Srisantiroj
Answer to the case of the week #272

July 15, 2010 - July 29, 2010.

Nattinee Srisantiroj MD., Tharinee Lumluk MD., Podjanee Padungkiatwattana MD., Somchai Sirijareonthai MD., Prapon Jaruyawong MD.

Fetal-maternal medicine unit, Department of Obstetric and Gynecology, Rajavithi hospital, Bangkok,Thailand.

Case report

A 28-year-old G1P0 was referred for an ultrasound examination at 28 weeks of gestation. Her previous ultrasound performed at 19 weeks was unremarkable.
The ultrasound examination showed findings suggestive of skeletal dysplasia. There was an enlarged amount of the amniotic fluid and micromelia. Long bones were curved and thickenned with increased echogenicity. There were no healing fractures detected. Thorax was small with short ribs. Liver was enlarged.
Patient delivered prematurelly at 30 weeks due to a preterm rupture of membranes. Neonate died first day after delivery.

The pathologist diagnosed a pren
atal cortical hyperosthosis which is a prenatal onset of infantile cortical hyperosthosis known as a Caffey disease.

Images 1,2: Image 1 shows enlarged amount of the amniotic fluid. Image 2 shows a small thorax and enlarged liver.

Images 3,4: Image 3 shows short, irregular, echogenic ribs. Image 4 shows the upper extremity with shortened and angulated long bones, humerus and radius.

Images 5,6: Image 5 shows long bones of the upper extremity, note the thickening od the diaphyses and irregular surface - hyperostosis. Image 6 shows the hand.

Image 7,8: 3-D images, image 7 shows the lower right extremity, note the bending od the calf. Image 8 shows the fetal face.

Video 1,2: Video 1 shows the thorax, note the ribs, increased echogenity, irregular surface. Video 2 shows a upper extremity with angulated, shortened long bones, their echogenity is increased and the diaphyses are thhickened with irregular surface.

Video 3: Video shows small thorax, enlarged liver, and micromelic, angulated bones.

Image 9: X-ray of the neonate. Note the thickness and irregular surface of the femur and tibia.

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