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2012-07-22-09 Case of the week #334 © Bronshtein www.TheFetus.net


Answer to the case of the week #334

December 20th, 2012 - January 3rd, 2012 


Moshe Bronshtein, MD

Department Obstetrics Gynecology, Rambam Medical Center, Haifa, 31096 Israel.

(Edited by F.G.)


Case report

A 32-year-old G2P0 woman conceived by IVF-ICSI (intracytoplasmic sperm injection) presented to our facility at 16 weeks of pregnancy. Her previous pregnancy was terminated at 16 weeks due to hydrocephalus and abnormal cerebellar vermis of the fetus. No other risk factors of congenital anomalies were noted.

Our ultrasound examination revealed noticeable dextroposition of the fetal heart, with no conspicuous changes of the lung parenchyma. The fetus was examined several times between 16 and 33 weeks and the initial striking cardiac dextroposition had resolved between 30 and 33 weeks. The lung parenchyma did not exhibit any remarkable changes in ultrasound imaging (maybe lightly more echogenic left lung).

The patient underwent MRI scan at 33 weeks of pregnancy revealing a "hyperinflation" or, put it more correctly, a "hyperhydration" of the left lung making the final diagnosis of congenital lung emphysema and differentiating the finding from microcystic congenital adenomatoid malformation or lung sequestration.  

The newborn was delivered at term and was asymptomatic. Now, several months after delivery, the child is doing well.

This case shows an interesting cause of fetal cardiac malposition that should be taken into consideration in differential diagnostic process of such cases. It also emphasizes the need of MRI examination enabling differentiation of congenital lobar emphysema from other possible cases of cardiac malposition such as congenital adenomatoid malformation or lung sequestration. 

Images 1, 2 and videos 1, 2: 16 weeks of pregnancy; the images and videos show transabdominal (image 1 and video 1) and transvaginal (image 2 and video 2) transverse scans of the fetal thorax with marked dextroposition of the heart. The lung parenchyma looks normal.

 

 

Images 3, 4 and videos 3, 4: 24 weeks of pregnancy; the images and videos show transverse (image 3 and video 3) and longitudinal (image 4 and video 4) scans of the fetal thorax with marked dextroposition of the heart and no conspicuous findings at lung parenchyma (maybe lightly hyperechoic left lung).

 

 

Image 5 and video 5: 30 weeks of pregnancy; the image and video shows transverse scan of the fetal thorax with still presented marked dextroposition of the heart and no conspicuous findings at lung parenchyma.

 

Image 6 and video 6: 33 weeks of pregnancy; the image and video shows transverse scan of the fetal thorax revealing resolution of previously seen malposition of the heart. The lung parenchyma looks normal.

 

Images 7, 8, 9: 33 weeks - MRI images showing hyperhydration within the left lung consistent with congenital lobar emphysema and differing the finding from congenital adenomatoid malformation or lung sequestration.

 



Images 10, 11: Postnatal X-ray of the newborn chest.

 

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