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2013-09-11-09 Case of the week #355 © Bronshtein www.TheFetus.net 

 

Answer to the case of the week #355

October 10, 2013 - October 24, 2013

 

Moshe Bronshtein, MD*; Inna Naroditsky, MD*; Frantisek Grochal, MD**.

*   Haifa, Israel.
** Femicare, s.r.o., Center of prenatal ultrasonographic diagnostics, Martin, Slovak republic.


Case report

This was a low-risk pregnancy first time seen at 16 weeks of gestation. Our ultrasonographic examination revealed:

1. Fetal stomach on the left side shifted dorsally;
2. Absent spleen;
3. Gallbladder located on the left side;
4. Aorta and pulmonary artery were in juxtaposition on the left side;
5. Levoversion and levoposition of the heart  with univentricular heart;
6. Missing left lungs causing levoposition of the heart.

The findings were consistent with right isomerism. Parents opted for the termination of the pregnancy and the findings were confirmed by autopsy.

Images: 1, 2, and 3: 16 weeks; transverse scan of the fetal abdomen showing the stomach on the left side, gallbladder located on the left side, aorta and pulmonary artery lying in juxtaposition on the left side, stomach is not visible and the spleen is not present. The image 2 is supplemented by drawings and descriptions of the structures that can be seen on the image 1.

 



Images: 4, 5, 6, 7, and 8: 16 weeks; transverse scans of the fetal thorax showing levo-position and levo-version of the fetal heart. The heart is univentricular, the left lung field is small due to the left lobar agenesis. The image 7 and 8 shows the drawings explaining the relationship of the structures seen on the ultrasonographic images.

 


 


 


Videos: 1, 2
16 weeks; the video 1 shows transverse scan of the fetal abdomen and thorax. The gallbladder located on the left side, aorta and pulmonary artery lying in juxtaposition on the left side, the spleen is not present. The heart is in levo-position and levo-version - the heart is univentricular. The left lung field is small due to left lobar agenesis.

 

Images 9, 10: Pathological images showing the fetus with right isomerism.

 

Images 11, 12: Pathological images showing the fetal heart - double outlet ventricle of the univentricular heart.

 

Images 13, 14, 15, and 16: Pathological images showing the symmetric mirror-right liver (image 13); gallbladder located on the left side (image 14); absent spleen (image 15); and absence of the left lung lobe (image 16).

 

 

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