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 2015-12-03  Case of the week # 413  © Thuy van Nguyen  www.TheFetus.net
Answer to the case of the week # 413
February 4, 2016 - February 18, 2016.

Thuy van Nguyen
1, MD; TU Nhu Tran2, MD, PhD.

1. Fetal Ultrasound Division, Family Hospital, Da Nang Viet Nam.
2. Head of Diagnostic Imaging, MRI of Da Nang ObGyn and Pediatric Hospital, Viet Nam.


Case report

A 31-year-old multiparous woman was referred to our hospital at 23 weeks 4 days of gestation with the suspicion of teratoma of the fetal brain. Her first ultrasound examination at 12 weeks of gestation was reported as normal.
 
Our ultrasound examination revealed a triangular anechoic cystic lesion located at the supratentorial compartment of the posterior fossa. No active vascular flow detected. Within this lesion there was an hyperechoic mass which was compatible with a blood clot.

The cerebellar hemispheres were not displaced but there were mild bilateral ventriculimegaly (10.5 mm) as a result of the mass effect of the lesion.

No associated extracranial findings or signs of cardiac failure was seen.

The extra-axial location and appearance of the lesion were compatible with dural sinus malformation with thrombosis. After counselling and despite the good prognosis, the parents opted for termination of the pregnancy and autopsy was refused.




Images 1-6: 2D axial scans of the fetal head showing a cystic image located above the posterior fossa at the level of the torcular Herophili with well-circunscribed echogenic area within, compatible with thrombosis and hemorraghic event, probably related to malformation of the posterior sinus or arterio-venous shunt. The mass effect produce displacing of the lateral ventricles anteriorly and mild ventriculomegaly.

   



Images 7, 8: 2D sagital scans of the fetal head showing a torcular Herophili thrombosis.

 
 


Videos 1-4: 2D and doppler images showing torcular Herophili thrombosis, with no vascular flow detected in color doppler examination and no signs of cardiac failure. The cerebellum looks normal.

  


Images 9-14, videos 5, 6: antenatal MRI T2 images of the fetal head in different planes show isolated dural sinus malformation with thrombosis.  The images show a well-circumscribed midline mass of extra-axial location displacing the lateral ventricles anteriorly. The signal (hyper and hipointense) suggests the presence of thrombosis and repeated hemorrhagic events. 

    

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