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2016-02-06  Case of the week # 417  © Fabrice Cuillier

Answer to the case of the week # 417
March 31, 2016 - April 14, 2016.

Fabrice Cuillier, MD.
Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.

Case report

A healthy young woman with unremarkable history (G2P1) was sent to our institution. 
The first trimester screening was normal (LCC 65mm - NT 1.4mm).  
She came to our unit again at 17 weeks of pregnancy for an ultrasound routine examan. We noticed an umbilical cord cyst surrounded by two vessels, a single umbilical artery and umbilical vein.
Based on the findings we permormed serial ultrasound controls at 24, 27, 29 and 31 weeks of gestation. 

At 24 weeks of gestational age we noticed edema of the Wharton´s jelly, without changes at 27 and 29 weeks of gestational ultrasound controls.

At 31 weeks of pregnancy another ultrasound shows that the Wharton´s jelly edema was increased without signs ot arterial thrombosis. Two weeks later the patient consults because of abscence of fetal movements and another ultrasound control was made, revealing a live fetus with diminished fetal movements.
Due to suspicion of incipient arterial thrombosis the patiente was hospitalized.

The baby was delivered prematurely (2.000 gr.). The presence of a large umbilical cord cyst with mucoid degeneration, Wharton´s jelly edema and single artery were confirmed, without any sign of arterial thrombosis.

17 weeks of gestation

Images 1-3 ; video 1:
2D and doppler images showing single umbilical artery and a large umbilical cord cyst. 

24 weeks of gestation

Image 4 ; video 2: 2D images revealed Wharton´s jelly edema. No signs of arterial thrombosis were noticed. 

27-29 weeks of gestation

Images 5 and 6: 
 2D and doppler images revealed Wharton´s jelly edema, without significant changes in comparison with previous exams. No signs of arterial thrombosis were noticed.   


31 weeks of gestation

Images 7 and 8: 2D and color doppler images showing an increased edema within the Wharton´s jelly without visible arterial thrombosis. Despite the color doppler findings we suspected an incipient arterial thrombosis.


Images 9 and 10:
gross specimen images confirmed the presence of a large umbilical cord cyst with mucoid degeneration, Wharton´s jelly edema and only two vessels within the cord.

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