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 2016-04-10  Case of the week # 423  © Emmanuel Julien   www.TheFetus.net
Answer to the case of the week # 423
June 23, 2016 - July 7, 2016

Emmanuel Julien
, MD.
France


Case report

A 30-year old woman, (G1P0) with unremarkable history and low risk first trimester screening was referred to us to rule out a severe cardiopathy at 25 weeks of pregnancy.
Our ultrasonographic examinations at different gestational age revealed the following findings:
  • Dextrocardia
  • Absent right lung and absent right pulmonary vessels
  • Normal biometry
  • Male fetus

 

Our diagnosis was isolated right lung agenesis. We propose fetal karyotype and comparative genomic hybridization (both with normal results), a monthly ultrasound scan, fetal magnetic resonance and consultation with a pediatric pulmonologist.

At 40 weeks labour was induced because of membranes rupture. A masculine infant (2900 g) was born with an initial Apgar: 0 and adrenaline was administered with good results. The first day was fine with artificial insufflation and low needs of oxygen, but the baby died two days later because of complete incompetence alveolar opening. 

 

Images 1-3; videos 1-3 - 25 weeks: 2D and color doppler axial images of the fetal thorax showing right lung agenesis with absent right pulmonary vessels, ipsilateral mediastinal displacement toward the agenetic lung including heart shifted to the right and hyperexpansion of the left lung.

   




Images 4-6; video 4 - 29 weeks: 
2D and color doppler axial images of the fetal thorax showing right lung agenesis with absent right pulmonary vessels, ipsilateral mediastinal displacement toward the agenetic lung including heart shifted to the right and hyperexpansion of the left lung.

  




Images 7 and 8; video 5 - 32 weeks:
normal fetal biometry.

 




 

Image 9, video 6 - 36 weeks: 2D and color doppler axial images of the fetal thorax showing right lung agenesis with absent right pulmonary vessels, ipsilateral mediastinal displacement toward the agenetic lung including heart shifted to the right and hyperexpansion of the left lung.

 
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