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 2016-10-01  Case of the week # 435  © Lusine Karapetyan
Answer to the case of the week # 435
December 8, 2016 - January 5, 2017.

Lusine Karapetyan
, MD
Moscow, Russia.

Case report

A 36-year old patient (G3P2) was referred to our unit for routine ultrasonography scan at 20 weeks of gestational age. F
irst trimester scan was done in other institution and it was reported to be normal.

Our ultrasound examination revealed the following images:


  • Mild ventriculomegaly
  • Bifid choroid plexus
  • Hypoplastic nasal bone and low nasal bridge
  • Distended stomach and distended first part of duodenum
  • Sandal gap
  • Hypoplastic middle phalanx of the 5th digit

Our diagnosis was duodenal obstruction (probably stenosis and high risk of T21).
Parents refused karyotyping and opted for the continuation of the pregnancy.

Emergency cesarean section was done at 30 weeks of gestational age due to bradycardia and abnormal doppler evaluation. Neonate weighted 1180 gr. and genetic test revealed 47 XX (+21) with an annular pancreas.

The baby has already undergone surgery and she is doing well.

20 weeks

Images 1-4; videos 1-4:
2D and 3D images showing mild ventriculomegaly, the ¨double bubble¨ appearance of the stomach and duodenum, hypoplastic nasal bone and low nasal bridge.


27 weeks

Images 5, 6 and 7; video 5
2D and 3D images showing bifid choroid plexus, hypoplastic middle phalanx of 5th digit, fetal profile and gastrointestinal tract obstruction due to annular pancreas.


30 weeks

Images 8, 9 and 10; video 6
2D and 3D images showing fetal profile, sandal gap and the  the ¨double bubble¨ sign.

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