Fetal Cardio 2018 - Krakow, Poland
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2018-12-14  Case of the week # 490  © Fabien Ho  www.TheFetus.net

Answer to the case of the week # 490
February 28, 2019 - March 14, 2019

Dr Ho F.1, Dr Cuillier F.2, Pr Doray B3

1. Radiologist, private sector, 97400 Saint-Denis, Reunion Island, France. 
2. Department of Obstetrics, Felix Guyon Hospital, Reunion Island, France.
3. Department of Genetics, Felix Guyon Hospital, 97400 Saint-Denis, Reunion Island, France. 


Case report
This patient had been referred to our hospital at 24 weeks of pregnancy. 
Routine 2nd trimester screening picked up unusual brain images. Previous personal, familial and obstetrical history was non relevant. 
Our US examination at 24 weeks of pregnancy revealed the following findings:

  • -Numerous bright echogenic thick foci on the ventricular walls as well as alongside the thalamocaudate groove, including the thalami;
-Mild ventricular dilation as well as subjective enlargement of the pericerebral spaces; 

-The corpus callosum appeared shortened: 16mm at 24 weeks (<3rd percentile at 24 weeks according to Pashaj et al. UOG 2013; 25mm marking the 50th percentile). These 2 elements may suggest associated white matter loss; 

-Cerebellum biometry was also abnormal, corresponding to the 50th percentile of 19 weeks;

-The morphology of the sylvian fissure seemed closer to 22weeks than 24 weeks;

-The bowel was hyperechoic;

-Hands were clenched: 1st and 5th digits extended while other digits flexed;


There was no elements suggesting fetal anemia (MCA velocimetry was normal, no cardiomegaly). We did not observe brain cysts, especially near the frontal and temporal horns.

All these elements suggested an infectious foetopathy as the most likely diagnosis to ascertain first.
We performed an amniocentesis and PCR testing for CytoMegaloVirus and it was positive. PCR for parvovirus B19, Herpes Simplex Virus were negative. Serologies for toxoplasmosis, rubeola, syphilis were also negative. Therefore our diagnosis was CMV-induced foetopathy.


Images 1-6: 2D sagittal images and axial images show numerous bright echogenic thick foci on the ventricular walls as well as alongside the thalamo-caudate groove, including the thalami. The corpus callosum appeared shortened.
Cerebellum biometry was also abnormal, corresponding to the 50th percentile of 19 weeks of gestation.
      


Video 1: 2D sagittal image shows shortened corpus callosum and echogenic foci in the ventricular walls.



Images 7-8: 2D images revealed 1st and 5th digits extended while other digits flexed, and the bowel was hyperechoic.
 
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