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Case of the week # 523 - Answer
August 27, 2020 - September 17, 2020

Dr Ho F.1, Dr Godefroy C.1,  Dr Cuillier F.2, Dr J-L Alessandri.3
1. Radiologist, private sector, 97400 Saint-Denis, Reunion Island, France. 
2. Department of Obstetrics, Felix Guyon Hospital, Reunion Island, France.
3. Department of Paediatrics, Felix Guyon Hospital, 97400 Saint-Denis, Reunion Island, France. 

Previous personal, familial and obstetrical history was non relevant for the case.
Previous US examinations at 12WG, 22WG and 28WG were normal. 
US exam at 31WG revealed the following anomalies:

            

Based on ultrasound, our first hypothesis was intracranial teratoma, with major mass effect and hydrocephaly, cardiomegaly secondary to vascular steal syndrome with mild pleural effusion and mild ascites. 

We performed an MRI at 31WG, which showed additional clues:
*Coronal T2 images

    

*Axial T2 images

 

*Axial T2* images:
 

*Axial and coronal T1 images

 


-a thin line of CSF fluid best seen in coronal view next to the frontal right lobe and parietal right lobe, separating the mass from the brain parenchyma itself : most likely an extra axial mass.
-Intra axial brain damage as well on the adjacent cortex.
-the mass mainly showed hemorraghic signal, with characteristic black hypointense signal on T2* images. The mixed signal in T1 images, and also fluid-fluid levels on all sequences suggested continuous hemorrhage since the blood signal varies according to its age.


Our final diagnosis was therefore dural sinus malformation with thrombosis, of the right lateral sinus in this case, with venous infarction of the adjacent brain parenchyma.
The major mass effect, brain damage, and associated signs of cardiac failure bore a poor prognosis in this case. There was therefore very little hope for spontaneous regression without sequelae.

The parents opted for normal delivery at 38WG. The newborn passed away 2 days after delivery, and fetopathological exam has been denied.

 

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REFERENCES:  

Cow 413 https://sonoworld.com/TheFetus/Case.aspx?CaseId=3606&answer=1

https://sonoworld.com/TheFetus/page.aspx?id=3780

https://sonoworld.com/TheFetus/page.aspx?id=3795

H. Laurichesse Delmas, N. Winer, D. Gallot, K. Lopes, F. Perrotin, S. Fluncker, F. Geissler, A. M. Beaufrere, F. Vendittelli, C. Couture, D. Lemery. Prenatal diagnosis of thrombosis of the dural sinuses: report of six cases, review of the literature and suggested management. (2008) Ultrasound in Obstetrics and Gynecology. 32 (2): 188. https://doi.org/10.1002/uog.5348 https://www.ncbi.nlm.nih.gov/pubmed/18512853


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