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2001-02-02-10 Answer to the case of the week #43 © Sleurs www.TheFetus.net

Answer to case #43

February 2-16,  2001

Submitted by Elke Sleurs, MD*&, Luc De Catte, MD*

*Vrije Universiteit Brussel  and &Women’s Health Alliance, Nashville TN

A 20-year-old primigravida was referred at the ultrasound department at 34 weeks of gestational age for an unspecified fetal mass. Her past surgical and obstetrical history were uneventful. Before and during pregnancy the patient had been using soft drugs (marijuana). The patient refused karyotyping.

There are 3 video clips of the shoulder (1.1 MB)  and the chest (0.9 MB) which demonstrate the findings better then the images below. There is also a combined clip that is more complete (but adds no further findings) and is 5.8 MB 

The first set of images are the shoulder of the baby (the other side presents similar findings). Large cystic cavities are seen all around the chest and shoulders.

 

The neck presents similar findings. The cysts are not as large as those of cystic hygroma.

The normal brain of the baby (the image was not obtained to demonstrate the brain, thus the oblique cut, but there is no brain alterations of size or morpholgy). This demonstrates that the lesion is not a cephalocele.

The chest of the baby: more cystic spaces and probably a little right hypertrophy. This may represent some failure.

  

 

Findings:

The finding here is thus a series of fluid collections all around the chest and shoulders of the baby. This is consistent with several diagnosis including the Klippel-Trenaunay-Weber syndrome and also Proteus syndrome. These fluid collections would be atypical for cystic hygroma, because of their sizes and distribution. Therefore Monosomy X (Turner) syndrome or Noonan syndrome are not likely.

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