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2014-27-06-11 Arteriovenous malformation of the right middle cerebral artery © Schneider www.thefetus.net


Arteriovenous malformation of the right middle cerebral artery

Martin SchneiderMD.

Pränataldiagnostik – Frauenheilkunde am Klinikum Passau, Germany.

Case report

A 41-year-old woman (7G6P) was sent to our department at 33+6 weeks of pregnancy due to mild fetal macrosomia, increased head circumference, and polyhydramnios. All tests for gestational diabetes were normal and second trimester ultrasonographic scan was unremarkable. Vascular malformations were not present in the mother's anamnesis.

Our examination revealed arteriovenous malformation of the right middle cerebral artery (see following images).

The newborn was delivered at term by cesarean section. After delivery signs of heart failure were observed and so endovascular coiling was indicated. After the procedure the signs of the heart failure had subsided soon and the newborn has been doing well.

Differential diagnosis

Sturge-Weber-Krabbe-Syndrome; Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome).

Prognosis

Development of the heart failure during the pregnancy or after delivery determines the prognosis of the finding.

Management

Cesarean section and observation at maternity clinic affiliated with interventional neuroradiology is recommended. Endovascular placement of metallic coils (endovascular coiling) is usually indicated to obliterate arteriovenous shunts.


Images 1, 2: 33+6 weeks of gestation; color Doppler imaging showing dilated middle cerebral artery and vein.


 

Images 3, 4: 33+6 weeks of gestation; 3D imaging of the fetal head with dilated superficial temporal artery.

 

Images 5, 6, 7: 33+6 weeks of gestation; 2D/3D/color Doppler imaging: although no shunting between the middle cerebral vessels and superficial temporal artery were observable, the prominent superficial temporal artery was clearly demonstrated by the 3D imaging.



Images 8, 9: 33+6 weeks of gestation; transverse scan of the fetal head showing intracranial aneurysmatic dilatation of the middle cerebral artery and vein. Turbulent flow within the arteriovenous shunt can be seen.

 

Image 10: 33+6 weeks of gestation; color Doppler and pulsed Doppler tracing showing pulsation of within the venous part of the arteriovenous fistula.



Image 11: 33+6 weeks of gestation; transverse scan of the fetal thorax at the level of the four-chamber-view of the heart showing moderate dilation of the right atrium. Polyhydramnios was also present.



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