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2015-10-12  Thoracic meningocele - 1º trimester  © Fabrice Cuillier  www.TheFetus.net

Thoracic meningocele - 1º trimester
Fabrice Cuillier1, MD, Midwife Mardamootoo1, Lemaire, P2

1. Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France. 
2. Department of Gynecology, Communal’s Hôpital, 97300 Saint-Benois, Ile de la Réunion, France. 


Case report


This was the third pregnancy of a non-consanguinous couple (32 year-old - G3P2). At 12 weeks of gestation an ultrasound revealed a “posterior thoracic cyst¨ and the patient was sent to our unit one week later.

We performed ultrasound examinations at 13, 14, 16 and 17 weeks of pregnancy and we observed:

  • A thoracic cyst structure without abnormal vascularization. The spine was normal and no vertebral defects were seen.
  • Normal brain at 13 weeks of gestation. At 14-16 weeks we suspected an Arnold-Chiari malformation, and at 17 weeks we noted enlargement of the lateral ventricles within normal limits.
Superior and inferior extremities were normal. 3D views of the ears were normal too.
Abdominal fetal sonography was normal, without kidney or hepatic dysplasia.
Fetal movements were physiological. 
The serological tests were normal (Toxoplasmosis, Rubeola, CMV, Herpes, Chikungunya).
Amniocentesis was practiced and the fetal caryotype was 46, XX. The alpha F-P level was normal.

Our diagnostic was a thoracic meningocele with normal bone spine.

The parents were informed. Nevertheless, because of Arnold-Chiari syndrome, the parents decided interruption of the pregnancy.  
Post-mortem analysis confirmed our diagnosis of posterior thoracic meningocele.



13 weeks

Images 1-4: 2D and 3D images in different planes at the level of the thoracic spine show a cystic mass without abnormal vascularization. The vertebral bodies were normal without signs of  dysraphism. 

   


13 weeks

Images 5, 6: 2D axial images of the fetal head show normal brain, without signs of hydrocephalus.  

 

14-16 weeks

Images 7, 8: 2D images of the fetal head showing Arnold Chiari signs and at 16 weeks of pregnancy (image 8) an enlarged lateral ventricules within normal limits. Internal nuchal translucency could not be measured at 13 weeks.

 


16 weeks

Images 9-12: Axial and coronal 2D and doppler images of the fetal thorax showing a posterior thoracic mass without abnormal vascularization.

 
 


17 weeks

Images 13-16: Axial and coronal 2D and 3D images of the fetal thorax showing a posterior thoracic mass without abnormal vascularization or signs of dysraphism.

  


Videos 1-6: 2D images at different gestational age showing posterior thoracic meningocele without dysraphism.




Images 17 and 18: Post-mortem analysis confirmed our diagnosis of posterior thoracic meningocele.

 

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