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2007-11-30-13 Answer to the case of the week #216 © Riano www.TheFetus.net


Answer to the case of the week #216

April 10, 2008 - April 24, 2008

Meyer Serrano Riano, MD.

Parinatology Unit, Villavicencio, Meta, Colombia.

 

Case report

27 years old patient, G2P1, with noncontributive history, referred to our antenatal unit at 20 weeks due to a fetal megacystis seen during her first trimester ultrasonographic examination. No further intervention or additional investigations were done. During the examination we found:

  • a normal amount of the amniotic fluid;
  • male gender of the fetus with the dilatation of the fetal urethra;
  • dilated thick-walled urinary bladder;
  • bilateral dilatation of the ureters;
  • hyperechoic kidneys of normal size;
  • right clubfoot of the fetus.

The patient was rescanned at 33 weeks and the findings had changed:

  • the dilatation of the urethra had disappeared and the penis seemed to have redundant prepuce;
  • the amount of the amniotic fluid was normal;
  • the urinary bladder and ureters were without changes;
  • the size of the kidneys was below the fifth percentile, with hyperechoic appearance and lost of the corticomedullary differentiation.

Based on the findings we presumed a meatal atresia with consequent resolution of the urethral dilatation via urethra-preputial fistulation.

The baby was delivered at 37 weeks and the diagnosis was confirmed. A vesical derivation was practiced. The baby underwent several episodes of urinary infections. Six months after delivery he has increased seric concentrations of creatinine and urea, but his status didn"t require a dialysis till now.

20 weeks

Images 1, 2: The images show dilated fetal urethra.

 

Images 3, 4: The image 3 shows scrotum and dilated fetal urethra; the image 4 shows dilated fetal urethra.

 

Images 5, 6: The images show dilated urinary bladder; dilated ureters can be also seen at the image 6.

 

Images 7, 8: The image 7 shows normal sized hyperechoic kidneys. The image 8 shows a club foot of the fetus.

 

33 weeks

Images 9, 10: The image 9 shows the scrotum and penis of the fetus. The image 10 shows bilateral ureteral dilatation.

 

Images 11, 12: The image 11 shows dilated ureter of the fetus. The image 12 shows small fetal kidney with undistinguishable corticomedullary differentiation.

 

Images 13, 14: Postnatal appearance of the genital.

 

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