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2012-01-24-09 Case of the week #317 © Grochal www.TheFetus.net


Answer to the case of the week #317

April 26th, 2012 - May 10th, 2012 

Frantisek Grochal, MD

Femicare, s.r.o., Center of prenatal ultrasonographic diagnostics, Martin, Slovak republic. UVN SNP Ruzomberok, Gynecological and obstetrical department. Catholic University in Ruzomberok, Faculty of Health Care, Ruzomberok, Slovak Republic.

(Edited by Franti Grochal)

 

Case report

A 31-year-old woman (G2P1) with non-contributive history was sent to our office at 34 weeks, 4 days of gestational age. Our examination revealed following findings:

  • polyhydramnios (AFI - Amniotic Fluid Index 300 mm);
  • absent fetal stomach;
  • dilatation of the proximal end of the esophagus ("pouch sign") during fetal deglutition due to esophageal atresia;
  • bicuspid aortic valve.
The neonate was delivered via cesarean section at 36 weeks of the pregnancy due to abnormal CTG records. Diagnosis of esophageal atresia was confirmed and the newborn underwent operation, but unfortunately has died six months later due to infections.

Images 1, 2: 34 weeks, 4 days of gestational age: images show sagittal scan of the fetal neck before (Image 1) and during (Image 2) fetal deglutition. Dilated proximal end of the esophagus can be seen on the Image 2.

 

Videos 1, 2, and 3: 34 weeks, 4 days of gestational age: videos show sagittal scan of the fetal neck. Periodic dilatation of the proximal end of the esophagus ("pouch sign") can be seen during fetal deglutition

 



Image 3 and videos 4, 5: 34 weeks, 4 days of gestational age: the image and video show transverse scan of the fetal abdomen. The fetal stomach is not visible due to lack of its filling in background of esophageal atresia.

 



Images 4, 5, and video 6: 34 weeks, 4 days of gestational age: the images and video show transverse scan of the fetal heart at the level aortic valve - the scanning plane is a bit tilted to depict both aortic and pulmonary valve (drawing on the image 5 shows approximate relation among orifices of the aortic, pulmonary and atrioventricular valves). This relation is better shown on the video 4 as the scanning plane is tilted between aortic and pulmonary orifices.

 

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