2010-04-29-10 Posterior urethral valve syndrome © Al-Asali www.TheFetus.net
Posterior urethral valve syndrome
Othman Al-Asali, MD*, Manal Al-Hakeem, MD**.
29-year-old G3 P2 was referred to our department at 19 weeks of gestation for the second trimester ultrasound scan. Her family and personal history were non-contributive. Both previous pregnancies were uncomplicated and both kids are healthy.
Our ultrasound examination showed a reduced amount of the amniotic fluid. Both kidneys showed signs of moderate hydronephrosis. Urinary bladder was severely distended. The proximal urethra was dilated, (so called "keyhole sign").
The ultrasound findings were suggestive of the posterior urethral valve syndrome.
Parents did not wish for any invasive procedure, such as vesical shunting and wish to continue in their pregnancy.
The subsequent ultrasound at 22 weeks of gestation showed a severely decreased amount of the amniotic fluid, mild amount of free fluid in the abdomen. Proximal urethra, bladder and both ureters were dilated.
The ultrasound examination at 25 weeks showed mild ascites and markedly dilated ureters.
Patient delivered vaginally at 37 weeks of gestation. The male neonate's weight was 1800 grams. There were no apparent anomalies on the clinical examination. The baby died 30 minutes after delivery due to a respiratory failure.
The autopsy was not performed upon the parents request.
Images 1,2: Sagittal view of the abdomen, note the dilated urinary bladder. Transverse view of the abdomen, note mild pyelectasis.
Images 3,4: Image 3 shows pyelectasis. Image 4 shows a dilated renal pelvis with a free fluid under the liver, note arrow.
Images 5,6: Image 5 shows a dilated urinary bladder. Image 6 shows a urinary bladder (*), arrow indicates dilated ureter.
Images 7,8: Image 7 shows urinary bladder with dilated ureters. Image 8 shows a dilated bladder with a "keyhole" sign which is caused by the obstruction of the urethra.
Image 9: 3D-image of the urinary bladder (white arrow) and dilated ureters (*).
* Maternity Department, Al-Hammadi Hospital, Riyadh, Saudi Arabia;
** Department of Radiology, Al-Hammadi Hospital, Riyadh, Saudi Arabia.