Case report 1:
CMV fetopathy: subependymal germinolyse cyst at 36 weeks.
Fabrice Cuillier, MD, Mardamootoo D. Midwife
Department of Gynecology, Felix Guyon Hospital, 97400 Saint-Denis, Reunion’ Island, France.
This is a 34-year-old-woman, G3P2, with no known obstetric risk factors and with no relevant medical history. The patient did not develop fever during the first and second trimester of pregnancy. The nuchal translucency was 1 mm
for 54 mm CRL. The triple test was 1:2000. The fetal growth was normal. The second scan at 22 weeks was normal.
At 32 weeks, the third sonography showed bilateral cerebral ventriculomegaly (16 mm) (Image 3, 4). Maternal viral serology revealed old immunization concerning Toxoplasmosis, Rubella and Herpes. The Kleihauer test was negative. However, CMV seroconvertion was noted.
Unfortunately, we saw this patient late, at 36 weeks. The ultrasound showed normal corpus callosus (Image 1, 2) and bilateral sub-epidermal germinolysis cyst on bilateral ventricular floor (Image 5, 6). Coronal view showed the same anomalies. Hyperechoic bowels were absent ( Image 7), as intrauterine growth restriction.
An amniocentesis was performed in emergency. Fetal karyotype was normal, but we found CMV on the amniotic fluid by
PCR technique. At 37 weeks, the ventriculomegaly has increased. A fetal cerebral MRI was done: All the anomalies were confirmed.
The patient consulted a neuro-pediatrician for explanation about the poor fetal neurological prognosis (failure to thrive, infantile spasms and seizures, deafness, etc…). The patient decided to end pregnancy at 37 weeks.
Image 1, 2: Normal corpus callosus
Image 3, 4: Ventriculomegaly
Image 5, 6: Bilateral sub-epidermal germinolysis cyst on bilateral ventricular floor
Image 7: Hyperechoic bowels were absent
This is the first pregnancy. The first ultrasound was normal. The second one at 23 weeks showed remarkable ascite and small head with relative ventriculomegaly, destruction of septum pellucidum, small cerebellum; calcified foci in brain, liver and splenic area.
Amniocentesis was performed for CMV analysis by PCR.
Termination of pregnancy is decided.
Image 8, 9: Small head and abdominal ascite
Image 10, 11: Relative ventriculomegaly and destruction of septum pellucidum
Image 12, 13: Small cerebellum
Image 14, 15: Calcified foci in brain, liver and splenic area.