2012-07-23-16 Subependymal pseudo-cyst, bilateral ©Fabric Cuillier www.TheFetus.net
Subependymal pseudo-cyst, bilateral
* Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
** Department of Radiology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
A woman was referred to our antenatal unit at 33 weeks for ultrasound examination. This was the first pregnancy of a non-consanguinous couple. Her husband has two healthy children.
The first sonography screening was performed at 13 weeks (nuchal translucency = 1 mm / LCR = 68 mm). The triple test was 1:1500. At 33 weeks, the fetus presented several anomalies :
- Particular facial profile with accentuation of naso-frontal angle. 3D facial sonography confirmed the profile.
- Bilateral ventriculomegaly, with a dilatation of 14 mm and 11 mm. Corpus callosum was, however, normal.
- Moderate third ventricular dilatation
- Germinolysis cyst on the ventricular floors on both sides
- Normal spine
Maternal serological tests were performed including Toxoplasmosis, Rubeola, Parvovirus B19, HIV, CMV (immunized), Herpes (immunized), Coxackie and Chikungunya. All theses maternal results were negative. Kleihauer test was normal also. Maternal anti-platelet antibodies were absent.
A fetal cerebral MRI was performed. The frontal horn of the lateral ventricles appeared dilated on T2-weighted sequences. Cysts were found laterally on the ventricle floor on the parasagital and coronal planes. On T1 and T2 weighted sequences, cerebral myelinization seemed abnormal, with signal anomalies behind ventricular occipital horns. There were signs of T2 hypersignal and T1 hyposignal of the white substance, behind the occipital horns of the lateral ventricles and the central part.
The diagnosis of subependymal pseudocysts was, of course, suggested. Amniocentesis was proposed. Karyotype was normal. But CMV ADN was found in the amniotic fluid.
At 35 weeks, the lateral ventricular dilatation (d # 15 mm) as well as the size of the cysts increased (d # 6mm). The parents decided to end the pregnancy at 36 weeks.
Figure 1, 2: Particular facial profile with accentuation of naso-frontal angle
Figure 3: 3D facial sonography confirmed the profile
Figure 4, 5: Bilateral ventriculomegaly and normal corpus callosum.
Figure 6, 7: Corpus callosus was normal with moderate third ventricular dilatation
Figure 8-11: Germinolysis cyst on bilateral ventricular floors.
Figure 12-13: At 35 weeks, the lateral ventricular dilatation (d # 15 mm) as well as the size of the cysts increased (d # 6mm):