Echogenic vessels in the fetal thalami and basal ganglia associated with cytomegalovirus infection

Abstract

MDBranching Jinear echogenic areas in the thalami and basal ganglia of neonates have been reported in asso· dation with congenital infection, chromosomal abnormality, and anoxic or toxic injury to the developing brain. 1 -6 To our knowledge, such linear areas . in the thalami and basal ganglia have not been reported in the fetus. We describe a case of congenital cytomegalovirus infection discovered antenatally by the obser· vation of hyperechoic foci in the cerebral cortex and branching linear areas of echogenicity in. the basa) ganglia. CASE REPORTA 28 year old gravida 2, para 2 Hispanic woman was referred for prenatal sonography because of diaphragmatic hernia in a previous child. At 20 weeks, the structural fetal survey showed a hyperechoic rim in the periphery of the fetal cerebral cortex. Subsequent maternal serologic results were consistent with active cytomegalovirus (CMV) infection during pregnancy. The patient returned at 31 weeks, and a repeat scan was performed using the transvaginal probe for better visualization of the fetal head in deep vertex position. Branch· ing linear areas of echogenidty were seen in the fetal thalami,

Neonatal Periventricular Leukomalacia Preceded by Fetal Periventricular Echodensity

“…Cytomegalovirus infection, which was reported to show high echogenicity of fetal brain [12], was not found in the 63 cases.…”

Contribution of Transvaginal Ultrasonography and Fetal Cerebral MRI in a Case of Congenital Cytomegalovirus Infection

“…Color Doppler studies strongly suggest that these images correspond to the thickened wall of the vessels in these areas. This sign has been reported antenatally only once before [11]. It is not specific to CMV infection, being also seen in chromosomal anomalies (trisomy 13 and 21), other infections (rubella, syphilis or bacterial meningitis), ischemic disease, nonimmune hydrops or in fetal alcohol syndrome [12,13].…”

Imaging of Fetal Cytomegalovirus Infection

“…Of 27 fetuses with abnormal US findings, US depicted ventriculomegaly/lateral ventricle dilatation in 9 while MRI diagnosed this condition in 14. In a similar study, Benoist et al examined 49 fetuses at a mean gestational age of CMV diagnosis of 31 weeks (range [27][28][29][30][31][32][33][34][35][36][37][38], and found cerebral lesions in 19. Ventriculomegaly was present in 9 and 5 fetuses by the time of the US and MRI examinations, respectively [15] .…”

“…Fetuses with ventriculomegaly were identified at a more advanced gestational age than those without ventriculomegaly [whole group mean gestational age 27.5 weeks (range 22-37); normal ventricular width group 24.3 weeks (range [22][23][24][25][26]; ventriculomegaly group 28.6 weeks (range [22][23][24][25][26][27]]. All fetuses with ventriculomegaly had associated findings.…”