Whale's tail sign in fetus with coronary sinus total anomalous pulmonary venous connection

Abstract

A 28-year-old primigravida was referred at 25 weeks' gestation for fetal cardiac evaluation. The four-chamber view showed significant ventricular disproportion due to right heart dilatation and a dilated coronary sinus (Figure 1a). The post-left atrial (LA) space index was 0.43 and the LA posterior-space-to-diagonal ratio was 0.18, of which both were below their respective cut-offs Figure 1 Imaging in fetus with coronary sinus (CS) total anomalous pulmonary venous connection at 25 weeks' gestation. (a) Grayscale ultrasound image in four-chamber view, showing significant ventricular disproportion due to right heart dilatation and dilated CS. (b-d) Color Doppler (b,c) and four-dimensional spatiotemporal image correlation with HD-live color silhouette selective-volume rendering (d) of three-vessel-and-trachea view (b) and transverse plane at level of left brachiocephalic vein (LBCV) (c,d) were normal. (e,f) Grayscale (e) and color Doppler (f) examination of four-chamber view, showing anomalous direct drainage of all pulmonary veins (PV) into dilated CS without a connecting vein, resembling whale's tail. (g) Spectral Doppler waveform of PV showing normal triphasic pattern.

Four‐dimensional imaging of fetal infracardiac total anomalous pulmonary venous connection with double drainage

“…Accurate prenatal detection of TAPVC has been made increasingly feasible due to improvements in ultrasound technology 1 . STIC with Doppler ultrasound can visualize pulmonary venous flow in three dimensions, which enables accurate diagnosis of pulmonary venous drainage abnormalities [2][3][4] . According to the Darling classification, there are four types of TAPVC: supracardiac, cardiac, infracardiac and mixed 5 .…”