EP16.30: Fetal triventricular hydrocephalus associated with different findings in pre‐ and postmortem fetal magnetic resonance imaging: a case report

Abstract

We present a case of fetal triventricular hydrocephalus associated with distinct different findings in the fetal cerebellum and liver when comparing pre- and postmortem fetal magnetic resonance imaging (MRI). A 34-year-old, gravid 2, para 1, woman underwent prenatal ultrasound examination at 22+4 weeks of gestation which showed a triventrucular hydrocephalus, along with hepatic calcification, a hyperechogenic intestine, ascites, mild pericardial effusion, and a white spot in the left ventricle without hemodynamic significance. The ultrasound examination at 13 weeks gestation had been completely normal. TORCH infection screen was negative. The couple declined invasive diagnostic screening for genetic analysis. The prenatal fetal MRI that showed suspicion of cerebellar infarction as the cause of the triventricular hydrocepalus. The liver calcification, with a hyperechogenic intestine, ascites, moderate pericardial effusion, and white spots in the left ventricle were confirmed. After intensive interdisciplinary counselling, the couple opted termination of pregnancy. After delivery the fetus underwent post-mortem fetal MRI, 6 days following the initial scan. This MRI suggested a cerebellar vascular malformation with minimal bleeding and subarachnoid hemorrhage but also showed a novel finding: hemangiomatosis of the liver with minimal bleeding and under perfused liver parenchyma. In conclusion, the use of post-mortem fetal MRI may be useful to identify pathological findings not evident in pre-mortem MRI due in part to the greater precision of the examination. Postmortem examination of the brain is often inconclusive. The use of post mortem MRI instead of autopsy offers a non-invasive way to identify the cause of fetal malformations. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.