070904 CONGENITAL CYTOMEGALOVIRUS INFECTION

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070904 CONGENITAL CYTOMEGALOVIRUS INFECTION

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Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.

Patient: 1 day old female

History: Abnormal low growth on both head and body noted on fetal ultrasound
images, suspicious symmetric intrauterine growth retardation.

Full term with gestational age: 38+4 weeks, G2P2
Birth weight:1780gm.

Images:

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Fig. 1: Non-enhanced CT scan


Fig. 2: Non-enhanced CT scan_axi_1


Fig. 3: Non-enhanced CT scan_axi_2


Fig. 4: Non-enhanced CT scan_axi_3


Fig. 5: Non-enhanced CT scan_axi_4


Fig. 6: Non-enhanced CT scan_axi_5


Fig. 7: Non-enhanced CT scan_axi_6


Fig. 8: MRI_axi_1


Fig. 9: MRI_axi_2


Fig. 10: MRI_axi_3


Fig. 11: MRI_axi_4


Fig. 12: MRI_axi_5

Images:

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large

as-submitted

images only

Findings:

MRI of brain with T1 weighted echo train spin echo, T2 weighted
echo train spin echo, fluid-attenuated inversion recovery echo
train spin echo, MR diffusion imaging, and without intravenous
gadolinium-enhancement; CT scan of brain with multiplanar
reconstruction, and without intravenous contrast:

1. BPD = 84mm; FOD = 98mm
   Cephalic index = (84/98)*100 = 85.7 within normal range.
   HC = (84+98)x1.57 = 285.7mm.
   Estimated gestational age: 28.3-33.7 (31.0) weeks (less than
   true gestational age 38+4 weeks from history), suggest small
   head size.
   Transcerebellar diameter (TCD): 44.0mm.
2. Relative smooth cerebral gyri and shallow sulci, predominant
   over right frontal-parietal lobe, with the appearance about
   33-34 weeks, delayed brain development can be suspected.
   But pachygyria can not be excluded at this time.
3. A long T1 and T2 cystic lesion without mass effect in left
   occipital lobe with adjacent left lateral ventricle occipital
   horn focal dilatation, in favor of encephalomalacia from
   previous brain insult.
4. Diffuse long T1 and T2 signals in bilateral cerebral white
   matter with partial liquefaction, predominant in bilateral
   anterior temporal lobes, white matter edema with necrosis
   can not be excluded.
5. A small short T1 and T2 calcified spot in periventricular
   white matter of right temporal lobe (fig1 and arrows in fig9)
(more obvious on CT scan than MRI). Susoicious a few of
   faint calcified spots in periventricular white matter of
   left parietal lobe.
6. Prominence of CSF space between two leaves of septum pellucidum,
   suggesting cavum septi pellucidi.
   Posterior extension of cavum septi pellucidi below corpus
   callosum and above fornix, suggesting cavum vergae.
7. Persistent metopic suture in midline anterior frontal bone.

Impression:
1. All of above findings (microcephaly, delayed brain development
   with cortical malformation, white matter damage with
   encephalomalacia and calcification) suggesting congenital
   cytomegalovirus infection.
2. Smooth cerebral gyri and shallow sulci, may due to delayed brain
   development, but pachygyria can not be excluded at this time.
3. Recommendation: Follow up with MRI of brain 3-6 months later,
   if clinical necessary. Thank you!

Urine cytomegalovirus polymerase chain reaction (CMV-PCR): positive (not showed on above figures!).

Diagnosis: Congenital cytomegalovirus infection

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