Radiology Teaching Files > Case 10791895

Contributed 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.

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

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.

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
great case, thanks :)--Larisa W, 2009-05-04
Additional Details:

Case Number: 10791895Last Updated: 2011-06-09
Anatomy: Cranium and Contents   Pathology: Infection
Modality: CT, MRAccess Level: Readable by all users
Keywords: cytomegalovirus, infection, polymerase, encephalomalacia, calcificationACR: 138.2066

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