Document Type : Case Report
Authors
1 Department of Obstetrics and Gynecology,Peking Union Medical College Hospital, Beijing, China
2 Department of Ultrasound (Qing Dai), Peking Union Medical College Hospital, Beijing, China
3 Department of Radiology, Peking Union Medical College Hospital, Beijing, China
4 4Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
Abstract
Keywords
Fetal dural sinus thrombosis is a rare finding because most pregnancies are terminated without a long-term follow-up. There are few reported cases and the prognosis is difficult to establish. Recently, there have been some reports of infants being born with normal neurological outcomes despite suffering from fetal dural sinus thrombosis, suggesting the favourable evolution of this disorder (
A 29-year-old woman (gravida 1, papa 0) was referred to our hospital at 31 weeks of gestation because of a suspected presence of a posterior fossa cyst identified during a routine third-trimester ultrasound examination. The patient and her husband’s medical records were unremarkable. Maternal serum screening for Down’s syndrome in the second trimester represented low risk and the ultrasound at 12 and 20 weeks of gestation revealed no abnormalities.
Ultrasound image (axial plane) of the fetal head at 32 weeks of gestation shows a cystic mass measuring 2.16×1.05cm at posterior fossa.
Ultrasound examination was repeated in our hospital and revealed a cystic mass measuring 2.16 × 1.05 cm in the posterior midline portion of the fetal brain (
Fetal magnetic resonance imaging (MRI was recommended to get more information. MRI at 32 weeks gestation showed a isolated triangle occipital mass measuring 2.5 × 2.4cm along the posterior surface of the brain with high signal intensity on T2 weighted MRI with occipital lobe compressed forward and superior longitudinal sinuses dilated (
MRI images of the fetal head at 32 weeks’s gestation shows a triangle dural sinus thrombosis measuring 2.5×2.4cm at torcular. A. T2 weighted image at axial plane with high signal intensity, B. T2 weighted image at sagittal plane shows dilation of the superior longitudinal sinus.
After a genetic counseling session where all the possible fetal outcomes were explained fully to the parents, they decided to continue the pregnancy. At 39 weeks of gestation, fetal MRI was repeated which showed the thrombosis had shrunk significantly without causing any brain compression (
MRI images of the fetal head at 39 weeks’s gestation shows the torcular thrombosis becomes smaller than before. A. T2 weighted images at axial plane, B. T1 weighted image at axial plane.
MRI images of neonate head three days after cesarean delivery shows further shrinkage of the torcular thrombosis (T2 weighted images at axial plane).
Thrombosis of the dural sinuses most often affects young adults, children and infants (
So far the cause of fetal dural sinuses thrombosis hasn’t been identified. Trauma, thrombophilia, or dural sinus malformation have been related to dural sinuses thrombosis in infants (
Most cases of fetal dural sinus thrombosis were diagnosed using ultrasound imaging and confirmed usingMRI (
Possible prognosis of fetal dural sinus thrombosis has crucial influence on prenatal consultation and decision-making. Of the 14 cases, 4 pregnanies terminated, 10 were live birth with 6 vaginal and 4 cesarean delivery. Two infants died postnatally, one of which died of DSM progression (
On the base of available evidences, we suggest that conservative treatment is appropriate to prenatal diagnosed dural sinus thrombosis with favorable prognostic factors mentioned above. Serial MRI or ultrasound should be taken every 1-2 months to monitor the thrombosis development and fetal well-beings.
All authors have no conflict of interest regarding this paper.