Contributed by
Nemours Children's Hospital
Sukriti Chaudhri, Kriti Gwal, Lauren May, and Jennifer Kucera .
History
A 23-year-old healthy primigravida female presented at 19 weeks gestation for a fetal anatomy scan. A review of her prenatal records was unremarkable with no family history of congenital malformations, birth defects, or chromosomal abnormalities. Abnormal findings on fetal anatomy ultrasound warranted fetal MRI, which was performed at 24 weeks gestation, revealing a number of abnormalities.
Top row: Transverse, Sagittal, and Oblique Coronal US images showing [A] bilateral hyperechoic lungs (green asterisks) with centralization of heart (red arrowhead), [B] echogenic lung with a flattened hemidiaphragm (purple arrow), and [C] a fluid filled dilated trachea (green arrowhead)
Bottom row: Coronal [D] and sagittal [E] T2- weighted SSFSE (single shot fast spin echo) images show a fluid filled dilated trachea (white arrow) and mainstem bronchi with upstream obstruction at the level of the larynx (yellow arrow), enlarged T2 hyperintense lungs, and flattened diaphragms (purple arrow).
Coronal [F] and axial [G] T2-weighted single shot fast spin echo (SSFSE) images show normal left renal parenchyma (orange arrowhead) and a multicystic dysplastic right kidney (pink arrowhead) with suggested fusion of the lower pole of the kidneys at the midline. Ascites is also present (green asterisks). Axial diffusion weighted image [H] confirms the horseshoe configuration of kidneys.
Axial T2-weighted SSFSE images show skin covering the globes (green arrows) in [I]. Subcutaneous edema is also identified at the scalp soft tissues in [J] (red arrowheads).
4 chamber view in fetal echo without [K] and with doppler [L] revealed a ventricular septal defect (green arrowhead). There was also presence of only one bone (radius or ulna) in the right forearm (pink asterisks) [M] while both the radius and ulna were seen in the left forearm [N].
Question
The fetus is most likely affected by which of these conditions?
