Detection of an aneurysm of the vein of Galen following signs of cardiac overload in a 22-week old fetus.
OBJECTIVE
To present early prenatal diagnosis of an aneurysm of the Vein of Galen by detecting signs of cardiac overload in a 22-week old fetus.


METHODS
We report on a 22-week old fetus presenting with dilation of the heart, tricuspid and mitral valve regurgitation, reversed flow in the aortic arch and dilated neck vessels. Evaluation of the fetal brain revealed a dilated left ventricle, signs of brain hemorrhage and an anechoic structure between the two hemispheres.


METHODS
By using the conventional Doppler technique, an intracerebral fistula and dilated vein of Galen was visualized. The complex vascular structure was demonstrated using 3-D color power angiography (3-D CPA). To our knowledge, this is the earliest diagnosis of this vascular malformation.


CONCLUSIONS
Although signs of cardiac overload rarely appear before the third trimester in cases of arteriovenous fistulae, it was shown that these signs could lead to the correct diagnosis of an aneurysm of the vein of Galen. Additionally, we show that 3-D CPA is a promising technique to visualize complex vascular structures and make them easier to understand.
Hartung
J
J
Unit of Fetal Medicine, Department of Gynecology and Obstetrics, Charité University Hospital, Berlin, Germany. john.hartung@t-online.de
Heling
K S
KS
Rake
A
A
Zimmer
C
C
Chaoui
R
R
D000025:Abortion, Eugenic; D000328:Adult; D002303:Cardiac Output, Low / Q000151:congenital / Q000000981:diagnostic imaging* / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging*; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008423:Maternal Age; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D018566:Pregnancy, High-Risk; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D016216:Ultrasonography, Prenatal