Differential diagnosis in fetuses with absent septum pellucidum.
OBJECTIVE
To elucidate the characteristic morphological features that may help in the prenatal differential diagnosis of absent septum pellucidum as demonstrated by ultrasound.


METHODS
Twenty-six fetuses were referred to the fetal neurology clinic due to mild to severe ventriculomegaly and a connection between the lateral ventricles. The following ultrasonographic features were evaluated: place and extent of the ventricular communication, non-cleavage of the hemispheres and deep gray nuclei, callosal anomalies, position of the choroid plexus, and other central nervous system and facial or body anomalies. A flowchart was created in order to facilitate the final diagnosis.


RESULTS
The presence of non-cleavage and/or characteristic facial anomalies prompted the diagnosis of holoprosencephaly (HPE) in 14 fetuses, including two fetuses with the middle interhemispheric variant. Ten fetuses were diagnosed as having hydrocephalus based on the lack of the same features and the observation that the communication between the lateral ventricles was at the level of the third ventricle with almost normal anterior and posterior segments. In two fetuses the diagnosis of septo-optic dysplasia vs. isolated agenesis of the cavum septi pellucidi was contemplated.


CONCLUSIONS
The use of the proposed flowchart enabled differentiation between hydrocephalus and HPE. The communication between the ventricles in hydrocephalic fetuses may be due to a disruption of the septum pellucidum or to a pathological enlargement of the foramen of Monro. Published by John Wiley & Sons, Ltd.
Malinger
G
G
Fetal Neurology Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon 58100, Israel. malinger@inter.net.il
Lev
D
D
Kidron
D
D
Heredia
F
F
Hershkovitz
R
R
Lerman-Sagie
T
T
D003937:Diagnosis, Differential; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000473:pathology; D011247:Pregnancy; D012688:Septum Pellucidum / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology; D012985:Software Design; D016216:Ultrasonography, Prenatal