A 34-year-old gravida was diagnosed with hydrops fetalis, hydrothorax with cardiac compression, hygroma, ascites, and subcutaneous edema at 20 weeks of gestation..

Kohl, Thomas

Qureshi, Adnan I

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CentraCare HealthDigitalCommons@CentraCare HealthArticles Posters and Scholarly Works6-2016Cerebral Venous Engorgement in Hydrops FetalisAdnan I. QureshiCentraCare Health, qureshia@centracare.comThomas KohlUniversity Hospital GiessenFollow this and additional works at: https://digitalcommons.centracare.com/articlesPart of the Neurology CommonsThis Article is brought to you for free and open access by the Posters and Scholarly Works at DigitalCommons@CentraCare Health. It has beenaccepted for inclusion in Articles by an authorized administrator of DigitalCommons@CentraCare Health. For more information, please contactschlepers@centracare.com.Recommended CitationQureshi, Adnan I. and Kohl, Thomas, "Cerebral Venous Engorgement in Hydrops Fetalis" (2016). Articles. 105.https://digitalcommons.centracare.com/articles/105Cerebral Venous Engorgement in Hydrops FetalisAdnan I. Qureshi, MD1 and Thomas Kohl, MD21Zeenat Qureshi Stroke Institute and Departments of Neurology and Neurosurgery, University of Minnesota, and CentraCareHealth, St. Cloud, MN, USA2German Center for Fetal Surgery and Minimally-Invasive Therapy (DZFT), University Hospital Giessen, Giessen, GermanyKeywordsCerebral venous engorgement; fetal ultrasound; hydrops fetalis; minimally invasive therapy A 34-year-old gravida was diagnosed with hydrops feta-lis, hydrothorax with cardiac compression, hygroma,ascites, and subcutaneous edema at 20 weeks of gesta-tion. The peak systolic umbilical artery and middle cere-bral artery velocities were 30 cm/sec and 28 cm/sec,respectively. The umbilical vein demonstrated a low-amplitude blunted waveform. The cerebral venoussinuses were imaged by color Doppler ultrasonographicat low Nyquist limits in transverse planes at the level ofcisterna magna (1). The tentorial venous sinuses (notvisualized routinely) and confluences of sinuses wereboth prominent (Figure 1A). Pulsed-wave Doppler inter-rogation at the confluence demonstrated a low-ampli-tude blunted pulsatile waveform composed of a systoliccomponent and a forward early diastolic component(Figure 1B).The patient underwent thoracoamniotic shunt insertionfor hydrothorax, the removal of ascites, aspiration andFigure 1A.  alcohol ablation of the hygroma, and amniotic fluiddrainage. Follow-up ultrasound on the day after surgerydemonstrated near complete resolution of hydrothorax.Postprocedure peak systolic umbilical artery and middlecerebral artery velocities were 30 cm/sec and 37 cm/sec,respectively. The umbilical vein demonstrated a pulsatilewaveform with a higher velocity after the procedure,compatible with acute cardiac improvement fromimproved filling.On the day after fetal chest drainage, the tentorialvenous sinuses were no longer visualized (Figure 2A).Color Doppler imaging at the confluence of sinusesdemonstrated an increase in signal amplitude and a nor-malization of waveform characteristics with forwardflow in early and reverse flow with atrial contraction inlate diastole; the peak systolic velocity increased from3.5 cm/sec to 10 cm/sec (Figure 2B).Figure 1B.  Vol. 9, No. 1, pp. 66–67. Published June, 2016.All Rights Reserved by JVIN. Unauthorized reproduction of this article is prohibitedCorresponding Author: Adnan I. Qureshi, MD, Zeenat Qureshi Stroke Institute, 1406 6th Ave N, St Cloud, MN 56303, USA qure-shai@gmail.com    Journal of Vascular and Interventional Neurology, Vol. 9The improvement in waveform amplitude and character-istics may be attributable to the resolution of cerebralFigure 2A.  Figure 2B.  venous engorgement by the reduction of intracranialvenous outflow resistance toward the chest and heartfrom thoraco-amniotic shunting as the procedure lowerscentral venous pressures and improves cardiac filling(2). This effect on brain hemodynamics is clinicallyimportant as cerebral venous engorgement may contrib-ute to the occurrence of bilateral thalamic and brainstemnecrosis seen in hydrops fetalis (3).References1. Laurichesse-Delmas H, Grimaud O, Moscoso G, Ville Y. ColorDoppler study of the venous circulation in the fetal brain and hemo-dynamic study of the cerebral transverse sinus. Ultrasound ObstetGynecol 1999;13(1):34–42.2. Tongsong T, Tongprasert F, Srisupundit K, Luewan S. Venous Dop-pler studies in low-output and high-output hydrops fetalis. Am JObstet Gynecol 2010;203(5):488e1–6.3. Szekessy DP, Bamberg C, Blechschmidt C, Kaindl AM, Stolten-burg-Didinger G. In utero development of symmetric thalamic andbrainstem necrosis in a preterm hydropic stillborn. Clin Neuropathol2010;29(6):365–71.Qureshi and Kohl 67Journal of Vascular and Interventional Neurology, Vol. 9

Cerebral Venous Engorgement in Hydrops Fetalis

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Cerebral Venous Engorgement in Hydrops Fetalis

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