Case of the Week # 160

Carlos A Elorza, MD, Maria Alejandra Giuricich, MD, Carolina Zehnder Dendia, MD

February 03 - February 16

Carlos A Elorza, MD*, Maria Alejandra Giuricich, MD#, Carolina Zehnder Dendia, MD#

* Chief of Echography Department, Staff member, Hospital Italiano Garibaldi, Virasoro 1249. Rosario, Santa Fe. CP S2000-ODA. Argentina

This is a scan of a 26-year-old woman, G3P2 performed at 33 weeks of gestation. There is no significant past medical or obstetric history.

If you do not have 4DView or the special 4DFetusView, you can get those from Tools > Computer Pearls > 4DFetusView or simply by clicking: 4DFetusView

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Answer

Case report: A 26-year-old woman, gravid 3, para 2, underwent ultrasound examination at 33 weeks of gestation. Previous scan at 13 and 20 weeks, performed at another institution, were reported as normal. The patient had neither familiar nor congenital malformations, and she refused undergoing an amniocentesis.

The 2D and 3D ultrasonographic images showed a single bone in the right forearm, it being the ulna, and an apparent radial proximal bone. The ulna appeared arcuated. The homolateral hand presented a radius-palmar deviation, being the carpus clearly seen but not the rest of the fingers, nor the thumb. The left upper limb showed no echographic alterations. No structural associated malformations were found neither in the lower limbs nor in any other fetal organs. The kidneys were in their usual place. Polyhydramnios was detected, having a 20cm AFI for a 12cm average at 33 weeks, as the only associated alteration.

Post-natal radiographic studies confirmed the findings described on the right upper limb. Post-natal ultrasonographic test did not show any associated malformations at renal level.

These is a  view at 33 weeks, including a 4D volume.

If you do not have 4DView or the special 4DFetusView, you can get those from Tools > Computer Pearls > 4DFetusView or simply by clicking: 4DFetusView

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The findings were consistent with radial ray aplasia.

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