2007-11-30-13 Answer to the case of the week #216 © Riano www.TheFetus.net
Answer to the case of the week #216
April 10, 2008 - April 24, 2008
Parinatology Unit, Villavicencio, Meta, Colombia.
Case report
27 years old patient, G2P1, with noncontributive history, referred to our antenatal unit at 20 weeks due to a fetal megacystis seen during her first trimester ultrasonographic examination. No further intervention or additional investigations were done. During the examination we found:
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a normal amount of the amniotic fluid;
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male gender of the fetus with the dilatation of the fetal urethra;
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dilated thick-walled urinary bladder;
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bilateral dilatation of the ureters;
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hyperechoic kidneys of normal size;
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right clubfoot of the fetus.
The patient was rescanned at 33 weeks and the findings had changed:
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the dilatation of the urethra had disappeared and the penis seemed to have redundant prepuce;
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the amount of the amniotic fluid was normal;
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the urinary bladder and ureters were without changes;
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the size of the kidneys was below the fifth percentile, with hyperechoic appearance and lost of the corticomedullary differentiation.
Based on the findings we presumed a meatal atresia with consequent resolution of the urethral dilatation via urethra-preputial fistulation.
The baby was delivered at 37 weeks and the diagnosis was confirmed. A vesical derivation was practiced. The baby underwent several episodes of urinary infections. Six months after delivery he has increased seric concentrations of creatinine and urea, but his status didn"t require a dialysis till now.
20 weeks
Images 1, 2: The images show dilated fetal urethra.