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Case Reports and Images in Obstetrics and Gynecology

 
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Case Report
 
Prenatal diagnosis of intrahepatic portosystemic shunt in intrauterine growth restricted fetus with transient fetal anemia and cardiomegaly: A case report
Babic I.1,5, Ferretti E.2,4,5, Jimenez-Rivera C3,4,5, Gruslin A.5†, Moretti F.1,5
1MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, General Campus - Ottawa Hospital.
2MD, Division of Neonatology.
3MD, Division of Gastroenterology, Hepatology and Nutrition.
4MD, Children's Hospital of Eastern Ontario.
3MD, University of Ottawa, Canada.
Dr. A. Gruslin passed away prior to writing this manuscript.

Article ID: 100016Z08BI2016
doi:10.5348/Z08-2016-16-CR-9

Address correspondence to:
Dr. Inas Babic
The Ottawa Hospital – General Campus
Division of Maternal-Fetal Medicine, Obstetrics & Gynecology
501 Smyth Road, Ottawa, Ontario
Canada, K1H 8L6

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How to cite this article:
Babic I, Ferretti E, Jimenez-Rivera C, Gruslin A, Moretti F. Prenatal diagnosis of intrahepatic portosystemic shunt in intrauterine growth restricted fetus with transient fetal anemia and cardiomegaly: A case report. J Case Rep Images Gynecol Obstet 2016;2:39–43.


Abstract
Introduction: Congenital intrahepatic portosystemic shunts are abnormal communications between hepatic and portal vessels. We present a case of antenatally diagnosed portohepatic shunt in intrauterine growth restricted (IUGR) fetus with cardiomegaly and transient fetal anemia.
Case Report: A 37-year-old primiparous woman was referred in a late second trimester for fetal growth assessment. Ultrasound revealed IUGR fetus at 9th centile with brain spearing and forward end-diastolic flow in umbilical artery. Middle cerebral artery (MCA) peak systolic velocity (PSV) Doppler was high for the gestational age, possibly representing fetal anemia. Fetal liver was enlarged with abnormal circulation consisting of tortuous dilated intrahepatic vessels originating from the umbilical vein and giving off several branches with no clear end point communication sites. Fetal echocardiography showed mild cardiomegaly with hyperdynamic flow state possibly related to fetal anemia. A vigorous baby was delivery at 38-week, weighing 2880 grams. Postnatal abdominal ultrasound confirmed mild hepatomegaly with abnormally dilated middle hepatic vein branch communicating with left portal vein, representing intrahepatic portosystemic shunt. The neonatal course was uneventful and the child was discharged home at two weeks of life. One year follow-up ultrasound showed spontaneous resolution of intrahepatic portosystemic shunts.
Conclusion: Our case of IUGR was probably related to intrahepatic shunt with increased preload causing cardiomegaly, and not driven by hypoxia. Transient fluctuating high MCA PSV Doppler was likely related to the hyperdynamic flow and not fetal or neonatal anemia, so transfusions were not required. IUGR fetuses without chromosomal or placental related pathologies should have thorough evaluation of the hepatic circulation to detect crucial congenital malformations and provide proper counseling.

Keywords: Cardiomegaly, Doppler, Fetal anemia, Growth restriction, Portosystemic shunt


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Author Contributions
Babic I. – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ferretti E. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Jimenez-Rivera C. – Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Gruslin A. – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Passed away prior to drafting the manuscript, however provided a substantial input in choosing the case for a publishable manuscript
Moretti F. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Babic I. et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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