Case report

A 41-year-old woman (7G6P) was sent to our department at 33⁺⁶ weeks of pregnancy due to mild fetal macrosomia, increased head circumference, and polyhydramnios. All tests for gestational diabetes were normal and second trimester ultrasonographic scan was unremarkable. Vascular malformations were not present in the mother's anamnesis.

Our examination revealed arteriovenous malformation of the right middle cerebral artery (see following images).

The newborn was delivered at term by cesarean section. After delivery signs of heart failure were observed and so endovascular coiling was indicated. After the procedure the signs of the heart failure had subsided soon and the newborn has been doing well.

Differential diagnosis

Sturge-Weber-Krabbe-Syndrome; Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu syndrome).

Prognosis

Development of the heart failure during the pregnancy or after delivery determines the prognosis of the finding.

Management

Cesarean section and observation at maternity clinic affiliated with interventional neuroradiology is recommended. Endovascular placement of metallic coils (endovascular coiling) is usually indicated to obliterate arteriovenous shunts.


Images 1, 2: 33⁺⁶ weeks of gestation; color Doppler imaging showing dilated middle cerebral artery and vein.