Case of the Week # 516

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Fabien Ho, MD1; Fabrice Cuillier, MD2; Tailon M, Mrs3

March 12, 2020 - March 26, 2020

1. Radiologist, private sector, 97400 Saint-Denis, Reunion Island, France.
2. Department of Obstetrics, Felix Guyon Hospital, Reunion Island, France.

Case report

This patient had been referred to our hospital after an unusual finding at 31weeks of pregnancy on the 3rd trimester ultrasound screening (according to french guidelines). Previous personal, familial and obstetrical history was non relevant.

Our sonography examination at 31 and 34 weeks of pregnancy revealed the following anomalies:

31 weeks of pregnancy

Images 1-4.

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31 weeks of pregnancy

Images 5-8; videos 1 and 2.

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Answer

Case report

This patient had been referred to our hospital after an unusual finding at 31weeks of pregnancy on the 3rd trimester ultrasound screening (according to french guidelines). Previous personal, familial and obstetrical history was non relevant.

Our sonography examination at 31 and 34 weeks of pregnancy revealed a cord varix, complicated with thrombosis at 34 weeks. The thrombus can be seen within the lumen as slightly echogenic material, in central location, spinning as the blood flows on its sides. Color Doppler with appropriate PRF settings does depict well the blood flowing on the sides of the thrombus. We feared for fetal demise within the next hours, should the thrombus become occlusive or generate emboli in the blood stream. Therefore, we performed an emergency C-section at 34 weeks, giving birth to a healthy newborn.

Cord varix is a rare condition characterized by focal dilation of the umbilical vein that can occur in the intrahepatic portion of the vein or in an extrahepatic location. The prognosis is slightly worse if cord varix is identified early in pregnancy or if there are associated fetal anomalies. Although most cases have a favorable outcome, fetal death is attributed to formation of a thrombus in the dilated segment of the vein that blocks fetal venous circulation. A fetus with cord varix should be monitored with serial US examinations from diagnosis to delivery. If other fetal anomalies are detected, fetal karyotyping should be considered to diagnose or exclude aneuploidy. Fetal echocardiography usually is indicated because cord varix is associated with fetal cardiac abnormalities.

31 weeks of pregnancy

Images 1-4: 2D and color Doppler images show an umbilical extrahepatic varix.

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31 weeks of pregnancy

Images 5-8; videos 1 and 2: 2D and color Doppler images show the umbilical vein varix, complicated with a mural thrombus.

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