Department of gynecology, Félix Guyon hospital, 97400 Saint-Denis, Ile de la Réunion, France.

Case report:

This is a 26-year-old woman, G1P0, with unremarkable familial history. Her ultrasound scan at 13 weeks was normal (NT = 1 mm, CRL = 60 mm). The triple test was 1:10.000.

Ultrasound at 22 weeks suspected sexual dysmorphology with first confirming female-like genitalia. The patient was referred to us at 23 weeks. We observed isolated genital abnormalities. According to us, the gender seemed masculine (figure 1-4). 3D sonography confirmed our suspicion (figure 5). 

At 26 weeks, we did not observe minor or major labia as well as hypertrophy of the clitoris but scrotum with testicles. Bladder and kidneys were normal.The follow-up ultrasounds show the same findings. The penile shaft seemed bent and the testes were present without cryptorchidy (figure 6-9). A tulip sign was typical. Scrotum seemed bifid (figure 10-13).

After counseling, the parents decided to perform an amniocentesis. An amniocentesis was done at 32 weeks (46 XY). The end of the pregnancy was normal.

After delivery, diagnosis confirmed isolated hypospadias (figure 14,15). The hormonal examination was normal. Surgery was performed after a few months.  

Figure 1-4: The gender seemed masculine.

Figure 5: 3D ultrasound

Figure 6, 7, 8, 9: At 26 weeks and later.

Figure 10-13: Scrotum seemed bifid. 

Image 14-15 : Postnatal images