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01.12.2011 | Case report | Ausgabe 1/2011 Open Access

Journal of Medical Case Reports 1/2011

Reverse end-diastolic flow in a fetus with a rare liver malformation: a case report

Zeitschrift:
Journal of Medical Case Reports > Ausgabe 1/2011
Autoren:
Antonella Giancotti, Antonella Spagnuolo, Valentina D'Ambrosio, Gaia Pasquali, Brunella Muto, Francescantonio Bisogni, Renato La Torre, Maurizio Marco Anceschi, Fabrizio De Gado
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-5-37) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

AG contributed to the concept and design of the case report; AS contributed to the design of the case report, revisiting the manuscript critically for important intellectual content; VD contributed to the collection and interpretation of data and made a major contributor to writing the manuscript; GP contributed to the collection and interpretation of data and contributed to writing the manuscript; BM contributed to the interpretation of data; FB contributed to the interpretation of data; RLT contributed to the critical writing and revisited the intellectual content; MMA contributed to the critical writing and revisiting the intellectual content; FDG revisited the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Abstract

Introduction

We describe a case of early and persistent reverse end-diastolic flow in the middle cerebral artery in a fetus with severe ascites. These features are associated with a rare liver malformation known as ductal plate malformation.

Case presentation

A 28-year-old Caucasian woman was referred to our high-risk obstetric unit at 24 weeks' gestation for fetal ascites detected during a routine ultrasound examination. During her hospitalization we performed medical investigations, including a fetal paracentesis, to detect the etiology of fetal ascites. The cause of fetal ascites (then considered non-immune or idiopathic) was not evident, but a subsequent ultrasound examination at 27 weeks' gestation showed a reverse end-diastolic flow in the middle cerebral artery without any other Doppler abnormalities. A cesarean section was performed at 28 weeks' gestation because of the compromised fetal condition. An autopsy revealed a rare malformation of intrahepatic bile ducts known as ductal plate malformation.

Conclusion

Persistent reverse flow in the middle cerebral artery should be considered a marker of adverse pregnancy outcome. We recommend careful ultrasound monitoring in the presence of this ultrasonographic sign to exclude any other cause of increased intracranial pressure. To better understand the nature of these ultrasonographic signs, additional reports are deemed necessary. In fact in our case, as confirmed by histopathological examination, the fetal condition was extremely compromised due to failure of the fetal liver. Ductal plate malformation altered the liver structures causing hypoproteinemia and probably portal hypertension. These two conditions therefore explain the severe hydrops that compromised the fetal situation.

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