BMJ 2017;356:j688 doi: 10.1136/bmj.

j688 (Published 2017 February 23) Page 1 of 2

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SPOT DIAGNOSIS

Abnormality in a fetus on ultrasound

1 2
Yong-Hai Zhou consultant paediatrician , Ming-Hua Zheng consultant hepatologist
1
Department of Pediatrics, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China;
2
Department of Hepatology, Liver Research Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

A pregnant 18 year old woman had an antenatal examination
at 30 weeks’ gestation. She was healthy and had no history of
smoking, drug abuse, or positive family history of chromosomal
disease or encephalodysplasia. She had experienced mild flu-like
symptoms during the first month of pregnancy but had not taken
any medication, and the symptoms had disappeared after three
days. During the antenatal appointment she had an ultrasound
scan (fig 1). What does the ultrasound image show?
(fig 2a, arrow C; fig 2b, arrow D) can be seen floating within
the ventricle (a “dangling choroid.”) The incidence of
hydrocephalus/ventriculomegaly is about one per 1500 live
births.2 Causes of fetal hydrocephalus include aqueductal
stenosis, neural tube defects, arachnoid cysts, Arnold-Chiari
malformation, and Dandy-Walker syndrome. The diagnosis can
be made antenatally on ultrasound. The prognosis depends on
causes and associated anomalies. Antenatal shunting should be
considered for those with progressive ventriculomegaly and
without severe malformations.

Fig 1 Ultrasound imaging of fetal brain at 30 weeks’

gestation
Answer
The US image shows enlarged lateral ventricles when measured
with reference to biparietal diameter, suggesting hydrocephalus.
Fetal hydrocephalus is measured as the ventricular diameter
compared with biparietal diameter.
Discussion
The ultrasound image shows enlarged lateral ventricles
compared with the standard biparietal diameter. The width of
the left ventricular posterior horn is 24 mm (fig 2a, arrow A)
and the width of the right one is 20 mm (fig 2b, arrow B).
Normal fetal lateral ventricular diameters are less than 10 mm.
A diameter ≥15 mm confirms a diagnosis of fetal
hydrocephalus,1 but lateral ventricular diameters of between 10
mm and 14 mm should also arouse suspicion of fetal
hydrocephalus. A separation of 3 mm or more of the choroid
plexus from the ventricular wall is another indication of
hydrocephalus/ventriculomegaly. In this case, the choroid plexus
Fig 2 Typical signs of fetal hydrocephalus: the left
ventricular posterior horn (arrow A) and right lateral
ventricle (arrow B) are widened, and the choroid plexus is
floating (a “dangling choroid”) (arrows C, D)
Learning points
Fetal hydrocephalus is most commonly diagnosed on antenatal
ultrasound. Fetal magnetic resonance imaging is a useful
alternative tool to guide diagnosis of fetal hydrocephalus. Early
diagnosis allows for antenatal intervention/treatment.
Patient consent obtained.
We have read and understood the BMJ policy on declaration of interests
and declare the following interests: We have no conflicts of interests.
1 Wyldes M, Watkinson M. Isolated mild fetal ventriculomegaly. Arch Dis Child Fetal Neonatal
Ed 2004;356:F9-13. doi:10.1136/fn.89.1.F9 pmid:14711845.
2 Persson EK, Anderson S, Wiklund LM, Uvebrant P. Hydrocephalus in children born in
1999-2002: epidemiology, outcome and ophthalmological findings. Childs Nerv Syst
2007;356:1111-8. doi:10.1007/s00381-007-0324-7 pmid:17429657.

Correspondence to M-H Zheng zhengmh@wmu.edu.cn

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