Case of the Week #580

VC Vandanaa
Shukran Diagnostics Private Limited

Posting Dates: Apr 17, 2023 - Apr 29, 2023

27-year-old primigravida presented at 13 weeks, 2 days gestation for a routine Nuchal translucency scan.  There was no history of consanguineous marriage or comorbidities.

Image 1
Video 1 © 2023 Vandanaa
Image 2
Video 2 © 2023 Vandanaa
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We present a case of Spina Bifida with Lumbosacral meningomyelocele and bilateral talipes equinovarus deformity.

Ultrasound revealed the following findings:

  • Sagittal image of the spine shows a small sac with neural elements. The sac approximately measures 1.1 x 0.6 x 0.8 cm (Image 1, Video 1). Axial image of the spine shows divergence of the posterior arches at the lumbosacral level (Image 2, Video 2).
  • Cisterna magna could not be visualized and fluid is not seen.  There is tight compression of the cerebellum over the occipital bone and the cerebellum is wrapped around the brainstem. Ventricles appear pointed. There is the Lemon sign and Banana sign (Image 3).
  • Intracranial translucency is absent. The occipital bone, fourth ventricle, anterior and posterior brain stem demarcation forming four lines is absent. (Image 4).
  • The lower extremities are persistently flexed at the knee joint and crossed at the ankles with no motion (Image 5).
  • Corresponding 3D images showing and confirming the findings seen in 2D imaging (Image 6-8).

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