Intracranial Calcifications
Paula J. Woodward, MD
DIFFERENTIAL DIAGNOSIS
Common
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Maternal Infection
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Cytomegalovirus
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Toxoplasmosis
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Varicella
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Rare but Important
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Teratoma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Significant overlap in imaging findings of in utero infections
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Intrahepatic and intracranial calcifications most common findings
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Intracranial calcifications may be non-shadowing and subtle
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Requires maternal/fetal serologies to make definitive diagnosis
Helpful Clues for Common Diagnoses
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Cytomegalovirus
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Most common congenital infection
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Main reservoir is children under < 2 years
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Brain most commonly affected area
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Calcifications (predominately periventricular), ventriculomegaly, microcephaly
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Other findings include intrauterine growth restriction (IUGR), hepatosplenomegaly, cardiomyopathy, echogenic bowel and hydrops
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Toxoplasmosis
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Cats are definitive hosts: Oocyst shed in feces
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Human infection from contaminated soil, water, undercooked meats
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Non-shadowing intracranial and intrahepatic calcifications
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Intracranial calcifications may be periventricular or random in distribution
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Other findings include ventriculomegaly, IUGR and echogenic bowel
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Varicella
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Transplacental infection of fetus following maternal chickenpox infection
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Intrahepatic and intracranial calcifications
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May also see liver, heart, renal calcifications
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Polyhydramnios due to neurologic impairment of swallowing
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Limb hypoplasia and contractures
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Paradoxical diaphragmatic motion on real time sonography due to unilateral paralysis
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Cutaneous lesions in dermatomal distribution seen in neonate
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Helpful Clues for Rare Diagnoses
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Teratoma
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Most common brain tumor in fetus
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Obvious, large, destructive mass with cystic and solid components
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Calcification most specific feature but not always present
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Image Gallery
![]() Coronal ultrasound focused on the frontal horns shows periventricular calcifications
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