Intracranial Calcifications

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

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Aug 10, 2016 | Posted by in OBSTETRICS | Comments Off on Intracranial Calcifications

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