Linear Hyperechoic Lesions in the Thalami and Basal Ganglia of Neonates and Infants:A Sonographic Finding of Vasculopathy and Clinical Significance

ABSTRACT

PURPOSE: This study is to evaluate the clinical significance and possible etiologies of abnormal neurosonographic findings that revealed linear or branching linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants. METHODS: Analysis of 2,866 cranial sonograms (US) and doppler ultrasonography obtained from 1,150 patients identified 53 patients with linear hyperechoic vascular lesions in the thalami or basal ganglia. Patients with only punctate or coarse, nonlinear lesions of echogenicity in these lesions were excluded. Clinical records in 53 patients were reviewed for documentation of congenital cytomegalovirus (CMV) infection, rubella, syphilis, toxoplasmosis, chromosomal abnormality and other major diagnoses. Brain computed tomography (CT) had been performed in 23 of the 53 patients and these images were compared with the cranial sonograms. RESULTS: There were five CMV infection, two congenital syphilis, three Down syndrome, and one Patau syndrome patients. Other major diagnoses encountered included perinatal asphyxia, ventriculomegaly, intraventricular hemorrhage, periventricular leukomalacia, small-for-gestational age, prematurity with hyaline membrane disease, multiple congenital anomalies, neonatal seizure, meningitis, congenital choroid plexus cyst, neonatal hyperbilirubinemia, congenital heart disease, bronchopulmonary dysplasia and others. Brain CT found small calcification in basal ganglia from one patient. Resolution of lesions found in 5 cases with follow-up US studies. CONCLUSION: A broad etiologic basis for linear hyperechoic vascular lesions in the thalami and basal ganglia of neonates and infants indicates complete screening for possible various etiologies.