First-trimester septated cystic hygroma and cavum velum interpositum cyst.

First-trimester septated cystic hygroma, frequently noted during general obstetric first-trimester screening, is strongly associated with fetal aneuploidy and structural anomalies and is considered an ominous finding. We present the case of a fetus with a first-trimester septated cystic hygroma and cavum velum interpositum cyst.

Sonographic Findings of Medullary Thyroid Carcinoma Leading to Diagnosis of Multiple Endocrine Neoplasia Type 2a during Pregnancy.

Multiple endocrine neoplasia (MEN) type 2a (Sipple's syndrome) is characterized by medullary thyroid carcinoma and pheochromocytoma, and in a smaller percentage of cases, multiglandular parathyroid hyperplasia. This autosomal-dominant syndrome is due to a mutation in the rearranged during transfection (RET) proto-oncogene located on chromosome 10cen-10q11.2 and rarely complicates pregnancy. We present an unusual case in a patient with an enlarged thyroid with sonographic findings characteristic of thyroid cancer, which led to diagnosis and subsequent management of RET proto-oncogene-positive MEN type 2a complicating pregnancy.

Gestational diabetes leading to diagnosis and management of multiple endocrine neoplasia type 2a.

BACKGROUND: Multiple endocrine neoplasia (MEN) type 2a is an autosomal dominant syndrome caused by specific proto-oncogene mutations characterized by medullary carcinoma of the thyroid, pheochromocytoma, and, occasionally, multiglandular parathyroid hyperplasia, which rarely complicates pregnancy. Secondary diabetes rarely has been reported in association with principal endocrinopathies complicating pregnancy. CASE: A 34-year-old primiparous woman with recently diagnosed gestational diabetes had repeated episodes of dizziness at 30 weeks of gestation, initially attributed to glyburide. Continued episodes of dizziness and later-appearing bouts of severe headache, palpitations, diaphoresis, severe hypertension, and marked tachycardia led to diagnosis and management of MEN type 2a complicating pregnancy. CONCLUSION: Patients with MEN type 2a complicating pregnancy may present with gestational diabetes.

Lower extremity claudication resulting from uterine leiomyoma-associated common iliac artery compression.

BACKGROUND: Rarely, uterine leiomyomas have been associated with deep venous thrombosis secondary to compression. Affected vessels include the inferior vena cava and the common iliac, iliac, and distal veins. Arterial compression has not been reported previously. Bilateral uterine artery embolization for symptomatic leiomyomata provides relief of bulk-related symptoms and reduction in menstrual flow. CASE: A 42-year-old woman presented with menorrhagia secondary to a myomatous uterus. Claudication of the right lower extremity was attributed to imaging-confirmed leiomyoma pressure-associated compression of the right common iliac artery. Examination disclosed an absent right common femoral artery pulse. Bilateral uterine artery embolization resulted in long-term resolution of the claudication. CONCLUSION: Claudication of the lower extremity may result from pressure-associated compression of the common iliac artery caused by uterine leiomyomas, and may be amenable to bilateral uterine artery embolization.

Unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy at 25 weeks' gestation.

Abdominal pregnancy is a rare condition in which the fetus and placenta are located within the peritoneal cavity. Sonographic findings include visualization of the fetus separate from the uterus, failure to visualize the uterine wall between the fetus and urinary bladder, close approximation of fetal parts to the maternal abdominal wall, eccentric position or abnormal fetal attitude, and visualization of extrauterine placental tissue. We present an unusual case in which mid-trimester transabdominal color Doppler sonographic findings depicted unusual maternal vasculature in the placental periphery leading to the diagnosis of abdominal pregnancy. Postpartum maternal angiography confirmed these vessels as abnormal maternal arterial perfusion of the extrauterine placenta emanating from the uterine arteries and inferior epigastric arteries. Systematic review of the literature confirms that this is the first report of such sonographic manifestations of an abdominal pregnancy.