ULTRASOUND FINDINGS IN CMV INFECTION

CNS FINDINGS

• Intracranial calcifications (1,2).
• Seen from second trimester onward.
• Bilateral, and situated in basal ganglia, thalami and brain parenchyma.
• Periventricular echodensities (may not cast an acoustic shadow) (3)

• Ring like areas of periventricular lucency is probably the earliest sign of CMV infection prior to the development of calcification.
• Branching linear echogenic areas in the thalami and basal ganglia corresponding to arteries (4,5).

• Microcephaly / Hydrocephalus / Lissencephaly.

• Cerebellar hypoplasia and a large cisterna magna.
• Cerebellar calcification.

• Paraventricular cysts (6,7) (due to subependymal necrosis and glial reaction).
• Ischemic destructive lesions such as porencephaly, hydranencephaly and polymicrogyria (8).

NON CNS FINDINGS (9-11)

• IUGR (21-50%).
• Fetal hepatosplenomegaly.
• Liver calcification.

	Placental calcifications at 18 wks GA

• Fetal ascites (12).
• Cardiac malformations.
• Meconium peritonitis (13).
• Echogenic fetal kidney (14).
• Echogenic bowel (15).

• Polyhydramnios.

REFERENCES

1. Graham D, Guide SM, Saunders RC. Sonographic features of in utero periventricular calcification due to cytomegalovirus infection. J Ultrasound Med 1982;1:171-172.
2. Ghidini A, Sirtori M, Vergani P et.al. Fetal intracranial calcifications. Am J Obstet Gynecol 1989;160:86-87.
3. Fakhry J, Khoury A. Fetal intracranial calcifications. The importance of periventricular hyperechoic foci without shadowing. J Ultrasound Med 1991;10:51-54.
4. Estroff JA, Parad RB, Teele RL et.al. Echogenic vessels in the fetal thalami and basal ganglia associated with cytomegalovirus infection. J Ultrasound Med 1992;11:686-688.
5. Teele RL, Hernaz-Schulman M, Sortel A. Echogenic vasculature in the basal ganglia of neonates: a sonographic sign of vasculopathy. Radiology 1988;169:423-427.
6. Achiron R, Pinchas-Hamiel O, Lipitz S et.al. Prenatal ultrasonographic diagnosis of fetal cerebral ventriculitis associated with asymptomatic cytomegalovirus infection. Prenat Diagn 1994;14:523-526.
7. Shaw CM, Alvord EC. Subependymal germinolysis. Arch Neurol 1974;31:374-381.
8. Tassin GB, Maklad NF, Stewart RR et.al. Cytomegalic inclusion disease: Intrauterine sonographic diagnosis using findings involving the brain. Am J Neuroradiol 1991;12:117-122.
9. Eliezer S, Ester F, Ehud W et al. Fetal splenomegaly; ultrasound diagnosis of cytomegalovirus infection. A case report. J Clin Ultrasound 1984;12:520-521.
10. Shackelford GD, Kirks DR. Neonatal hepatic calcification secondary to transplacental infection. Radiology 1977;122:753-757.
11. Binder ND, Buckmaster JW, Benda GI. Outcome for fetuses with ascites and cytomegalovirus infection. Pediatrics 1988;82:100-103.
12. Yamashita Y, Iwanaga R, Goto A et.al. Congenital cytomegalovirus infection associated with fetal ascites and intrahepatic calcifications. Acta Pediatr Scand 1989;78:965.
13. Pletcher BA, Williams MK, Mulivor RA et.al. Intrauterine cytomegalovirus infection presenting as fetal meconium peritonitis. Obstet Gynecol 1991;78:903.
14. Choong KK, Gruenewald SM, Hodson EM. Echogenic fetal kidneys in cytomegalovirus infection. J Clin Ultrasound 1993;21:128.
15. Weiner Z. Congenital cytomegalovirus infection with oligohydramnios and echogenic bowel at 14 weeks gestation. J Ultrasound Med 1995;14:617-618.