ULTRASOUND IN TOXOPLASMOSIS

CENTRAL NERVOUS SYSTEM (CNS) FINDINGS

• Calcifications (18%): These represent foci of necrosis and are echogenic.
• Often poorly calcified at the time of prenatal diagnosis and therefore do not shadow.
• Multifocal (basal ganglia, periventricular area, white matter and cerebral cortex). CMV has a predilection for the periventricular areas of the brain.
• Hydrocephalus (75%) - bilateral, symmetrical and evolves rapidly (2).
  It is reported to be due to necrotizing lesions in the region of the aqueduct.
• Microcephaly.
• Brain atrophy.
• Hydranencephaly.

EXTRA CNS FINDINGS (1,3,4)

• Thickened placenta with hyperechoic areas.
• Liver echogenicities (due to Toxoplasma gondii hepatitis).
• Hepatomegaly.
• Ascites.
• Pericardial and pleural effusions.
• Congeital cataracts (5).

	Placental calcifications
	Ascites and anasarca

Hohfeld and co-workers (1) retrospectively analyzed 89 cases of in utero toxoplasmosis and found that prenatal diagnosis could be made between 20-32 weeks gestation. Sonographic findings were present in 36% of their patients.

DIFFERENTIAL DIAGNOSIS (1,3,4)

1. CMV infection.
2. Tuberous Sclerosis.
3. Teratoma.
4. Transverse or sagittal sinus thrombosis.

REFERENCES

1. Hohfeld P, MacAleese J, Capella-Pavlovski et.al. Fetal toxoplasmosis:ultrasonographic signs. Ultrasound Obstet Gynecol 1991;241-244.
2. Desai MB, Kurtz AB, Martin ME, Wapner Rj. Characteristic findings of toxoplasmosis in utero: A case report. J Ultrasound med 1994;13:60-62.
3. Blaakaer J. Ultrasonic diagnosis of fetal ascites and toxoplasmosis. Acta Obstet Gynecol Scand 1986;65:653-654.
4. Vanhaesebrouck P, De Wit M, Smets K et.al. Congenital toxoplasmosis presenting as massive neonatal ascites. Helv Paediatr Acta 1988;43:97-101.
5. Pedreira DAL, Diniz EMA, Schultz R et.al. Fetal cataract in congenital toxoplasmosis. Ultrasound Obstet Gynecol 1999;13:266-267.