Figure 1
Brain Ultrasound
Intracerebral periventricular cysts in newborn: Connatal cysts
SectionPaediatric radiology
Case TypeClinical Cases
Authors
Connected authors
2 days, female
Clinical History
A 2-day-old, full-term, otherwise asymptomatic female was followed up for “ventricular asymmetry” detected on prenatal ultrasound.
Imaging Findings
There are oblong cysts parallel to superolateral margins of lateral ventricles. No associated haemorrhage, gliosis or hydrocephalus.
Discussion
Connatal cysts are benign, isolated findings which likely represent a normal variant, also referred to as "coarctation of the lateral ventricles". No associated intracranial hemorrhage or gliosis is seen. These typically resolve by 1-2 months corrected gestational age/ post-term. No adverse neurological outcome is associated [1].
The major differential considerations include subependymal cysts and periventricular leukomalacia, both of which are clinically more significant than connatal cysts. The location of the abnormality is the key distinguishing feature (see illustration); with connatal cysts noted at the superolateral margins of the frontal horns of lateral ventricles, subependymal cysts noted at the level of/extending posterior to the foramen of Monro and periventricular leukomalacia involving white matter above the ventricles, the centrum semiovale and in a posterior/occipital distribution [1].
There are two types of subependymal cysts: posthemorrhagic or congenital, related to germinolysis. These can be an isolated finding in otherwise healthy newborns. In other instances, these can be related to haemorrhage, infection, hypoxia, chromosomal or metabolic abnormalities [1].
Periventricular leukomalacia is the most ominous of these cystic lesions and represents an ischemic injury involving the watershed area of the preterm brain-the periventricular white matter. This may be challenging to diagnose by ultrasound in the acute/early phase [2]. In chronic cases, cyst formation may be noted within the affected white matter, brain ventricles may be enlarged and there may be a loss of deep white matter [2]. There is a history of marked prematurity and difficult labour.
The major differential considerations include subependymal cysts and periventricular leukomalacia, both of which are clinically more significant than connatal cysts. The location of the abnormality is the key distinguishing feature (see illustration); with connatal cysts noted at the superolateral margins of the frontal horns of lateral ventricles, subependymal cysts noted at the level of/extending posterior to the foramen of Monro and periventricular leukomalacia involving white matter above the ventricles, the centrum semiovale and in a posterior/occipital distribution [1].
There are two types of subependymal cysts: posthemorrhagic or congenital, related to germinolysis. These can be an isolated finding in otherwise healthy newborns. In other instances, these can be related to haemorrhage, infection, hypoxia, chromosomal or metabolic abnormalities [1].
Periventricular leukomalacia is the most ominous of these cystic lesions and represents an ischemic injury involving the watershed area of the preterm brain-the periventricular white matter. This may be challenging to diagnose by ultrasound in the acute/early phase [2]. In chronic cases, cyst formation may be noted within the affected white matter, brain ventricles may be enlarged and there may be a loss of deep white matter [2]. There is a history of marked prematurity and difficult labour.
Differential Diagnosis List
Connatal cysts.
Subependymal cysts.
Periventricular leukomalacia.
Final Diagnosis
Connatal cysts.
References
[1] Tan ZY, Naidoo P, Kenning N. (2010) Case of the month. Ultrasound and MRI features of connatal cysts: clinicoradiological differentiation from other supratentorial periventricular cystic lesions. Br J Radiol 83(986):180-3. (PMID: 20139266)
[2] Gupta P, Sodhi KS, Saxena AK, Khandelwal N, Singhi P. (2016) Neonatal cranial sonography: A concise review for clinicians. J Pediatr Neurosci Jan-Mar;11(1):7-13. (PMID: 27195026)
Case information
| URL: | https://www.eurorad.org/case/14330 |
| DOI: | 10.1594/EURORAD/CASE.14330 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Illustration depicting nature of brain cysts based on location.
Illustration depicting the various locations of intracerebral cystic anomalies encountered in the newborn.
CC= Connatal cyst
SC= Subependymal cyst
PVL= Periventricular Leukomalacia
Brain Ultrasound
Transfontanellar coronal ultrasound image of the brain reveals simple, oblong cysts adjacent and along the supero-lateral margins of both frontal horns.
University of Rochester Medical Center, Rochester, NY, USA.
University of Rochester Medical Center, Rochester, NY, USA.
Transfontanellar sagittal ultrasound image of the brain reveals simple, oblong cysts adjacent to the anterior aspect of the brain ventricles.
University of Rochester Medical Center, Rochester, NY, USA.
University of Rochester Medical Center, Rochester, NY, USA.
Illustration depicting nature of brain cysts based on location.
Illustration depicting the various locations of intracerebral cystic anomalies encountered in the newborn.
CC= Connatal cyst
SC= Subependymal cyst
PVL= Periventricular Leukomalacia
University of Rochester Medical Center, Rochester, NY, USA. Image courtesy: Nadezhda Kiriyak, Medical Illustrator at the Department of Imaging Sciences, University of Rochester, Rochester, NY, USA.
University of Rochester Medical Center, Rochester, NY, USA. Image courtesy: Nadezhda Kiriyak, Medical Illustrator at the Department of Imaging Sciences, University of Rochester, Rochester, NY, USA.