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The recent popularity of prenatal magnetic resonance (MR) imaging has been associated with the development of ultrafast MR imaging techniques such as the single-shot fast spin-echo sequence. However, the majority of previous reports have concerned the fetal central nervous system (CNS) and chest disorders. MR imaging can demonstrate non-CNS fetal anatomy and pathologic conditions clearly. With its excellent tissue contrast, MR imaging provides information that supplements that provided by ultrasonography (US), especially in cases of neck, chest, and gastrointestinal lesions. Because of its large field of view, MR imaging allows evaluation of the relationship between a large lesion and adjacent structures. MR imaging should be considered if the diagnosis of a suspected non-CNS lesion is unclear at fetal US. MR imaging plays an important complementary role to US in cases of non-CNS fetal lesions and will be further accepted for fetal imaging in the future.

CASE REPORTA 34-year-old woman, gravida 3 para 0, was referred to our institute at 37 weeks' gestation for evaluation of a fetal abdominal cystic mass. She had conceived by intrauterine insemination with ovulation induction after three spontaneous miscarriages. Because of her history, low-dose aspirin (81 mg/day) was administered in the current pregnancy up to 36 weeks' gestation. A routine fetal ultrasound examination in the second trimester showed no abnormal findings, but at 35 weeks of gestation a cystic mass was detected in the fetal abdomen. Detailed ultrasonography at referral revealed a retrovesical septate hypoechogenic mass measuring 77 × 76 × 73 mm within the fetal abdomen (Figure 1). Bilateral mild hydronephrosis was present, but there was no ascites. Cardiac anatomy and the extremities were normal. It was not possible to visualize the fetal external genitalia by ultrasound due to the late gestation and the sonographic findings were inconclusive. Magnetic resonance imaging (MRI) was then used to perform a detailed evaluation of the fetal abdominal mass. MRI confirmed that the abdominal mass was located in the midline posterior to the bladder and showed that it was connected to the dilated uterine cavity (Figure 2a). The mass was fluid-filled with a mid-plane septum (Figure 2b). A four-chamber appearance consisting of the septate mass and two small uterine cavities was observed (Figure 2c). These findings were consistent with a diagnosis of hydrometrocolpos with septate vagina and uterus didelphys. The rectum was not clearly visible in the T1-weighted image in which the presence of meconium appeared as hyperintense signals (Figure 2d). Although the cystic lesion was large and occupied the fetal abdomen, pulmonary hypoplasia was not observed on MRI.At 38 weeks' gestation a Cesarean section was performed due to the arrest of labor during induction with oxytocin. A female infant weighing 2438 g and with a length of 44 cm, and Apgar scores of 8 and 8 after 1 and 5 min, respectively, was delivered. Physical examination revealed abdominal distension, ambiguous genitalia and anal atresia. However, the face, limbs and digits were normal. There was a single perineal opening through which a urethral catheter was introduced, but

Non-accidental trauma is the leading cause of intracranial hemorrhage (ICH) in infancy. In contrast, ICH as a part of vitamin K deficiency bleeding (VKDB) secondary to hepatobiliary disease is rare, but encountered even in the era of vitamin K (VK) prophylaxis. During 43 months, six cases with ICH were diagnosed as an initial presentation of VKDB. Clinical features and imaging findings of them were retrospectively reviewed. All cases were breastfed and received oral VK prophylaxis. Liver dysfunction was found in five. Brain CT showed hemorrhage in subdural and subarachnoid space in six, parenchyma in three, and ventricle in one. Abdominal ultrasound was positive in four with final diagnoses of biliary atresia in two, neonatal hepatitis in one, and milk allergy in one. Two cases with negative ultrasound were diagnosed as idiopathic VKDB. In conclusion, ICH with secondary VKDB is rare, but important in infancy in the era of VK prophylaxis.

Agranulocytosis is an extremely serious, although rare, adverse effect of antithyroid drugs (ATDs), including methimazole (MMI) and propylthiouracil (PTU), in children and adolescents. There are few reports about the characteristics of ATD-induced agranulocytosis in Japanese children and adolescents. This report presents the cases of three girls with ATD-induced agranulocytosis and a retrospective analysis of 18 patients with ATD-induced agranulocytosis, whose cases had been referred to the drug manufacturer, Chugai Pharmaceutical Co., Ltd. Our 3 patients, ranging in age from 12 to 14 yr, developed ATD-induced agranulocytosis between the 15th and 57th day of ATD treatment for hyperthyroidism. Fever and sore throat were the earliest symptoms of agranulocytosis. The patients were rescued by ceasing ATD therapy and administering antibiotics, potassium iodide, glucocorticoid, immunoglobulin and granulocyte colony-stimulating factor (G-CSF). We retrospectively analyzed 18 cases of ATD-induced agranulocytosis treated with MMI in 16 cases and PTU in 2 cases. Twelve patients were treated with 20–45 mg/d MMI. Agranulocytosis developed between the 15th and 1,344th day of therapy. In conclusion, considering the risk of ATD-induced agranulocytosis, we recommend low-dose MMI therapy for treatment of Graves’ disease.