Bifid choroid plexus: Always a normal fetal brain structure variant?

Abstract

Choroid plexus, a fetal organ developing approximately from the sixth week of gestation, plays a fundamental role in developing fetal brain organization. As relatively little is known about the relationship between anomalies of choroid plexuses structure and their role in brain function, we examined cases of bifid choroid plexus (BCP) and discussed their potential association with lateral ventriculomegaly, other abnormal ultrasound findings, and their potential role as markers of fetal chromosomal abnormalities. In the present study, we described 23 cases of fetal BCP found in 2145 routine second trimester ultrasounds. For each patient 2D and 3D ultrasound volumes were acquired. BCP was defined as a choroid plexus whose body was divided into two portions (arms) differently located and oriented on the three spatial axes in correspondence to the lateral ventricle, in one or both sides. The entity of the separation and reciprocal orientation of the two arms was examined. The presence of BCP in a low-risk population of pregnant women undergoing routine second trimester ultrasound was showed. Lateral ventricles significantly increased in the presence of BCP. Malformations were found in four of 23 fetuses with BCP. Pregnancy outcome was favorable only in one of these four cases. We suggest that in the presence of mono or bilateral BCP without associated abnormal ultrasound findings, a closer look at fetal brain or extra-cranial structures is recommended. If no related abnormalities are found, serial prenatal and postnatal sonographic follow-up should be considered. In the presence of concomitant abnormal findings, genetic counseling, fetal karyotyping and magnetic resonance imaging, if possible by gestational age, are strongly advised.

Dysmorphic choroid plexuses and hydrocephalus associated with increased nuchal translucency: Early ultrasound markers ofde novothanatophoric dysplasia typeIIwith cloverleaf skull (Kleeblattschaedel)

“…Abnormal CP has been recently described by Centini et al. () in 23 out of 2145 routine second trimester scans (an incidence of 1.07%). Centini et al.…”

“…In the case reported by Angle et al (1998) a C-to-A change at nucleotide 1620 (C1620A) in the tyrosine kinase domain of the FGFR3 gene was demonstrated, thus providing supportive evidence that a mutation in the FGFR3 gene may result in altered growth in both cranial and long bones. Abnormal CP has been recently described by Centini et al (2013) in 23 out of 2145 routine second trimester scans (an incidence of 1.07%). Centini et al (2013) concluded that dysmorphic CP may be a variant of normalcy and may be seen also associated with multiple congenital anomalies such as corpus callosum abnormalities, ventriculomegaly, incarcerated lumbar hemivertebra and, trisomy 9.…”

“…Centini et al. () concluded that dysmorphic CP may be a variant of normalcy and may be seen also associated with multiple congenital anomalies such as corpus callosum abnormalities, ventriculomegaly, incarcerated lumbar hemivertebra and, trisomy 9. The latter association has also been confirmed by Tonni et al.…”

“…Bronshstein and Ben-Shlomo (1991) demonstrated the presence of distortions in the structure of the CP in 1237 transvaginal sonographic scans, and also indicated prevalent patterns such as early absence of the plexus, hypoplasia, shrinkage and "Swiss cheese", the latter being suggested as landmarks of developing hydrocephalus. Increased separation between CP and ventricular wall has been associated with a higher frequency of unfavorable outcomes in fetuses with ventricular dilatation (Centini et al 2013).…”

“…Increased separation between CP and ventricular wall has been associated with a higher frequency of unfavorable outcomes in fetuses with ventricular dilatation (Centini et al. ).…”