Congenital Cytomegalovirus infection | Radiology Case

Congenital Cytomegalovirus infection | Radiology Case

5 month old male baby presents with recurrent seizures.

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Observation and interpretation

  • Multiple calcifications in the bilateral periventricular regions with ventriculomegaly and cerebral atrophic changes.

Principal Diagnosis

Congentital CNS infection (TORCH) - Cytomegalovirus (CMV)

Differential Diagnosis

  • Other TORCH infections like Toxoplasmosis, HIV, rubella, HSV.
  • Congenital toxoplasmosis is less common than congenital CMV. Calcifications can be scattered within the cerebral parenchymal (cortical and subcortical) as compared to the predominantly periventricular pattern seen in congenital CMV. Migrational abnormalities are uncommon.

Further Management

  • Pediatric MDT referral
  • Antiviral treatment
  • Family counseling

Teaching Points

  • Cytomegalovirus (CMV)  is the most common in-utero infection seen in neonates (1%).
  • Imaging findings of congenital CMV infection consists of intracranial calcifications, ventriculomegaly, cerebral volume loss, white matter disease, neuronal migrational abnormalities, periventricular cysts and microcephaly. These findings may be seen individually or in association. The presence of additional findings with intracranial calcification suggests poor outcomes.
  • Intracranial calcification is commonly reported in congenital CMV infection, occurring in 30%–70% of patients. CT is rather sensitive in depicting and locating intracranial calcifications. Thick calcifications with periventricular distribution are usually seen. Basal ganglia calcifications may be associated.
  • Cerebral atrophy & ventriculomegaly are common features in congenital CMV, ventriculomegaly being the second most common feature after intracranial calcifications.
  • Microcephaly caused as a result of cerebral volume loss can be seen in upto 27% cases.
  • Migrational abnormalities such as lissencephaly, pachygyria and polymicrogyria have been reported.
  • Periventricular cysts can be seen in some cases as cystic lesions adjacent to the ventricles.
  • Thin septations or strands within the ventricles (Ventricular adhesions) may be seen.
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