Question
A neonate presents with congestive heart failure, on examination enlarging fontanelIae, bruit on auscultation, on USG shows midline hypoechoeic lesion, most likely diagnosis:
| A. |
Malformation of vein of Galen
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| B. |
Aqueduct stenosis
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| C. |
Arachnoid cyst
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| D. |
Medulloblastoma
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Show Answer
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Correct Answer � A
Explanation
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A vein of Galen malformation is a rare vascular anomaly where abnormal connections between arteries and the vein of Galen can lead to increased blood flow and pressure in the area. This condition can present in neonates with symptoms of high-output heart failure due to the significant arteriovenous shunting.
The findings of a bruit on auscultation and a midline hypoechoic lesion on ultrasound, indicative of a large vascular channel, further support this diagnosis.
Reasons for ruling out other options are-
Option B: Aqueduct stenosis is incorrect. Aqueductal stenosis involves the narrowing of the cerebral aqueduct leading to obstructive hydrocephalus.
While it may present with enlarging fontanelles due to increased intracranial pressure, it typically does not cause heart failure or produce a bruit, nor is it associated with a midline hypoechoic lesion indicative of a vascular abnormality on ultrasound.
Option C: Arachnoid cyst is incorrect. An arachnoid cyst is a cerebrospinal fluid-filled sac in the arachnoid space and can cause increased intracranial pressure if large.
However, it generally does not result in heart failure or a bruit, and on ultrasound, it appears as a well-defined cystic lesion, not as a hypoechoic midline lesion.
Option D: Medulloblastoma is incorrect. Medulloblastoma is a type of brain tumor primarily seen in children and can present with increased intracranial pressure.
However, it would not typically present with congestive heart failure or a bruit, and it is not likely to appear as a midline hypoechoic lesion on ultrasound.
