Prenatal diagnosis of fetal left transverse venous sinus thrombosis with intracranial hemorrhage: imaging findings and short-term outcome.

This report presents the prenatal imaging findings and short-term clinical outcome of a rare case of fetal cerebral sinovenous thrombosis, along with a brief review of the literature. A 31-year-old pregnant Afghan woman at 34 weeks of gestation (gravida 3, para 0, abortion 2) presented to the hospital with complaints of decreased fetal movement. Fetal cranial ultrasonography revealed a thick-walled, avascular, hypoechoic, mass-like lesion (17×18×18 mm) extending from the left foramen of Monro to the superior aspect of the thalamus and displacing the body of the left lateral ventricle. Fetal cranial magnetic resonance imaging (MRI) suggested subacute hemorrhage and demonstrated hyperintensity in the left transverse venous sinus, indicative of thrombosis. Serial follow-up revealed stability of the lesion; however, at 36 weeks, an emergency cesarean section was performed due to fetal distress. Postnatal cranial MRI and magnetic resonance venography (MRV) confirmed left transverse venous sinus thrombosis with subacute hemorrhage. The newborn received enoxaparin therapy for 3 months, remained clinically stable, and had no neurological deficits at the 4-month follow-up. Fetal intracranial hemorrhage has a broad differential diagnosis, and accurate identification of the underlying etiology is critical for prognosis and management. Fetal cerebral sinovenous thrombosis should be considered in the differential diagnosis when mass-like hemorrhagic lesions are detected on prenatal imaging. While short-term outcomes may be favorable in the absence of additional cranial pathology, the long-term prognosis remains uncertain.