P122Fetus with partial hyperechoic cardiac walls

Objective To present a rare case of a fetus with very echogenic cardiac atrial walls, but with normal density in the rest of the heart, perhaps due to a viral infection. Case report The first ultrasound examination at 17 weeks was normal, but in the next exam at 24 weeks we detected that the fetal cardiac atrial walls were very echogenic. However, the density of the atrioventricular valves and the ventricular cardiac walls were normal. The morphology of the heart was also normal. There was also an important amount of ascites. Doppler study of the atrioventricular valves was normal. Later examinations were similar but the quantity of ascites gradually decreased. At 34 weeks, the patient had a premature rupture of the membranes and a healthy infant was born. The ascites had disappeared and the baby's outcome was normal. Discussion To prevent misdiagnosis of the density of the cardiac walls, we made exams of different fetal positions, but hyperechoic atrial walls were always seen. After consulting a neonatal cardiologist, we concluded that the cause of this alteration may have been a viral infection, which could have produced partial density alteration of the cardiac walls. The hyperechoic atrium may cause poor contractability and produce ascites. Conclusions Despite the impressive aspect of the hyperechoic atrial cardiac walls and an important ascites, the infant's outcome was normal.