CHAOS: Prenatal imaging findings with post mortem contrast radiographic correlation

Area of Science:

• Medical Imaging
• Fetal Medicine
• Pediatric Surgery

Background:

• Congenital high airway obstruction syndrome (CHAOS) is a rare but severe fetal anomaly.
• Characteristic prenatal findings include enlarged echogenic lungs, diaphragmatic abnormalities, and fetal hydrops.
• Timely prenatal diagnosis is essential for effective perinatal management.

Purpose of the Study:

• To highlight the typical ultrasound and MRI findings of CHAOS in a fetus.
• To demonstrate the utility of contrast radiography in confirming the diagnosis postnatally.
• To correlate prenatal imaging with postnatal and autopsy findings.

Main Methods:

• Ultrasound and MRI at 19 weeks gestation to identify fetal anomalies.
• Contrast radiography (retrograde laryngogram) for postnatal airway evaluation.
• Sonography of aborted fetus and fetal autopsy for correlation.

Main Results:

• A male fetus presented with classic ultrasound and MRI features of CHAOS.
• Contrast radiography confirmed the upper airway obstruction.
• Prenatal imaging findings were consistent with postnatal and autopsy results.

Conclusions:

• Prenatal ultrasound and MRI are vital for early detection of CHAOS.
• Contrast radiography plays a key role in confirming the diagnosis and guiding management.
• Accurate prenatal diagnosis improves perinatal outcomes for infants with CHAOS.