Imaging of the thymus

Hector Quiroga, MD.

Centro MĆ©dico Profesional Rosancar. Barquisimeto, Estado Lara, Venezuela.

Introduction

The thymus has been studied in fetuses with conotruncal anomalies as a marker of microdeletion 22q11. More recently, it has also been investigated in relation to its immune function in association with prolonged rupture of membranes and intrauterine growth restriction. The thymus can be identified on the three-vessel view of the upper mediastinum, but its visualization is not always straightforward.

Paladini [1] reported a simple way to locate the thymus, so called "Thymus-box". The internal mammary arteries course laterally to the thymus identifying its lateral borders, and by using color doppler ultrasonography with a low repetition frequency these vessels and, consequently, the thymic area, are readily displayed in the fetus from the first to the third trimester of pregnancy [1].

Case report

Here we present two uncomplicated pregnancies where we identified the normal looking thymus using the internal mammary arteries as landmarks. TheĀ third caseĀ is a case of thymic hypoplasia diagnosed at 23 weeks of gestation.

Case 1

Images 1-3: 23 weeks, Images are showing normal looking thymus which is located between the right and left mammary artery.

Thy-box_Hector_1
Thy-box_Hector_2
Thy-box_Hector_3


Video 1: 23 weeks, video of the normal looking thymus, mammary arteries form the lateral borders of the thymus.



Case 2

Images 4,5
: 33 weeks, Images of the normal looking thymus.

Thy-box_Hector_4
Thy-box_Hector_5


Video 2: 33 weeks, thymus of normal size and appearance located between the right and left mammary artery.



Case 3

This is a case of an Aortic atresia associated with a hypoplasia of the thymus.

Image 6: 23 weeks, images of the hypoplastic thymus.

Thy-box_Hector_6

References:

1. Paladini D. How to identify the thymus in the fetus: the thy-box. Ultrasound Obstet Gynecol 2011;37:448-492.

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