Pathological Case of the Month

A 23-YEAR-OLD pregnant white woman, gravida 2, para 0, presented at 35 weeks' gestation with absence of fetal movements. The patient was admitted for fetal monitoring. The fetal heart rate had dropped to 70/min. Ultrasonographic evaluation showed breech presentation with evidence of ascites and pleural effusion suggesting hydrops fetalis. A live male infant weighing 3250 g was delivered by emergency cesarean section. The newborn had generalized edema, absent muscle tone, and bradycardia, with an Apgar score of 1 at 1 and 20 minutes. An echocardiogram detected a bright echo on the inferoposterior aspect of the interventricular groove with normal systolic function and ejection fraction (Figure 1). Despite resuscitation, the infant died 12 hours afterbirth. At autopsy, the heart weighed 42 g. There were numerous flame-shaped epicardial hemorrhages. Near the tip of the left ventricle on the lateral surface, a pale tan mass measuring 22 ×15×8mm was seen (Figure 2).