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Ozkose ZG, Suzen Caypinar S, Bestel A, Ozdemir O. Predictive value of prenatal ultrasound in foetal intraabdominal cystic lesions and evaluation of perinatal outcomes: a single-centre study results. J OBSTET GYNAECOL 2022; 42:2659-2664. [PMID: 35653805 DOI: 10.1080/01443615.2022.2081791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prenatal diagnosis of intra-abdominal cystic lesions is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound in identifying the aetiology of foetal intra-abdominal cysts and to describe the prenatal and postnatal outcomes. This study is a retrospective analysis of 137 foetuses diagnosed with intraabdominal cysts during the prenatal period, except those originating from the urinary system, conducted from April 2015 to August 2018. Among 137 intraabdominal cysts identified as antenatal, ovarian cysts had the highest rate of prenatal diagnosis. The most frequently misdiagnosed pathologies were gastrointestinal system obstructions with 6 cases. There were 129 (94.2%)cases of intraabdominal cysts born alive. Intrabdominal cystic lesions resolved spontaneously in 23(16.8%) cases in the intrauterine period and 28 cases within 12 (20.4%) months after birth during follow-up. Postpartum surgical treatment was performed in 44 (%32.1) cases. The overall neonatal mortality was 21/137 (15.3%),with no death in the intrauterine period; 8(5.8%) of these were death following termination of pregnancy, 6(4.4%) were postpartum, and 7(5.1%) were post-surgical death. Postnatal results of intraabdominal cysts are variable. Therefore, individual assessing and managing each case is of clear benefit due to cyst's variable course. IMPACT STATEMENTWhat is already known on this subject? The prenatal diagnosis of intra- abdominal cystic lesions is relatively common and prenatal ultrasound is the main screening tool. The diagnosis of a foetal intra-abdominal cyst might represent a diagnostic and management dilemma due to the wide variety of potential diagnosis.What the results of this study add? The accuracy of prenatal ultrasound in identifying the origin of a foetal intra-abdominal cyst seems to be high with detailed ultrasonographic examinations and the perinatal outcome of these foetuses is favourable in most of them.What the implications are of these findings for clinical practice and/or future research? Regardless of the cyst's origin, it should be kept in mind that prenatal and postnatal clinical courses can be variable in each case, and every pregnant woman with a foetus with an intraabdominal cyst must be managed individually in every aspect.
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Affiliation(s)
- Zeynep Gedik Ozkose
- Department of Maternal and Fetal Medicine, Kanuni Sultan Suleyman Training and Research Hospital, İstanbul, Turkey
| | - Sema Suzen Caypinar
- Department of Maternal and Fetal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ayşegül Bestel
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ozge Ozdemir
- Department of Maternal and Fetal Medicine, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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2
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Shen AW, Kothari A, Flint A, Kumar S. Prenatal imaging features and perinatal outcomes of foetal volvulus-A literature review. Prenat Diagn 2022; 42:192-200. [PMID: 34981841 DOI: 10.1002/pd.6083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/04/2021] [Accepted: 12/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a review of the literature on foetal volvulus with emphasis on prenatal imaging, pregnancy characteristics and clinical outcomes. METHODS A review of all published cases of foetal volvulus diagnosed prenatally and indexed in Medline, EBSCOhost, CINAHL, SOCIndex and Healthy Policy Reference Centre. Studies without antenatal sonographic signs of foetal volvulus and without a postpartum surgical diagnosis were excluded. Data were analysed for frequencies and distributions and tested for statistical significance. RESULTS Eighty-eight cases of foetal volvulus were identified from 58 published case reports/series. The most common ultrasound findings were dilated bowel/stomach (77.3%), polyhydramnios (30.7%) and whirlpool/snail sign (28.4%). Median gestation at diagnosis was 31.9 weeks (IQR 27-34) and mean gestation at delivery was 34.5 weeks (SD 2.8). Underlying aetiology included intestinal malrotation (15.9%), cystic fibrosis (14.8% of all cases, 32.5% of tested cases) and abnormal mesenteric fixation (12.5%). Complications included intestinal atresia (36.4%) and foetal anaemia (9.1%). The overall perinatal mortality rate was 14.5%. CONCLUSION Foetal volvulus is a rare condition with high rates of preterm birth and perinatal mortality. Intestinal malrotation and cystic fibrosis are common predisposing causes, although the majority are idiopathic. Bowel and/or gastric dilatation is by far the most common sonographic finding.
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Affiliation(s)
- Andrew Wang Shen
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Alka Kothari
- Department of Obstetrics and Gynaecology, Redcliffe Hospital, Redcliffe, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Anndrea Flint
- Department of Paediatrics, Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Sailesh Kumar
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia.,Mater Research Institute/University of Queensland, South Brisbane, Queensland, Australia.,Mater Centre for Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
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3
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Gai S, Wang L, Zheng W, Xu B, Luo Q, Qin J. Outcomes of sonographically-suspected fetal intra-abdominal cysts: Surgical intervention, conservative management and spontaneous regression. Front Pediatr 2022; 10:1015678. [PMID: 36741089 PMCID: PMC9891233 DOI: 10.3389/fped.2022.1015678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The prenatal diagnosis of fetal intra-abdominal cysts is challenging. This study aimed to evaluate the diagnostic ability of prenatal ultrasound for fetal intra-abdominal cysts and to develop a predictive method for pre- and postnatal outcomes. METHODS We retrospectively reviewed fetuses with ultrasound-detected intra-abdominal cysts between January 2013 and January 2020. The maternal-fetal clinical characteristics and ultrasound parameters were integrated into a model of pre- or postnatal outcomes. RESULTS The study enrolled 190 eligible fetuses, including 94 cases of spontaneous regression, 33 cases of conservative management and 63 cases of surgical intervention. For the 63 cases of surgical intervention, prenatal ultrasound was found to identify fetal intra-abdominal cysts with 80.00% sensitivity (95% CI: 67.03%-89.57%), 37.50% specificity (95% CI: 8.52%-75.51%), 89.80% positive predictive value (95% CI: 83.51%-93.86%), 21.43% negative predictive value (95% CI: 8.80%-43.53%) and 74.60% accuracy (95% CI: 62.06%-84.73%). The predictive model of prenatal spontaneous regression was as follows: y = -3.291 + 0.083 × gestational age + 1.252 × initial diameter, with an area under the curve (AUC) of 0.819 (95% CI: 0.739-0.899) and an optimal cut-off value of 0.74. The large cyst diameter before delivery was an independent predictor of postnatal surgical intervention (p < 0.001), with an AUC of 0.710 (95% CI: 0.625-0.794) and an optimal cut-off value of 3.35 cm. CONCLUSION Although ultrasound has a limited ability in the accurate diagnosis of fetal abdominal cysts, a simple method of measuring the diameter can predict fetal outcomes and identify the cases that may require surgical intervention or spontaneous regression.
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Affiliation(s)
- Shuangshuang Gai
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lixiu Wang
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weizeng Zheng
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bin Xu
- Department of Ultrasound, National Clinical Research Center for Child Health, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Women's Reproductive Health of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiale Qin
- Department of Ultrasound, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Women's Reproductive Health of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sepulveda W, Sepulveda F, Gonzalez G, Arce C, Alcalde E. Congenital hepatic cyst: Prenatal and postnatal imaging findings. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2021; 29:193-198. [PMID: 34567232 DOI: 10.1177/1742271x20970601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/04/2020] [Indexed: 12/23/2022]
Abstract
Introduction Congenital hepatic cyst is a rare hepatobiliary malformation that can present as an asymptomatic, unilocular, upper abdominal cystic mass in the fetus. Cases We report two cases of congenital hepatic cyst in which the diagnosis was made by prenatal ultrasound at 25 and 33 weeks' gestation. The diagnosis was confirmed postnatally by abdominal ultrasound and radiologic imaging studies. Although the infants remained asymptomatic, laparoscopic excision was performed due to the increasing size of the cyst in both cases. Pathological examination of the resected specimens confirmed a simple cyst in one case and an epidermoid cyst in the other. Conclusions Our cases and those described in the literature demonstrate the usefulness of incidental prenatal detection of congenital hepatic cyst, especially during late pregnancy. Such a diagnosis can allow for proper perinatal surveillance, selection of the route of delivery, and timely postnatal surgical intervention if required.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Francisco Sepulveda
- FETALMED Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Gloria Gonzalez
- Department of Surgery, 'Luis Calvo Mackenna' Children Hospital, National Health Service, Santiago, Chile
| | - Claudio Arce
- Department of Pathology, 'Luis Calvo Mackenna' Children Hospital, National Health Service, Santiago, Chile
| | - Elisa Alcalde
- Department of Pathology, 'Luis Calvo Mackenna' Children Hospital, National Health Service, Santiago, Chile
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Davidson JR, Uus A, Matthew J, Egloff AM, Deprez M, Yardley I, De Coppi P, David A, Carmichael J, Rutherford MA. Fetal body MRI and its application to fetal and neonatal treatment: an illustrative review. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:447-458. [PMID: 33721554 PMCID: PMC7614154 DOI: 10.1016/s2352-4642(20)30313-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
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Affiliation(s)
- Joseph R Davidson
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Alena Uus
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jacqueline Matthew
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia M Egloff
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Maria Deprez
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Iain Yardley
- Paediatric Surgery, Evelina London Children's Hospital, London, UK
| | - Paolo De Coppi
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK; Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anna David
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; Fetal Medicine Unit, University College London, London, UK
| | - Jim Carmichael
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Mary A Rutherford
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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6
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Sanna E, Loukogeorgakis S, Prior T, Derwig I, Paramasivam G, Choudhry M, Lees C. Fetal abdominal cysts: antenatal course and postnatal outcomes. J Perinat Med 2019; 47:418-421. [PMID: 30763268 DOI: 10.1515/jpm-2018-0311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/16/2018] [Indexed: 11/15/2022]
Abstract
Background There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results Eighty abdominal cysts were identified antenatally at 28+4 weeks (range 11+0-38+3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n=45, 56%), followed by intestinal (n=15, 18%), choledochal (n=3, 4%), liver (n=2, 3%) and renal/adrenal origins (n=2, 3%), respectively. In 16% (n=13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery.
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Affiliation(s)
- Elisabetta Sanna
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Gynecologic and Obstetric Clinic, Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Stavros Loukogeorgakis
- Department of Children's Surgery, Chelsea and Westminster Hospital - NHS Trust, London, UK
| | - Thomas Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iris Derwig
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gowrishankar Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Muhammad Choudhry
- Department of Children's Surgery, Chelsea and Westminster Hospital - NHS Trust, London, UK
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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7
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Husen M, Schut PC, Neven ACH, Yousoufi N, de Graaf N, Sloots CEJ, Eggink AJ, Cohen-Overbeek TE. Differences in Origin and Outcome of Intra-Abdominal Cysts in Male and Female Fetuses. Fetal Diagn Ther 2019; 46:166-174. [PMID: 30630186 DOI: 10.1159/000495506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the origin and outcome in a cohort of male and female fetuses with intra-abdominal cysts, in order to provide recommendations on management and to improve prenatal counselling. METHODS From 2002 to 2016, intra-abdominal cysts were detected by ultrasound in 158 fetuses. Cases with an umbilical vein varix were excluded. Fetal, neonatal, and maternal characteristics were retrieved from electronic patient files. RESULTS In female fetuses (n = 114), intra-abdominal cysts were diagnosed at a later gestational age compared with male fetuses (n = 44) (median 32.0 vs. 21.5 weeks, p < 0.001). The maximum prenatal cyst diameter was larger in female fetuses (median 35 vs. 17 mm, p < 0.001). Associated anomalies were less frequent in females (n = 15, 13.2%) compared with males (n = 15, 34.1%). In females (n = 114), most cysts were of ovarian origin (n = 81, 71.1%). Surgery was performed in 30 (26.3%) female and 15 (34.1%) male neonates (p = 0.33). Anorectal malformations were present in 6 cases and often not recognized prenatally. CONCLUSIONS The differences in the origin of intra-abdominal cysts between male and female fetuses, resulting in differences in prenatal presentation and postnatal outcome should be taken into account in prenatal counseling within a multidisciplinary team. Evaluation of the fetal perianal muscular complex is indicated.
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Affiliation(s)
- Marjolein Husen
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Pauline C Schut
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands,
| | - Adriana C H Neven
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Nagma Yousoufi
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Nanko de Graaf
- Erasmus MC, University Medical Center Rotterdam, Department of Pediatric Radiology, Rotterdam, The Netherlands
| | - Cornelius E J Sloots
- Erasmus MC, Sophia Children's Hospital, University Medical Center Rotterdam, Department of Pediatric Surgery, Rotterdam, The Netherlands
| | - Alex J Eggink
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
| | - Titia E Cohen-Overbeek
- Erasmus MC, University Medical Center Rotterdam, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, The Netherlands
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Gerscovich EO, Sekhon S, Loehfelm TW, Wootton-Gorges SL, Greenspan A. A reminder of peristalsis as a useful tool in the prenatal differential diagnosis of abdominal cystic masses. J Ultrason 2017; 17:129-132. [PMID: 28856022 PMCID: PMC5516084 DOI: 10.15557/jou.2017.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
Abstract
With routine antenatal ultrasound and recent advances in ultrasound technology, fetal intraabdominal cystic masses are recognized more often and are better characterized than in the past. They may be classified as solid and cystic, and may originate from multiple structures. When considering the extensive differential diagnosis of cystic masses, the observation of peristalsis narrows the possibilities to the gastrointestinal tract. To find this feature on ultrasound, the examiner must expressly think and look for it, otherwise it may be missed. Our case report illustrates one of those cases.
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Affiliation(s)
| | - Simran Sekhon
- Department of Radiology, UC Davis Health, Sacramento, California
| | | | | | - Adam Greenspan
- Department of Radiology, UC Davis Health, Sacramento, California
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Munireddy RA, Radhakrishnan P. Fetal Intra-abdominal Cyst: An Unusual Presentation. JOURNAL OF FETAL MEDICINE 2017. [DOI: 10.1007/s40556-017-0117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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CARSOTE MARA, GHEMIGIAN ADINA, TERZEA DANA, GHEORGHISAN-GALATEANU ANCUTAAUGUSTINA, VALEA ANA. Cystic adrenal lesions: focus on pediatric population (a review). CLUJUL MEDICAL (1957) 2017; 90:5-12. [PMID: 28246490 PMCID: PMC5305088 DOI: 10.15386/cjmed-677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/18/2016] [Accepted: 05/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults. GENERAL DATA Three major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks. CONCLUSION Pediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia- related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable.
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Affiliation(s)
- MARA CARSOTE
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - ADINA GHEMIGIAN
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - DANA TERZEA
- Endocrinology Department, Monza Oncoteam Hospital & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | | | - ANA VALEA
- Endocrinology Department, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca, Romania
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Dhombres F, Friszer S, Castaing O, Bessis R, Jouannic JM. [Fetal abdominal cysts at the first trimester scan]. ACTA ACUST UNITED AC 2016; 43:491-5. [PMID: 26117662 DOI: 10.1016/j.gyobfe.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Abdominal cysts are seldom detected at the first trimester scan. The aim of this study is to ascertain their outcome, which is currently not established. METHODS The French College of Fetal Ultrasound conducted a prospective observational study of 24months, collecting all cases of abdominal cysts discovered during the first trimester ultrasound. Cases of megacystis were excluded from the study. Ultrasound images, prenatal diagnosis expert reports and pregnancy outcomes were collected by sonographers after patient consent. RESULTS Ten cases of abdominal cysts were collected. The cysts had a mean diameter of 15mm. They were anechoic in 5 cases, hyperechoic in 2 cases and mixed in 3 cases. In 6 of 10 cases, complete resolution was observed at 18WG with a good post-natal outcome; the five cases with anechoic images were associated with normal pediatric examination at birth and in the case of the resolved hyperechoic image, an isolated imperforate anus was observed. In the four cases of hyperechoic or mixed images that had not resolved, the outcome was poor with four termination of pregnancies, including two cases of cloacal dysgenesis. CONCLUSIONS Abdominal cysts are rare at the first trimester scan. They resolve in two thirds of cases and are then associated with good outcome. When they do not resolve or when they are not strictly anechoic, they require a referral ultrasound examination at 18 and 22WG.
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Affiliation(s)
- F Dhombres
- Pôle de périnatalité, service de médecine fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est Parisien, hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), 26, avenue A.-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie (UPMC), Paris, France; Collège français d'échographie fœtale (CFEF), Paris, France.
| | - S Friszer
- Pôle de périnatalité, service de médecine fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est Parisien, hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), 26, avenue A.-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie (UPMC), Paris, France
| | - O Castaing
- Collège français d'échographie fœtale (CFEF), Paris, France
| | - R Bessis
- Collège français d'échographie fœtale (CFEF), Paris, France
| | - J-M Jouannic
- Pôle de périnatalité, service de médecine fœtale, centre pluridisciplinaire de diagnostic prénatal de l'Est Parisien, hôpital Armand-Trousseau, Assistance Publique-Hôpitaux de Paris (AP-HP), 26, avenue A.-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie (UPMC), Paris, France; Collège français d'échographie fœtale (CFEF), Paris, France
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12
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Catania VD, Briganti V, Di Giacomo V, Miele V, Signore F, de Waure C, Calabrò GE, Calisti A. Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound. J Matern Fetal Neonatal Med 2015; 29:1691-9. [PMID: 26135755 DOI: 10.3109/14767058.2015.1059812] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes. METHODS All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated. RESULTS In total 47 fetuses (10/37 M/F) were identified. The mean gestational age at the time of diagnosis was 33 ± 4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases. CONCLUSIONS The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases.
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Affiliation(s)
| | - Vito Briganti
- a Pediatric Surgery and Urology Unit , San Camillo Forlanini Hospital , Rome , Italy
| | | | - Vittorio Miele
- b Radiology Department , San Camillo Forlanini Hospital , Rome , Italy
| | - Fabrizio Signore
- c Department of Obstetrics and Gynecology , San Camillo Forlanini Hospital , Rome , Italy , and
| | - Chiara de Waure
- d Department of Public Health , Section of Hygiene, Catholic University of the Sacred Heart , Rome , Italy
| | - Giovanna Elisa Calabrò
- d Department of Public Health , Section of Hygiene, Catholic University of the Sacred Heart , Rome , Italy
| | - Alessandro Calisti
- a Pediatric Surgery and Urology Unit , San Camillo Forlanini Hospital , Rome , Italy
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Khalil A, Cooke PC, Mantovani E, Bhide A, Papageorghiou AT, Thilaganathan B. Outcome of first-trimester fetal abdominal cysts: cohort study and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:413-419. [PMID: 23828440 DOI: 10.1002/uog.12552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The aims of this study were to ascertain the outcome of fetuses with an abdominal cyst detected at 11-14 weeks' gestation in our unit and to undertake a review of cases reported in the literature. METHODS This was a retrospective study that included all fetuses found to have an abdominal cyst on ultrasound examination at 11-14 weeks, identified over a 14-year period. Pregnancy management and outcome were ascertained from maternal and neonatal records. We also performed a review of the literature using a systematic search strategy, to identify the outcome of similar cases and propose a management algorithm. RESULTS Fourteen cases were identified during the study period, of which four had associated abnormalities. Of the 10 isolated cases, the cyst had resolved at follow-up scan in eight (80.0%), one fetus died in utero at 15 weeks' gestation and the other case underwent surgery for a choledochal cyst 9 weeks after birth. An additional 19 cases were reported in the literature. In eight fetuses there were associated structural abnormalities, of which four had a diagnosis of anorectal malformation after birth. In two of these four, the cyst resolved in the second trimester. Of those cases with an isolated cyst (n = 11), the cyst resolved in seven (63.6%). The remainder were variably diagnosed as hepatic cyst, ileal duplication or choledochal cyst. CONCLUSION Fetal abdominal cysts at 11-14 weeks' gestation are rare. They constitute an isolated finding in the majority of cases and are usually associated with a good perinatal outcome. In view of the reported association with anorectal and other gastrointestinal malformations, perinatal assessment is recommended, even if the cyst resolves during pregnancy.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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14
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Amari F, Beyer DA, Diedrich K, Weichert J. Fetal intra-abdominal tumors: assessment of spectrum, accuracy of prenatal diagnosis, perinatal outcome and therapy at a tertiary referral center. Eur J Obstet Gynecol Reprod Biol 2013; 167:160-6. [DOI: 10.1016/j.ejogrb.2012.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 11/04/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
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15
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Donnelly JC, Malone FD. Early fetal anatomical sonography. Best Pract Res Clin Obstet Gynaecol 2012; 26:561-73. [PMID: 22776410 DOI: 10.1016/j.bpobgyn.2012.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 06/13/2012] [Indexed: 11/25/2022]
Abstract
Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
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Affiliation(s)
- Jennifer C Donnelly
- Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland.
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