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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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Kahraman N, Celik O, Obut M, Arat O, Celikkan C, Iskender C, Celen S, Ustun Y. Cysts of the fetal abdomen: Antenatal and postnatal comparison. J Med Ultrasound 2022; 30:203-210. [DOI: 10.4103/jmu.jmu_192_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/04/2022] Open
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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Eyerly-Webb SA, Joshi S, Dion E, Snowise S, Lillegard J, Feltis BA. Fetal Non-Ovarian Abdominopelvic Cystic Lesions: A Single-Center Report. Fetal Diagn Ther 2020; 47:955-959. [PMID: 33049734 DOI: 10.1159/000510814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is a paucity of reports describing the clinical course and likely postnatal outcomes of prenatally identified simple cystic abdominopelvic lesions which are not associated with the ovary. OBJECTIVE The aim of this study was to describe the natural history and postnatal outcomes of prenatally discovered abdominopelvic cystic lesions seen at our center. METHODS This study is a retrospective review of all newborns with prenatally discovered non-ovarian simple cystic abdominal or pelvic lesions (September 2012-December 2018). Prenatal solid organ involvement, lesion size, and postnatal clinical outcomes are described. RESULTS Sixty-six patients with 68 cystic lesions were identified; 22 patients with 24 lesions met the defined study criteria and were included. Eleven (46%) resolved prenatally, while 5 (21%) resolved by 18 months of age. Of the 10 lesions associated with an organ, 4 (40%) resolved prenatally. Of the remaining 14 lesions not associated with a solid organ, 7 (50%) resolved prenatally. Seven lesions (29%) required postnatal surgical intervention. Larger maximum prenatal lesions tended toward postnatal surgical intervention (one-way ANOVA: p = 0.072). CONCLUSIONS The majority of simple non-ovarian cystic abdominopelvic lesions at our center resolved in the perinatal period. Due to the low frequency of these lesions at fetal centers, a larger multicenter study based on a consistent monitoring protocol should be undertaken to better describe the resolution patterns of simple non-ovarian cystic lesions for improved prenatal counseling.
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Affiliation(s)
- Stephanie A Eyerly-Webb
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA,
| | - Shilvi Joshi
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Eric Dion
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Saul Snowise
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Joseph Lillegard
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.,Division of General Surgery Research, Mayo Clinic, Rochester, Minnesota, USA.,Pediatric Surgical Associates, Minneapolis, Minnesota, USA
| | - Brad A Feltis
- Midwest Fetal Care Center, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA.,Pediatric Surgical Associates, Minneapolis, Minnesota, USA
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Lewis S, Walker J, McHoney M. Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome? Early Hum Dev 2020; 147:105102. [PMID: 32521469 DOI: 10.1016/j.earlhumdev.2020.105102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The outcome of antenatally detected fetal intra-abdominal cysts is highly variable and challenging to predict. Antenatal ultrasound scans may be of value in predicting postnatal outcome. AIMS To report antenatal and postnatal course of fetal intra-abdominal cysts identified on antenatal ultrasound and establish the value of cyst dimensions for predicting outcome. STUDY DESIGN Retrospective observational study. SUBJECTS All intra-abdominal cysts diagnosed in a single centre between 2013 and 2019. OUTCOME MEASURES Cyst characteristics were recorded from radiological reports and postnatal diagnosis and outcomes documented. Growth characteristics were identified to distinguish different diagnosis. The maximum antenatal diameter of all cysts was identified and the best cut-off diameter to predict whether a cyst would persist postnatally or require surgery was identified. Best cut-off values were identified using Youden index. RESULTS Of the 38 cysts identified on antenatal ultrasound, 24 (63%) persisted postnatally, 8 required surgery (21%) and 4 (11%) were not considered an intra-abdominal cyst postnatally. Ovarian cyst and duplication cyst may have different growth characteristics. In the prediction of cysts persisting postnatally, the area under the ROC curve (AUC) was 0.81 (95% CI, 0.66-0.95). Two cut off values were identified, 37.5 mm (50% sensitivity, specificity 100%, Youden's index 0.50) and 28.5 mm (sensitivity 65%, specificity 85%, Youden's index 0.50). In the prediction of surgery, no optimal diameter was found; AUC was 0.57 (95% CI, 0.34-0.81). CONCLUSIONS Maximum antenatal cyst diameter is useful for the prediction of whether a cyst will persist postnatally but not for the prediction of surgery.
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Affiliation(s)
- Sarah Lewis
- University of Edinburgh, School of Medicine, United Kingdom of Great Britain and Northern Ireland.
| | - Jane Walker
- Department of Fetal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, United Kingdom of Great Britain and Northern Ireland.
| | - Merrill McHoney
- University of Edinburgh, School of Medicine, United Kingdom of Great Britain and Northern Ireland; Department of Paediatric Surgery, Royal Hospital for Sick Children, 9 Sciennes Road, Edinburgh EH9 1LF, United Kingdom of Great Britain and Northern Ireland.
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Cochran ED, Lazow SP, Kim AG, Burkhalter LS, Frost NW, Stitelman D, Davis J, Santiago-Munoz P, Buchmiller TL, Perrone EE, Schindel DT. The in-utero diagnosis of choledochal cyst: can postnatal imaging predict benefit from early surgical intervention? J Matern Fetal Neonatal Med 2020; 35:1070-1074. [PMID: 32188329 DOI: 10.1080/14767058.2020.1742320] [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: 10/24/2022]
Abstract
Background: Infants prenatally suspected of having a choledochal cyst (CDC) typically undergo ultrasound imaging shortly after birth. This study sought to evaluate features on the initial postnatal ultrasound (IPU) that could identify newborns at risk for early complications.Methods: Following IRB approval, patients from four US fetal centers with prenatal suspicion for CDC and postnatal imaging from 2000 to 2017 were reviewed. Imaging and clinical courses were assessed.Results: Forty-two patients had prenatal ultrasounds suspicious for CDC. Nineteen (45.2%) were excluded due to diagnostic revision (n = 9), cyst resolution (n = 5), lack of IPU measurements (n = 3), or lack of follow-up (n = 2). The 23 remaining patients were included in the study. Of these, five (21.7%) developed symptoms at a median age of 16.5 days (IQR 16-19 days), and 18 (78.3%) remained asymptomatic throughout the first year after birth. Five patients (21.7%) had cysts ≥ 4.5 cm on IPU (Symptomatic: n = 3; Asymptomatic: n = 2). Eighteen patients (78.3%) had cysts < 4.5 cm on IPU (Symptomatic: n = 2; Asymptomatic: n = 16). An IPU cyst size ≥ 4.5 cm was associated with neonatal symptom manifestation (p = 0.048), with 88.9% specificity (95% CI 65.3-98.6%) and 60% sensitivity (95% CI 14.7-94.7%).Conclusions: In newborns with prenatally diagnosed CDC, a cyst size ≥ 4.5 cm on IPU is associated with symptom development during the first month after birth and therefore early cyst excision is recommended.
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Affiliation(s)
- Elizabeth D Cochran
- Children's Health, Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Stefanie P Lazow
- Pediatric Surgery, Harvard University Medical Center/Boston Children's Hospital, Boston, MA, USA
| | - Aimee G Kim
- Pediatric Surgery, CS Mott's Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Lorrie S Burkhalter
- Pediatric Surgery, Harvard University Medical Center/Boston Children's Hospital, Boston, MA, USA
| | - Natalie W Frost
- Children's Health, Neonatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Stitelman
- Pediatric Surgery, Yale University Medical Center, New Haven, CT, USA
| | - James Davis
- Children's Health, Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Terry L Buchmiller
- Pediatric Surgery, Harvard University Medical Center/Boston Children's Hospital, Boston, MA, USA
| | - Erin E Perrone
- Pediatric Surgery, CS Mott's Children's Hospital, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - David T Schindel
- Children's Health, Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Lv M, Zhao B, Luo Q. Prenatal diagnosis and prognosis assessment of fetal intra-abdominal cystic lesions: a retrospective study in 264 cases. J OBSTET GYNAECOL 2019; 39:922-927. [PMID: 31045471 DOI: 10.1080/01443615.2019.1576601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To assess the accuracy of prenatal diagnosis and the prognosis of fetal-abdominal masses, we reviewed all of the cases which had been diagnosed as having abdominal masses from January 2014 to December 2016. In total, 264 cases were identified as having abdominal masses. Among them, 141 cases (53%) had received specific prenatal diagnoses by prenatal ultrasound (US). MRI had assisted in the diagnosis and prognostic evaluation in 69 cases, increasing the diagnostic rate to 65%. The prenatal diagnoses of 111 cases (65%) were concordant with the postnatal diagnoses. Surgical intervention after birth was needed in 96 cases (39%). Most outcomes were good (89%). We suggest that prenatal US can detect and identify most fetal abdominal masses and that MRI helps to further describe the masses. With early intervention after birth, the prognosis was good in most cases. Impact Statement What is already known on this subject? Fetal-abdominal masses are commonly detected in antenatal examinations. A prenatal ultrasound is the main screening tool for detecting fetal intra-abdominal cystic lesions. What the results of this study add? We suggest that MRI is more helpful in some systems to reveal locations and structures. Even prenatal diagnosis cannot reach before birth, prognosis is quite good and expectant therapy is sufficient. What the implications are of these findings for clinical practice and/or future research? Our data strengthens the current knowledge of fetal abdominal masses to help relieve anxious parents by telling them that this congenital malformation has good outcomes. But multidiscipline consultation is necessary.
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Affiliation(s)
- Min Lv
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine , Hangzhou , China
| | - Baihui Zhao
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine , Hangzhou , China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine , Hangzhou , China
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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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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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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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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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Marchitelli G, Stirnemann J, Acanfora MM, Rousseau V, Salomon LJ, Ville Y. Prenatal diagnosis of intra-abdominal cystic lesions by fetal ultrasonography: diagnostic agreement between prenatal and postnatal diagnosis. Prenat Diagn 2015; 35:848-52. [PMID: 25962705 DOI: 10.1002/pd.4614] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic agreement between the prenatal diagnosis of intra-abdominal cystic lesions made by ultrasound examination and the postnatal diagnosis. METHODS We reviewed all consecutive cases referred for an anechoic abdominal cyst from 2009 to 2013. Prenatal ultrasound diagnosis was compared with postnatal diagnosis. Prenatal diagnosis was defined as 'correct' if a specific prenatal diagnosis or one of the possible diagnoses was confirmed postnatally, as 'not confirmed' if the postnatal examination revealed no abnormalities and as 'incorrect' if the postnatal diagnosis was different from those suggested prenatally. RESULTS Seventy-three cases were included, and prenatal diagnoses were made at a median gestational age of 27 weeks (range: 13-36). Correct diagnoses were made in 66 cases (90.4%), including four in which the lesion resolved spontaneously in utero; two diagnoses were 'not confirmed' postnatally, and one was incorrect (a prenatal diagnosis of intestinal duplication was in fact an anorectal malformation). Postnatal diagnosis was not achieved in four cases: None of them required surgery, and clinical follow-up was favorable. The abdominal cysts were isolated in 52 cases (71%) and associated with other anomalies in 21 cases (29%). Aneuploidies were diagnosed in three cases (all trisomy 21). Eight cases underwent termination of pregnancy; there were no fetal deaths and one neonatal death. Postnatal surgery was performed in 30 out of 65 liveborn infants (46.1%). CONCLUSION Overall diagnostic agreement between prenatal and postnatal diagnosis of fetal intra-abdominal cystic lesions is high.
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Affiliation(s)
- Giulia Marchitelli
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
| | - Julien Stirnemann
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
| | - Marta Maddalena Acanfora
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
| | - Veronique Rousseau
- Pediatric Surgery, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
| | - Laurent J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
| | - Yves Ville
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université René Descartes, Paris, France
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Hugele F, Dumont C, Boulot P, Couture A, Prodhomme O. Does prenatal MRI enhance fetal diagnosis of intra-abdominal cysts? Prenat Diagn 2015; 35:669-74. [DOI: 10.1002/pd.4590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 02/28/2015] [Accepted: 03/02/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Florence Hugele
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Coralie Dumont
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Pierre Boulot
- Service de gynécologie-obstétrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Alain Couture
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
| | - Olivier Prodhomme
- Service de radiologie pédiatrique; Pôle mère-enfant, Hôpital Arnaud-de-Villeneuve; Montpellier Cedex 5 France
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Thakkar HS, Bradshaw C, Impey L, Lakhoo K. Post-natal outcomes of antenatally diagnosed intra-abdominal cysts: a 22-year single-institution series. Pediatr Surg Int 2015; 31:187-90. [PMID: 25399359 DOI: 10.1007/s00383-014-3635-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to establish the post-natal diagnosis and outcome of antenatally diagnosed intra-abdominal cysts between 1991 and 2013 at our institution. METHODS All antenatally diagnosed intra-abdominal cysts between 1991 and 2013 were identified using a foetal anomaly database. The cysts were monitored for resolution. In all cases where the cyst had not resolved antenatally, additional post-natal scans were conducted. Antenatal diagnosis, post-natal diagnosis and outcomes were also recorded. RESULTS 118 cases of antenatal intra-abdominal cysts were identified over the 22-year study period with a 98 % live birth rate. The overall accuracy of an antenatal diagnosis at our institution was 92 %. 26 cases (22 %) resolved spontaneously in utero, the majority of which (77 %) were ovarian in nature. Four tumour cases were identified in the series, which included two neuroblastomas, one yolk sac tumour and one teratoma. 90 cysts persisted post-natally with 52 % requiring surgery. These primarily included choledochal and enteric duplication cysts as well as symptomatic solid organ cysts. Diagnostic revision was limited to 8 % of cases over the study period with an overall improvement over the last decade. Overall, 40 % of all antenatally diagnosed cysts required surgical intervention. In those cysts that persisted post-natally, 52 % required surgery. CONCLUSIONS A fifth of prenatally diagnosed intra-abdominal cysts will resolve with most ovarian cysts regressing in utero. Half of all persistent cysts will, however, require surgical intervention. These data are useful for prenatal counselling and demonstrates the important role played by the paediatric surgeon in the overall management of intra-abdominal cysts.
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Affiliation(s)
- H S Thakkar
- Department of Paediatric Surgery, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK,
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15
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Role of magnetic resonance imaging in the prenatal diagnosis of gastrointestinal fetal anomalies. Radiol Med 2014; 120:393-403. [PMID: 25348138 DOI: 10.1007/s11547-014-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/05/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE This study was done to evaluate the role of fetal magnetic resonance imaging (MRI) in the study of gastrointestinal malformations in comparison to prenatal ultrasound (US). MATERIALS AND METHODS A prospective (2010-2012) study of 38 fetal MRI scans was performed on 38 fetuses between 24 and 38 weeks of gestation. All the fetuses had a US diagnosis of gastrointestinal anomalies. T2-weighted HASTE, T1-weighted fast gradient echo, TrueFISP and diffusion-weighted images of the fetal abdomen were obtained on a 1.5-Tesla magnet. All fetal MRI diagnoses were compared with postnatal US findings, autopsy or surgical reports. RESULTS Fetal MRI was able to confirm the sonographic findings in nine of 38 fetuses (23.7%), to provide additional information in 23 of 38 fetuses (60.6%), to exclude the US diagnosis in five cases (5.2%) and to change it in two cases (5.2%). It was not able to characterize a case of gastric duplication and a case of abdominal cystic lymphangioma (5.2%). CONCLUSIONS Fetal MRI can be used as a complementary imaging modality to US in prenatal evaluation of gastrointestinal anomalies and can be considered a valuable tool not only for confirming or excluding but also for providing additional information to fetal ultrasonographic findings.
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16
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Kamisawa T, Ando H, Suyama M, Shimada M, Morine Y, Shimada H. Japanese clinical practice guidelines for pancreaticobiliary maljunction. J Gastroenterol 2012; 47:731-59. [PMID: 22722902 DOI: 10.1007/s00535-012-0611-2] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/02/2012] [Indexed: 02/07/2023]
Abstract
There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.
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Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113 8677, Japan.
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17
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Lecarpentier E, Dreux S, Blanc T, Schaub B, Ville Y, Mandelbrot L, Ghoneimi AE, Oury JF, Muller F. Biochemical analysis of cystic fluid in the diagnosis of fetal intra-abdominal masses. Prenat Diagn 2012; 32:627-31. [DOI: 10.1002/pd.3871] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Edouard Lecarpentier
- Gynécologie Obstétrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Sophie Dreux
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; Paris France
| | - Thomas Blanc
- Chirurgie Viscérale et Urologie Pédiatrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Bruno Schaub
- Gynécologie Obstétrique; Centre Hospitalier Universitaire; Fort-de-France France
| | - Yves Ville
- Gynécologie Obstétrique; Hôpital Necker Enfants Malades, AP-HP; Paris France
| | | | - Alaa El Ghoneimi
- Chirurgie Viscérale et Urologie Pédiatrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Jean-François Oury
- Gynécologie Obstétrique; Hôpital Robert Debré, AP-HP, Université Paris-Diderot; Paris France
| | - Françoise Muller
- Biochimie-Hormonologie; Hôpital Robert Debré, AP-HP; Paris France
- Université Versailles Saint Quentin; Versailles France
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Gupta P, Sharma R, Kumar S, Gadodia A, Roy KK, Malhotra N, Sharma JB. Role of MRI in fetal abdominal cystic masses detected on prenatal sonography. Arch Gynecol Obstet 2009; 281:519-26. [DOI: 10.1007/s00404-009-1190-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 07/16/2009] [Indexed: 11/30/2022]
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