Natural history and long-term follow-up of antenatally detected liver cysts

Imaging features and management of focal liver lesions

Notably, the number of incidentally detected focal liver lesions (FLLs) has increased dramatically in recent years due to the increased use of radiological imaging. The diagnosis of FLLs can be made through a well-documented medical history, physical examination, laboratory tests, and appropriate imaging methods. Although benign FLLs are more common than malignant ones in adults, even in patients with primary malignancy, accurate diagnosis of incidental FLLs is of utmost clinical significance. In clinical practice, FLLs are frequently evaluated non-invasively using ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Although US is a cost-effective and widely used imaging method, its diagnostic specificity and sensitivity for FLL characterization are limited. FLLs are primarily characterized by obtaining enhancement patterns through dynamic contrast-enhanced CT and MRI. MRI is a problem-solving method with high specificity and sensitivity, commonly used for the evaluation of FLLs that cannot be characterized by US or CT. Recent technical advancements in MRI, along with the use of hepatobiliary-specific MRI contrast agents, have significantly improved the success of FLL characterization and reduced unnecessary biopsies. The American College of Radiology (ACR) appropriateness criteria are evidence-based recommendations intended to assist clinicians in selecting the optimal imaging or treatment option for their patients. ACR Appropriateness Criteria Liver Lesion-Initial Characterization guideline provides recommendations for the imaging methods that should be used for the characterization of incidentally detected FLLs in various clinical scenarios. The American College of Gastroenterology (ACG) Clinical Guideline offers evidence-based recommendations for both the diagnosis and management of FLL. American Association for the Study of Liver Diseases (AASLD) Practice Guidance provides an approach to the diagnosis and management of patients with hepatocellular carcinoma. In this article, FLLs are reviewed with a comprehensive analysis of ACR Appropriateness Criteria, ACG Clinical Guideline, AASLD Practice Guidance, and current medical literature from peer-reviewed journals. The article includes a discussion of imaging methods used for the assessment of FLL, current recommended imaging techniques, innovations in liver imaging, contrast agents, imaging features of common nonmetastatic benign and malignant FLL, as well as current management recommendations.

Diagnosis and Follow-up of Incidental Liver Lesions in Children

Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.

Congenital anomalies of the gastrointestinal tract: the liver, extrahepatic biliary tree and pancreas

Congenital anomalies of the liver, biliary tree and pancreas are rare birth defects, some of which are characterized by a marked variation in geographical incidence. Morphogenesis of the hepatobiliary and pancreatic structures initiates from two tubular endodermal evaginations of the most distal portion of the foregut. The pancreas develops from a larger dorsal and a smaller ventral outpouching; emergence of the two buds will eventually lead to the fusion of the duct system. A small part of the remaining ventral diverticulum divides into a "pars cystica" and "pars hepatica", giving rise to the cystic duct and gallbladder and the liver lobes, respectively. Disruption or malfunctioning of the complex mechanisms leading to the development of liver, gallbladder, biliary tree and pancreas can result in numerous, albeit fortunately relatively rare, congenital anomalies in these organs. The type and severity of anomalies often depend on the exact moment in which disruption or alteration of the embryological mechanisms takes place. Many theories have been brought forward to explain their embryological basis; however, no agreement has yet been reached for most of them. While in some cases pathological evaluation might be more centered on macroscopic evaluation, in other instances small biopsies will be the keystone to understanding organ function and treatment results in the context of congenital anomalies. Thus, knowledge of the existence and histopathological characteristics of some of the more common conditions is mandatory for every pathologist working in the field of gastrointestinal pathology.

Laparoscopic Excision of Solitary Dysontogenetic Liver Cysts in Young Children: Technical Aspects and Outcome

Background: Solitary dysontogenetic liver cysts are rare in young children. However, large cysts can cause symptoms and require therapy. Cyst excision is the therapeutic method least associated with cyst recurrence. Only limited data are available on cyst excision performed laparoscopically in this age group. We present our experience using this surgical approach. Methods: Since 2005, 7 children including 5 newborns and infants with solitary dysontogenetic liver cysts have undergone minimally invasive excision of the cyst at our institution. Patient data were analyzed retrospectively. Results: Median age of the patients at surgery was 8 months (3 days to 6 years); 5 of them were younger than 1 year. The cysts had varying locations in the segments IV-VIII, and median size was 5.4 cm (3.8-7.9). Complete excision was realized in all cases. Median duration of surgery was 120 minutes (60-171). All procedures could be completed laparoscopically. One intraoperative complication occurred (injury of a bile duct that could be sutured laparoscopically). Median follow-up was 29 months (14-173). Cyst recurrence was not observed in any of the cases. Conclusion: Laparoscopic excision of solitary dysontogenetic liver cysts is an effective treatment in young children. Resection is not limited to cysts in anterior and lateral liver segments.

Fetal abdominal tumors and cysts

This article reviews the contemporary diagnosis and management of the most common abdominal neoplasms and cystic lesions diagnosed in the fetus. Fetal tumors discussed include teratomas (sacrococcygeal, cervical or mediastinal), mesoblastic nephroma, nephroblastoma (Wilms' tumor), neuroblastoma, and hepatoblastoma. Fetal abdominal cystic lesions discussed include ovarian cyst, choledochal cyst, intestinal duplication cyst, mesenteric cyst, simple hepatic cyst, and meconium pseudocyst. We discuss the rare indications for fetal intervention or fetal surgery and other perinatal management, including prenatal interventions and fetal surgery for sacrococcygeal teratoma. The lesions reviewed are detected by widespread use of screening ultrasonography during pregnancy. Work-up for these abnormalities may include fetal MRI which enhances the diagnostic accuracy of abdominal tumors and cystic lesions and can aid in characterization of the lesion in relationship to surrounding anatomic structures. Accurate prenatal diagnosis of such lesions permits recommendations for optimal location and timing of delivery, and inclusion of appropriate caregivers and expertise to facilitate postnatal management. Perinatal management of the fetus with a neoplasm requires consideration of the optimal timing and mode of delivery, and pediatric oncology and surgical specialty care. The majority of tumors diagnosed antenatally have good prognosis with current multimodality treatment.

Antenatally detected liver and biliary pathology

Liver and biliary pathology in the neonate are rare and include a broad range of structural, neoplastic, infectious, genetic, and metabolic diseases. While most conditions present postnatally, antenatal detection is increasing given recent advances in antenatal imaging capabilities. In certain structural or obstructive liver diseases, antenatal detection now proves essential to help guide treatment and prevent morbidity. We review the epidemiology, pathophysiology, common antenatal diagnostic findings, and recommendations for surgical liver and biliary pathology in the neonate.

Management of benign liver tumors

Benign liver tumors in children are far less frequent than their malignant counterparts. Recently, there have been advances of diagnostic procedures and novel treatments with improved classification as a result. While malignant pediatric liver tumors have been comprehensively addressed by multicenter international tumor trials, benign tumors have more usually relied upon individualised workup and treatment. Due to the rarity and heterogeneity of these different entities, large studies are lacking. In this article the authors highlight the spectrum of benign liver tumors with special focus on specific clinical features, pathology, and treatment.

Antenatally-detected liver cysts: Causes and characteristics, indications for intervention

AIM

The prevalence of antenatally-detected hepatic cysts is increasing owing to increased use of maternal ultrasonography (USS). Diagnostic precision, however, is challenging and subsequently there is no clear consensus on postnatal management. The aim of the study was to evaluate the natural history and long-term follow up of congenital simple hepatic cysts.

METHODS

Single-center review of prospectively-maintained dataset collected over a 25-year period. Data are quoted as median (range).

RESULTS

In the period 1991-2016, 31 infants presented with an antenatally-detected cyst which, on postnatal imaging, was likely confirmed as a simple parenchymal hepatic cyst. These together with a further infant who presented at 4 days without any antenatal imaging comprised the study group (n = 32). Gestational age at detection was 23 (13-38) weeks. Maximum antenatal cyst diameter was measured at 19 (4-120) mm. Only the largest required percutaneous aspiration at 35 weeks' gestation being associated with polyhydramnios. Postnatally, serial USS was performed alongside MRI/CT or liver scintigraphy if there was diagnostic doubt. Initial maximum cyst diameter was 30 (12-120) mm. Five infants came to surgical intervention and this included excision ± marsupialization (n = 4), and a cyst-jejunostomy en Roux in one child thought to have a connection with the biliary tract on intraoperative cholangiography. The mucosal lining in two cysts showed areas of squamous metaplasia, with one more showing an intact squamous lining probably more consistent with an epidermoid cyst. In the remaining cases (n = 27), all asymptomatic, serial USS showed volume maintenance (n = 16) actual volume regression (n = 4) and resolution (n = 7). Median follow-up in these cases was 42 (4-252) months.

CONCLUSION

This is the largest case series to date of antenatally-detected simple hepatic cysts. Most can be managed conservatively, and relative regression or resolution is likely. Surgical intervention should be reserved for those: that are large at the outset; show rapid cyst growth - these being typically exophytic in nature; wall irregularity or where there is diagnostic doubt.

TYPE OF STUDY

Case series.

LEVEL OF EVIDENCE

Level IV.

Spontaneous postnatal complete resolution of an antenatally diagnosed fetal hepatic cyst: A case report

RATIONALE

Antenatal diagnosis of a fetal hepatic cyst is rare. Since in most cases the lesion is treated after birth by surgery only a few reports present a complete spontaneous resolution of an antenatally diagnosed hepatic cyst.

PATIENT CONCERNS

A single hepatic cyst (1.34/1.47 cm) was diagnosed in a fetus at 36 weeks of pregnancy while mother was in labor. After an uneventful vaginal birth, a multidisciplinary evaluation of the newborn confirmed the presence of the cyst.

DIAGNOSES

Single hepatic cyst INTERVENTIONS:: Passive approach; periodic ultrasound monitoring of the cyst OUTCOMES:: The latest ultrasound examination performed at 18 months of age confirmed complete resolution of the cyst. No other medical complications occurred before 18 months of age.

LESSONS

The management of such a case depends on the cyst dimensions, the types of involved structure and could require urgent prenatal or neonatal treatment. In our case a complete spontaneous resolution of the hepatic cyst was achieved before 18 months of age.

Cysto-cholecystostomy: A More Physiological Procedure for Hepatic Cysts with Biliary Communications and Cystic Dilatations of Main Intrahepatic Ducts

OBJECTIVE

Hepatic cysts with biliary communications (HC) and cystic dilatations of main intrahepatic ducts (CIHD) can cause biliary obstruction, cholestasis, stone formation, cholangitis, liver damage and carcinoma. Conventionally, Roux-Y cysto-jejunostomy is employed to manage these conditions. However, it is technically demanding and may be complicated with major biliary disruption and bacteria migration from intestine to intrahepatic duct. We have carried out laparoscopic cysto-cholecystostomies for HC with biliary communication and CIHD and evaluated outcomes.

METHODS

Twenty patients with HC (n = 10) or CIHD (n = 10) who successfully underwent laparoscopic cysto-cholecystostomies in our center, between September 2010 and March 2017, were reviewed.

RESULTS

The mean age of the patients at surgery was 2.06 and 2.23 years for HC and CIHD groups, respectively. Eighteen patients were symptomatic, with abdominal pain, fever, vomiting and jaundice. Laboratory results showed abnormal liver functions in 8 patients. Pathological results verified hepatic cellular damages in 8 patients. The mean operative time was 0.97 and 0.92 h for HC and CIHD patients, respectively. The median follow-up duration was 27 months (1-54 months) and 35 months (1-79 months) for HC and CIHD groups, respectively. No patient developed bile leak, anastomotic stenosis, stone formation or cholangitis. Liver function normalized postoperatively.

CONCLUSIONS

Laparoscopic cysto-cholecystostomy is a simpler and more physiological surgical alternative for managing HC with biliary communication and CIHD.

Outcomes associated with fetal hepatobiliary cysts: systematic review and meta-analysis

OBJECTIVE

To explore the outcomes associated with fetal hepatobiliary cysts.

METHODS

MEDLINE and EMBASE were searched for studies reporting on outcomes of fetal hepatobiliary cysts. Outcomes observed were resolution/reduction and increase in cyst size, associated congenital anomalies of the biliary tract and liver, abnormal postnatal liver function tests, clinical symptoms, need for surgery, postsurgical complications and predictive accuracy of prenatal ultrasound in identifying correctly hepatobiliary cysts. Meta-analysis of proportions was used to analyze the data.

RESULTS

The search identified 1498 articles, and 22 studies (252 fetuses) were included in the systematic review. For fetal hepatic cysts, resolution or reduction in cyst size either pre- or postnatally occurred in 59.3% (95% CI, 30.9-84.7%) of cases, while an increase in cyst size occurred in 8.7% (95% CI, 1.1-22.4%). No case of hepatic cyst had associated malformations of the biliary tract at birth. Clinical symptoms occurred in 14.8% (95% CI, 6.3-26.1%) of cases and, in 5.4% (95% CI, 0.9-13.6%), they were related to the presence of bile obstruction due to compression of the cyst on the biliary tract. No case of hepatic cyst had abnormal liver function at birth. For fetal biliary cysts, resolution or reduction in cyst size occurred in 8.7% (95% CI, 2.7-17.5%) of cases and an increase in size occurred in 34.4% (95% CI, 20.5-49.8%). Congenital anomalies of the biliary tract and liver, such as fibrosis, occurred in 21.5% (95% CI, 10.2-35.6%) and 17.4% (95% CI, 5.4-34.4%) of cases, respectively. 57.3% (95% CI, 33.9-79.0%) of cases showed impairment in liver function after birth, while 55.0% (95% CI, 37.5-71.9%) showed clinical symptoms, mainly due to bile obstruction (47.9% (95% CI, 29.4-66.7%)). Postsurgical complications occurred in 10.9% (95% CI, 3.7-21.3%) of operated cases. Risk assessment according to different cut-offs of cyst size could not be performed in view of the very small number of included studies.

CONCLUSIONS

Fetal hepatic cysts are benign, with a low likelihood of associated anomalies of the hepatobiliary tract, abnormal liver function or clinical symptoms. Congenital biliary cysts are associated with a high rate of progression, abnormal liver function after birth and clinical symptoms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Spontaneous Subcapsular Hematoma of the Fetal Liver: A Case Report and Review of Literature

We report a case of a cystic abdominal mass on ultrasound which presented a diagnostic dilemma at 32 weeks gestation. A presumptive antenatal diagnosis of a subcapsular liver hematoma (SCH) was made based on the location and ultrasound appearance similar to SCH seen in pediatric and adult patients. Sequential evaluation of the mass showed an evolving ultrasound appearance which reinforced our initial impression of a subcapsular hematoma of the fetal liver. Postnatal ultrasound confirmed the resolving SCH as well as a previously undetected echo bright lesion characteristic of an infantile focal hemangioma directly adjacent to the resolving SCH. A review of the literature is provided.

Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound

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.

Postnatal sonographic spectrum of prenatally detected abdominal and pelvic cysts

OBJECTIVE

The purpose of this article is to illustrate the sonographic findings of a spectrum of neonatal abdominal and pelvic cystic lesions.

CONCLUSION

Neonatal abdominal and pelvic cystic lesions can arise from many organs, and they have a broad differential diagnosis. Distinctive sonographic findings may be present and can help establish the correct cause and guide proper management.

Liver masses: a clinical, radiologic, and pathologic perspective

Liver masses present a relatively common clinical dilemma, particularly with the increasing use of various imaging modalities in the diagnosis of abdominal and other symptoms. The accurate and reliable determination of the nature of the liver mass is critical, not only to reassure individuals with benign lesions but also, and perhaps more importantly, to ensure that malignant lesions are diagnosed correctly. This avoids the devastating consequences of missed diagnosis and the delayed treatment of malignancy or the unnecessary treatment of benign lesions. With appropriate interpretation of the clinical history and physical examination, and the judicious use of laboratory and imaging studies, the majority of liver masses can be characterized noninvasively. Accurate characterization of liver masses by cross-sectional imaging is particularly dependent on an understanding of the unique phasic vascular perfusion of the liver and the characteristic behaviors of different lesions during multiphasic contrast imaging. When noninvasive characterization is indeterminate, a liver biopsy may be necessary for definitive diagnosis. Standard histologic examination usually is complemented by immunohistochemical analysis of protein biomarkers. Accurate diagnosis allows the appropriate selection of optimal management, which is frequently reassurance or intermittent follow-up evaluations for benign masses. For malignant lesions or those at risk of malignant transformation, management depends on the tumor staging, the functional status of the uninvolved liver, and technical surgical considerations. Unresectable metastatic masses require oncologic consultation and therapy. The efficient characterization and management of liver masses therefore requires a multidisciplinary collaboration between the gastroenterologist/hepatologist, radiologist, pathologist, hepatobiliary or transplant surgeon, and medical oncologist.

ACG clinical guideline: the diagnosis and management of focal liver lesions

Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.

Current diagnosis and management of simple hepatic cysts detected prenatally and postnatally

PURPOSE

The optimal management of simple hepatic cysts (SHCs) remains controversial. A retrospective review was carried out to evaluate the clinical presentation and surgical consideration of children with SHCs and outcome of management at our institution.

METHODS

We performed a retrospective review of all patients diagnosed with SHCs between January 1993 and May 2013. Patient variables included prenatal findings, age, gender, presenting symptoms, signs and diagnostic modality. Operative management and nonoperative follow-up were abstracted.

RESULTS

The 67 patients comprised 42 females and 25 males: 16 had prenatally detected, and 51 had postnatally detected hepatic cysts with a mean follow-up of 3.2 years (10 months-12 years). The average age was 5.9 years (0-17 years). Ten patients (six females and four males) were treated surgically. Fifty-seven asymptomatic patients were observed. Of those 57 patients, 9 (17%) had enlarged cysts, and 1 (2%) had clinical signs. The average enlargement time was 36 months (6-67 months). The cysts occurred in the right lobe in 47 patients, in the left lobe in 17 patients and in both lobes in 3 patients. The median cyst size for the asymptomatic cases was 2.1 cm (1.5-6 cm) and 13.7 cm (8-25 cm) for the surgery group. A statistically significant difference in cyst size was found between these two groups (p < 0.05). Prenatally detected cysts (n = 5) were subjected to surgery postnatally at an average age of 1.5 months (1 week-6 months). The main indication was the compressive effect of the cyst on the surrounding area. There was one case of hepatomegaly found to be causing pressure symptoms, two cases of respiratory distress, one case of hydroureteronephrosis, and one case of jaundice due to compression of the biliary system. Five patients underwent surgery in the postnatally detected group, and the main indication was a complication of the cyst or progressive enlargement. Symptoms included abdominal discomfort and pain in all five patients: one case exhibited a hemorrhage within the cyst, one case displayed a rupture with possible peritonitis, one case had a 25-cm cyst leading to secondary infection, and two cases were admitted with progressive enlargement with clinical symptoms.

CONCLUSION

Conservative management of SHCs is practical. Surgical excision is recommended in patients with larger cysts, causing pressure symptoms, or if the cyst size does not seem to involute with intractable abdominal pain or becomes complicated in the follow-up period.

Congenital hepatic cyst with antenatal diagnosis: a case report and literature review

Congenital hepatic cysts are rare lesions of infancy. While operative management and outcomes have been extensively studied in adult patients with hepatic cysts, data in pediatric patients are limited. We discuss our experience in an infant and review relevant literature regarding operative technique and surgical outcomes.

Laparoscopic excision of an antenatally diagnosed large simple hepatic cyst in the newborn

Non-parasitic hepatic cysts are rare in infants and children. Advances in antenatal imaging have improved their detection, while development of laparoscopic techniques has expanded options for treatment. We present a case of an antenatally diagnosed non-parasitic hepatic cyst in a neonate, which was successfully excised laparoscopically with no recurrence.

Hepatic cysts and liver abscess

Benign pathologies of the liver often include several cystic diseases, such as simple cysts, autosomal dominant polycystic liver disease, and Caroli's disease. The differential of hepatic cysts also includes infectious pathologies, such as pyogenic liver abscess, hydatid cysts, and parasitic infections if the appropriate clinic setting. Understanding of the various causes, clinical presentation, and treatment options is required to ensure the appropriate surgical management of these patients.

Prenatal and postnatal Ciliated Hepatic Foregut Cysts in infants

PURPOSE

Ciliated Hepatic Foregut Cyst (CHFC) is a rare congenital lesion arising from the embryonic foregut. Since squamous cell carcinomas arising from CHFC have been reported in adults, complete resection should be considered. We report our experience with CHFC.

METHODS

We reviewed the charts of 2 patients who had surgery after prenatal detection of a CHFC and 2 patients with postnatal diagnosis.

RESULTS

Two patients had antenatally detected liver cyst. Postnatal ultrasonography showed a cyst in segment IV, with wall calcifications and sediments. Bile ducts were encased in the wall of the cyst. They underwent central hepatectomy with double biliary diversion and uneventful post operative course. The two other patients underwent non anatomical resection of a cyst on the left lobe and in segment IV, found prior or during liver surgery. Pathology examination showed cysts filled with mucinous fluid, surrounded by an epithelium composed of ciliated cells. One case had a squamous metaplasia.

CONCLUSION

In infants, CHFC are found antenatally or incidentally. A solitary uni or mutilocular cyst with wall calcifications, sediments, located in the central liver segments should raise the diagnosis. Resection of large cysts in the central segments of the liver is challenging and biliary diversion should be considered.

Significance of early prenatal diagnosis of fetal hepatic cyst

PURPOSE

: To summarize our experience of early prenatal diagnosis of fetal hepatic cysts.

METHOD

: We reviewed all cases of fetal hepatic cyst detected in our institution between 13 and 17 weeks' gestation over the last 20 years. All scans were initially performed transvaginally to improve image quality. Most of the scans were performed as a routine fetal anatomy scan in a low-risk population.

RESULTS

: Seven fetal hepatic cysts were detected out of 54,500 fetal anatomy scans performed between 13 and 17 weeks' gestation. Five peripheral cysts measuring 3-5 mm disappeared during the follow-up period, between 18 and 24 weeks' gestation. Two hilar cysts appeared on sonography as choledochal cysts; one disappeared at 22 weeks' gestation, and the other diminished in size during the postnatal follow-up.

CONCLUSION

: Based on our experience, when hepatic cysts are diagnosed during an early fetal anatomy scan, disappearance of these cysts can be expected, especially when the cysts are initially small and peripheral. (c) 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.

Two- and three-dimensional prenatal sonographic diagnosis of hepatic cysts

We describe the 2-dimensional and 3-dimensional multiplanar sonographic diagnosis and characterization of isolated hepatic cysts in 2 fetuses. Two-dimensional imaging of a fetus at 36 weeks' gestation revealed 2 right upper quadrant cystic masses anterior to the gallbladder, demonstrating no peristalsis or blood flow. Postnatal sonographic examination confirmed 2 simple hepatic cysts. Two- and three-dimensional sonograms suggested 2 hepatic cysts in a 23-week-old fetus that resolved by 33 weeks' gestation. In reporting 2 unusual cases of prenatally diagnosed fetal hepatic cysts, we also demonstrate the diagnostic use of 3-dimensional multiplanar imaging.

Ciliated hepatic foregut cyst: from antenatal diagnosis to surgery

Ciliated hepatic foregut cyst is the only ciliated cystic lesion known to occur in the liver. It is an extremely rare, benign and solitary cyst that probably arises from remnants of the embryonic foregut in the liver. We report a 16-month-old girl who underwent surgical excision of a hepatic cyst discovered during antenatal ultrasonography. Surgical exploration and excision were performed because of the uncertain aetiology of the cyst and because on postnatal follow-up US the size of the mass had increased causing extrinsic biliary obstruction. Pathology revealed a ciliated hepatic foregut cyst. This is the fourth child affected by this lesion reported in the literature, the second undergoing surgical excision, and the second with antenatal diagnosis.