Foetal cystic abdominal masses

Congenital Hepatic Cyst in Patients With Patau Syndrome: A Rare Clinical Finding

Trisomy 13 (T13), frequently referred to as Patau syndrome, is a rare autosomal aneuploidy most commonly due to nondisjunction in meiosis. Frequently seen characteristics include cleft lip, cleft palate, cerebral defects, anophthalmia, and polydactyly among many more. We report a rare case of a newborn female with T13, demonstrating several known anomalies associated with the syndrome and an associated large congenital hepatic cyst, exhibiting a significant mass effect on vital organs. Based on a literature review conducted in August 2023, we found no previous documentation of a congenital hepatic cyst reported with T13.

Improving prenatal detection of abdominal supraumbilical anomalies: The sonographic examination of fetal anechoic spaces of upper abdomen revisited

Visualization of the axial plane of the fetal abdomen is mandatory to obtain abdominal biometry in the assessment of fetal growth in the second and third trimesters. The main anatomic landmarks that must be identified in this view include the fetal stomach and the intrahepatic portion of the umbilical vein, which are easily identifiable as they appear anechoic on ultrasound. The gallbladder is the other prominent anechoic structure in this plane. Focused study of the morphological characteristics of, and spatial relationship among, these three anechoic spaces is a simple technique to detect anomalies involving fetal upper abdominal organs. In this review, the sonographic features of those conditions that can be detected using this technique, which was termed the Fetal Examination of the Anechoic Spaces of upper abdomen Technique (FEAST), are classified and illustrated.

A Case of Multicystic Dysplastic Kidney Presenting as a Single Midline Pelvic Cyst

We present an unusual case of a female neonate presenting with a single midline pelvic cyst. Prenatal imaging was suggestive of multicystic dysplastic kidney (MCDK), but postnatal imaging was atypical for this diagnosis given the location and singular cyst noted. The patient ultimately underwent surgical exploration and was diagnosed with an ectopic MCDK. Ectopic MCDK should be considered in the differential diagnosis of unilocular cystic pelvic lesions identified in the perinatal period.

Predictive value of prenatal ultrasound in foetal intraabdominal cystic lesions and evaluation of perinatal outcomes: a single-centre study results

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.

Accuracy of Magnetic Resonance Imaging in Prenatal Diagnosis of Choledochal Cysts: A Single-Center Retrospective Analysis

BACKGROUND

The purpose of this study is to evaluate the accuracy of prenatal MRI in diagnosing choledochal cysts (CDC), evaluate the sensitivity and specificity of MRI signs in the diagnosis of fetal CDC, and first compare the trend of size of CC between prenatal and postpartum.

METHODS

A total of 18 fetal who were diagnosed with CDCs through prenatal MRI were enrolled in the study. We summarized and analyzed the prenatal clinical data and prognosis information of prenatal and postpartum surgery, then compared the sensitivity, specificity, and diagnostic accuracy of various signs of MRI and postpartum MRCP diagnosis of CC. Finally, we tried to compare the earliest prenatal detection of common bile duct cysts with the size of surgery, and calculated the growth rate of common bile duct cysts for the first time.

RESULTS

All 18 patients were delivered in our institution. Among these patients, 14 were confirmed with CDCs after postpartum surgery, two patients had CDCs that disappeared, and two patients were confirmed with cystic biliary atresia (CBA) through the Kasai operation. Furthermore, 13 patients with CDCs and two patients with CBA underwent MRCP before the operation, and one patient with CDCs ruptured at birth and underwent ultrasound diagnosis. The sensitivity and diagnostic compliance of prenatal MRI signs for the location were higher when compared to postnatal MRCP (100% vs. 76.9% and 83.3% vs. 66.7%): the cyst was located at the porta hepatis, which was higher than the lowest edge of the liver, and parallel to the hepatoduodenal ligament.

CONCLUSION

Prenatal MRI is higher than that of US for diagnosing CDCs, specifically in identifying the location of the cyst and confirming the origin of the cyst. The length, width, and size of the CDC become slightly bigger in our study.

Congenital hepatic cyst: Prenatal and postnatal imaging findings

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.

Fetal Non-Ovarian Abdominopelvic Cystic Lesions: A Single-Center Report

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.

Congenital and hereditary cystic diseases of the abdomen

Congenital and hereditary cystic lesions of the abdomen are relatively rare. Correct diagnosis is critical as they may simulate several other benign and malignant acquired diseases of the abdomen. With the correct and appropriate use of imaging, diagnosis may be relatively straightforward and clinical management may be implemented appropriately. The purpose of this article is to describe imaging findings of common and uncommon congenital and hereditary cystic disease of the abdominal organs.

Antenatally detected abdominal cyst: Does cyst size and nature determine postnatal symptoms and outcome?

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.

Fetal abdominal cysts: antenatal course and postnatal outcomes

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.

Prenatal diagnosis and prognosis assessment of fetal intra-abdominal cystic lesions: a retrospective study in 264 cases

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.

Splenic cyst as a rare cause of fetal abdominal cystic mass: A multicenter series of nine cases and review of the literature

Introduction

Congenital splenic cysts are a rare cause of abdominal cystic masses in the fetus. We describe nine cases of this condition, the largest reported experience to date. A review of the literature for similar cases was also performed.

Methods

Cases of congenital splenic cyst were collected from three prenatal diagnostic centers and from a dedicated website of prenatal diagnosis. Information regarding clinical and sonographic findings was obtained by reviewing ultrasound reports and medical records. An electronic search of the Pubmed/MEDLINE database for similar cases, with subsequent manual cross-referencing, was performed and the relevant information from the articles was retrieved.

Results

A total of nine cases were added to the currently existing literature of 32 cases. In all but one of our cases, the prenatal detection of the splenic cyst was made in the third trimester, with a median gestational age at diagnosis of 30 weeks (range 22-37). The splenic cyst was confirmed after delivery in all but one case, which was lost to follow up. Postnatal sonographic examinations performed in the remaining eight cases showed that the cyst increased in size in two (25%), was stable in size in one (12%), decreased in size in one (12%), and completely regressed in the other four cases (50%). No complications associated with the cysts were reported in the infants.

Conclusions

Congenital splenic cyst appears to be a benign condition with no known risk of perinatal complications. Nevertheless, differential diagnosis with other fetal cystic masses of the left upper abdominal quadrant and postnatal sonographic follow up to monitor the size of the cyst are important issues to be considered in the perinatal management of these cases.

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.

A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst

Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst.

Ultrasound and differential diagnosis of fetal abdominal cysts

The present study aimed to investigate the use of ultrasound and differential diagnosis to diagnose a fetal abdominal cyst. A retrospective analysis of 41 cases of fetal abdominal cyst, which included ovarian cysts, choledochal cysts, intestinal duplication and mesenteric cysts, was performed. Imaging characteristics of various types of cysts were summarized, compared and discussed. Among 41 fetal abdominal cyst cases, there were 21 cases of ovarian cysts, 11 cases of bile duct cyst, six cases of intestinal duplication and three cases of mesenteric cyst. Each type of fetal cyst had its own distinctive characteristics on abdominal ultrasound examination. Ovarian cysts were located at one side of the bladder, round-shaped and observed in female fetuses; choledochal cysts were located in the hilar, were oblong- or oval-shaped and connected to the bile duct; intestinal duplication was located in the middle of abdomen, close to the intestine, and presented as an intestinal wall-like structure; mesenteric cysts were round-shaped with thin tensionless wall, presented with multiple chambers, and were easily deformable on compression. The findings of the present study demonstrated that a comprehensive analysis of the association between the cyst and its adjacent location, shape, wall thickness, motility and other aspects of dynamic changes via ultrasonography may provide a differential diagnosis of different types of fetal abdominal cysts.

Magnetic resonance imaging of fetal pelvic cysts

The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.

Outcome of fetal gastro-intestinal cysts: a systematic review and meta-analysis

OBJECTIVES

To explore the outcome of fetal gastrointestinal (GI) cysts and to ascertain the detection rate of prenatal ultrasound in identifying these anomalies.

METHODS

Medline and Embase databases were searched. The outcomes explored were: resolution of the cyst, additional GI anomalies detected only at birth, clinical symptoms, need for surgery, post-surgical complications and diagnostic accuracy. Meta-analyses of proportions and hierarchical summary receiver operating characteristics (HSROC) model were used to analyse the data.

RESULTS

Ten studies were included; 27.0% (95% CI 2.6-64.4) of the cysts resolved either pre or post-natally. Additional GI anomalies were detected in 6.0% (95% CI 1.1-14.7). Clinical symptoms occurred in 31.1% (95% CI 14.9-50.2), while 50.6% (95% CI 10.0-90.8) had surgery. Post-surgical complications occurred in 6.1% (95% CI 0.2-19.6). Overall detection rate of prenatal ultrasound in correctly identifying GI cysts was good (sensitivity: 94.5%, 95% CI: 39.1-99.8; specificity: 97.7%, 95% CI 89.9-99.5).

CONCLUSION

GI cysts are usually benign. Clinical symptoms occur in approximately one third of children. About one third of the cysts resolves, while the rate of complications after surgery is low. Prenatal ultrasound has an overall good diagnostic accuracy in identifying these anomalies. © 2016 John Wiley & Sons, Ltd.

Management of fetal teratomas

Fetal teratomas are the most common tumors diagnosed prenatally. The majority of these tumors are benign and cured by complete resection of the mass during the neonatal period. Prenatal diagnosis has improved the perinatal management of these lesions and especially for the teratomas that might benefit from fetal intervention. A comprehensive prenatal evaluation including conventional ultrasounds, Doppler, echocardiography and fetal MRI, is essential for an effective counseling and perinatal management. Antenatal counseling helps the parents to better understand the natural history, fetal intervention, and perinatal management of these tumors, which differ dramatically depending on their size and location. Fetal surgical debulking improves survival in cases of sacrococcygeal teratoma with cardiac decompensation. Additionally, the use of an EXIT procedure reduces the morbidity and mortality if a complicated delivery in cases of cervical and mediastinal teratomas. Here, we offer an overview of all fetal teratomas and their recommended management, with emphasis on in utero treatment options.

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.

Prenatal diagnosis of intra-abdominal cystic lesions by fetal ultrasonography: diagnostic agreement between prenatal and postnatal diagnosis

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.

Fetal tumors: prenatal ultrasonographic findings and clinical characteristics

The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.

Outcome of first-trimester fetal abdominal cysts: cohort study and review of the literature

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.

A rare case of renal dysplasia: prenatal and postnatal management

The ultrasonographic detection of renal anomalies may modify obstetric management and facilitate pediatric care of the newborn. We performed prenatal differential diagnosis of an isolated unilateral cystic renal mass (71 × 74 × 82 mm) in a pregnant woman at 26 weeks of gestation. No other abnormalities were detected by ultrasonography, except for polyhydramnios. Repeated percutaneous cyst aspirations were required because of the increasing risk of vital organ damage. Postnatal nephroureterectomy was performed. Anatomopathologic analysis led to the diagnosis of segmental renal dysplasia, which could not be included in any of the four groups of Potter's classification of cystic renal dysplasia.

Fetal adrenal gland in the second half of gestation: morphometrical assessment with 3.0T post-mortem MRI

Background

The morphometry of fetal adrenal gland is rarely described with MRI of high magnetic field. The purpose of this study is to assess the normal fetal adrenal gland length (AL), width (AW), height (AH), surface area (AS) and volume (AV) in the second half of gestation with 3.0T post-mortem MRI.

Methods and Findings

Fifty-two fetal specimens of 23–40 weeks gestational age (GA) were scanned by 3.0T MRI. Morphological changes and quantitative measurements of the fetal adrenal gland were analyzed. Asymmetry and sexual dimorphism were also obtained. The shape of the fetal adrenal gland did not change substantially from 23 to 40 weeks GA. The bilateral adrenal glands appeared as a ‘Y’, pyramidal or half-moon shape after reconstruction. There was a highly linear correlation between AL, AW, AH, AS, AV and GA. AW, AH, AS and AV were larger for the left adrenal gland than the right. No sexual dimorphism was found.

Conclusions

Our data delineated the normal fetal adrenal gland during the second half of gestation, and can serve as a useful precise reference for anatomy or in vivo fetus.

A rare cause for a neonatal cystic abdominal mass

Intrauterine ovarian torsion is a rare event, but it is a possible cause for unilateral ovarian aplasia. Most commonly the ovary undergoes autolysis after torsion so that no tissue or remnants can be discovered on the involved side. We report a rare case of unilateral intrauterine torsion followed by autoamputation and abdominal reimplantation resulting in an intra-abdominal complex cystic mass with a review of the literature.

Retroperitoneal gastric duplication cyst: a case report and literature review

A rare case of retroperitoneal gastric duplication is reported and discussed. An intra-abdominal cyst was detected at 31 weeks gestation and was followed up prenatally as a left sided duplex kidney. Post-natal ultrasound however, showed a normal kidney, but a cyst with features of enteric duplication in the left upper quadrant adjacent and compressing the kidney. Surgery was carried out during infancy and a retroperitoneal cyst was excised that contained heterotrophic gastric mucosa.

Evolution of sonographic findings in a fetus with ileal atresia

We report a case of a meconium pseudocyst secondary to ileal atresia and midgut volvulus. Initially, a single anechoic cyst was detected on prenatal sonography. The cyst gradually increased in size during the second trimester and eventually appeared as a large mass in the lower abdomen with echogenic content and associated with bowel dilatation. This case indicates that until the mid third trimester a single sonolucent cyst without signs of bowel obstruction may be associated with congenital intestinal obstruction.

Pediatric chylolymphatic mesenteric cyst - a separate entity from cystic lymphangioma: a case series

Introduction

Chylolymphatic mesenteric cysts are rare entities with variable presentations and this has surgical implications in the pediatric age group.

Case presentation

We carried out a retrospective analysis of the clinical and histopathological records of pediatric patients diagnosed and treated for chylolymphatic mesenteric cysts at our institute from 1998 to 2008. Eight patients met the histopathological criteria of chylolymphatic mesenteric cyst. These patients were in the age range 18 months to 10 years with a mean age of 4.5 years. Of these eight patients, four presented with an abdominal lump, and two each with abdominal pain and acute intestinal obstruction. On clinical examination, five out of the eight patients had a palpable abdominal mass. Laparotomy and complete excision of the cyst along with the involved gut was performed in all patients. There were no postoperative complications or any recurrence during the follow-up period which ranged from 4 months to 8 years.

Conclusion

Although very rare, chylolymphatic mesenteric cyst should be kept in mind as one of the differential diagnoses of cystic masses of the abdomen including cystic lymphangioma. Ultrasonography and computed tomography suggest the diagnosis but histopathological examination is required for confirmation. Complete excision of the cyst yields excellent results.

Fetal abdominal cysts in the first trimester: prenatal detection and clinical significance

OBJECTIVE

In order to determine the clinical significance of fetal abdominal cysts detected in the first trimester, we reviewed our experience with such cases collected over a 5-year period.

METHODS

Five cases in which a fetal abdominal cyst was detected by ultrasound in the first trimester were identified. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in all cases.

RESULTS

The abdominal cyst was confirmed by an early second-trimester scan at 14-16 weeks in all cases, at which time no associated anomalies were detected. The standard detailed second-trimester scan at 18-22 weeks demonstrated complete resolution in three cases. These women had an uneventful antenatal course, and normal newborn infants were delivered at term. However, one of these infants had intestinal malrotation, chronic abdominal distension and midgut volvulus requiring surgery at the age of 7 months. Among the remaining two cases in which the abdominal cyst persisted, one required prenatal aspiration at 19 weeks owing to significant enlargement and resolved. The other remained stable in size and was managed conservatively, but the infant required surgery at the age of 7 weeks owing to a choledochal cyst causing intermittent episodes of acholia.

CONCLUSION

Abdominal cysts in early pregnancy often resolve spontaneously or remain small and are usually associated with a good outcome. Nevertheless, as they can also be associated with serious underlying gastrointestinal pathological conditions, close surveillance in the perinatal period is advocated.

Postnatal outcome of antenatally diagnosed intra-abdominal cysts

The aim of this study is to establish the postnatal diagnosis and outcome of all abdominal cystic lesions diagnosed antenatally over a 13-year period. All prenatally suspected and postnatally confirmed intra-abdominal cysts seen and delivered between 1991 and 2004 were identified. Antenatal diagnosis, gestational age at delivery, sex and postnatal diagnosis and outcome were recorded. Fifty-five patients were identified with an antenatal diagnosis of abdominal cystic lesion. There were 53 live births and 2 intrauterine deaths. In 13 cases (24%) the cyst had resolved on a postnatal scan. Sixteen (29%) required surgical intervention postnatally. Twenty-six (47%) were given a "non-specific" diagnosis of abdominal cyst antenatally. Three (11%) of these non-specific cysts had resolved on postnatal scan. A "specific" diagnosis of the abdominal cyst was made antenatally in 29 cases (53%) of which 12 (43%) had the diagnosis confirmed postnatally. In ten (35%) of these there was a normal postnatal scan. Antenatal ultrasound scans may not reliably predict the exact pathological diagnosis of abdominal cystic lesions. However this study provides valuable information on the proportion of correctly diagnosed lesions and those that will persist into the postnatal period allowing more informative counselling for prospective parents.

Fetal abdominal magnetic resonance imaging

This review deals with the in vivo magnetic resonance imaging (MRI) appearance of the human fetal abdomen. Imaging findings are correlated with current knowledge of human fetal anatomy and physiology, which are crucial to understand and interpret fetal abdominal MRI scans. As fetal MRI covers a period of more than 20 weeks, which is characterized not only by organ growth, but also by changes and maturation of organ function, a different MR appearance of the fetal abdomen results. This not only applies to the fetal intestines, but also to the fetal liver, spleen, and adrenal glands. Choosing the appropriate sequences, various aspects of age-related and organ-specific function can be visualized with fetal MRI, as these are mirrored by changes in signal intensities. Knowledge of normal development is essential to delineate normal from pathological findings in the respective developmental stages.

Enteric duplications presenting as antenatally detected abdominal cysts: is delayed resection appropriate?

PURPOSE

The aim of this study was to evaluate delayed elective resection of antenatally detected enteric duplication cysts.

METHODS

A retrospective casenote study of intraabdominal cysts detected antenatally between January 1991 and January 2002 found 37 fetuses with cysts. Twelve were enteric duplications. Two were duodenal, 1 was an 85-cm tubular jejunoileal duplication, and 9 were ileocecal. Asymptomatic cysts were followed with serial ultrasound scars and resected electively over 14 months.

RESULTS

Three neonates had small bowel obstruction demanding laparotomy: 1 of the 2 infants with duodenal duplication cysts, 1 infant with an ileocecal duplication, and the infant with the tubular duplication. One with an ileocecal duplication became symptomatic at 2 months and underwent a laparotomy. Seven had their duplications resected electively between 6 weeks and 14 months, and the other is still being followed. Four of the 7 asymptomatic duplications electively resected contained gastric mucosa.

CONCLUSIONS

Intraabdominal enteric duplication cysts are increasingly likely to be detected antenatally. The majority are likely to remain asymptomatic for several months at least, after which a resection can be planned. The prevalence of gastric mucosa suggests that they should not be left indefinitely. Laparoscopically assisted resection of ileocecal duplications is safe and effective.