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Huerta CT, Beres AL, Englum BR, Gonzalez K, Levene T, Wakeman D, Yousef Y, Gulack BC, Chang HL, Christison-Lagay ER, Ham PB, Mansfield SA, Kulaylat AN, Lucas DJ, Rentea RM, Pennell CP, Sulkowski JP, Russell KW, Ricca RL, Kelley-Quon LI, Tashiro J, Rialon KL. Management and Outcomes of Pediatric Lymphatic Malformations: A Systematic Review From the APSA Outcomes and Evidence-Based Practice Committee. J Pediatr Surg 2024:S0022-3468(24)00349-X. [PMID: 38914511 DOI: 10.1016/j.jpedsurg.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Significant variation in management strategies for lymphatic malformations (LMs) in children persists. The goal of this systematic review is to summarize outcomes for medical therapy, sclerotherapy, and surgery, and to provide evidence-based recommendations regarding the treatment. METHODS Three questions regarding LM management were generated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Publicly available databases were queried to identify articles published from January 1, 1990, to December 31, 2021. A consensus statement of recommendations was generated in response to each question. RESULTS The initial search identified 9326 abstracts, each reviewed by two authors. A total of 600 abstracts met selection criteria for full manuscript review with 202 subsequently utilized for extraction of data. Medical therapy, such as sirolimus, can be used as an adjunct with percutaneous treatments or surgery, or for extensive LM. Sclerotherapy can achieve partial or complete response in over 90% of patients and is most effective for macrocystic lesions. Depending on the size, extent, and location of the malformation, surgery can be considered. CONCLUSION Evidence supporting best practices for the safety and effectiveness of management for LMs is currently of moderate quality. Many patients benefit from multi-modal treatment determined by the extent and type of LM. A multidisciplinary approach is recommended to determine the optimal individualized treatment for each patient. LEVEL OF EVIDENCE: 4
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Affiliation(s)
| | - Alana L Beres
- Division of Pediatric General and Thoracic Surgery, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brian R Englum
- Division of Pediatric Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Gonzalez
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Tamar Levene
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Derek Wakeman
- Division of Pediatric Surgery, University of Rochester, Rochester, NY, USA
| | - Yasmine Yousef
- Division of Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Brian C Gulack
- Division of Pediatric Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Henry L Chang
- Department of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | | | - Phillip Benson Ham
- Division of Pediatric Surgery, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, NY, USA
| | - Sara A Mansfield
- Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Afif N Kulaylat
- Division on Pediatric Surgery, Penn State Children's Hospital, Hershey, PA, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Naval Medical Center San Diego, CA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Rebecca M Rentea
- Division of Pediatric Surgery, Children's Mercy- Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri- Kansas City, Kansas City, MO, USA
| | | | - Jason P Sulkowski
- Division of Pediatric Surgery, Children's Hospital of Richmond, Richmond, VA, USA
| | - Katie W Russell
- Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert L Ricca
- Division of Pediatric Surgery, University of South Carolina, Greenville, SC, USA
| | - Lorraine I Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Jun Tashiro
- Division of Pediatric Surgery, Hassenfeld Children's Hospital, NYU Langone Health, New York, NY, USA
| | - Kristy L Rialon
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Meneses-Parra AL, Tarazona-Bueno RE, Aragón-Mendoza RL, Altman-Restrepo M. Teratoma nasofaríngeo inmaduro con diagnóstico prenatal: reporte de un caso y revisión de la literatura. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2023; 74:68-86. [PMID: 37093940 PMCID: PMC10174717 DOI: 10.18597/rcog.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/16/2023] [Indexed: 03/30/2023]
Abstract
Objetivos: reportar el caso de una gestante con diagnóstico de feto con teratoma nasofaríngeo inmaduro y realizar una revisión describiendo el pronóstico de esta patología.
Materiales y métodos: se reporta el caso de una gestante de 27 años, atendida en la Unidad de Ginecología y Obstétrica de un centro de referencia en Bogotá (Colombia), por hallazgo durante el control prenatal de un feto con evidencia de polihidramnios secundario a teratoma nasofaríngeo. Se realizó una búsqueda bibliográfica en las bases de datos Medline vía PubMed, Scopus, SciELO y ScienceDirect, restringiendo tipo de idioma (inglés y español) y por fecha de publicación (enero de 2001 a enero de 2021). Se incluyeron reportes de caso y series de casos que abarcaran el pronóstico de esta patología.
Resultados: la búsqueda recuperó 168 títulos, de los cuales 55 cumplieron con los criterios de inclusión. En total se reportó el resultado perinatal de 58 fetos con diagnóstico de teratoma nasofaríngeo inmaduro detectado en etapa prenatal. En los casos identificados, la mortalidad perinatal fue del 25,4 % y el porcentaje de óbito fue cercano al 3,6 %.
Conclusiones: el teratoma nasofaríngeo inmaduro es una patología poco frecuente. La literatura disponible sugiere que el pronóstico fetal depende del grado de compromiso de las estructuras intracraneales y de la posibilidad de resección de la lesión. Se requieren más estudios que evalúen el pronóstico de los fetos con teratoma nasofaríngeo inmaduro.
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Srikanthan A, Scott S, Desai V, Reichert L. Neonatal Airway Abnormalities. CHILDREN 2022; 9:children9070944. [PMID: 35883928 PMCID: PMC9322467 DOI: 10.3390/children9070944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023]
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations.
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Affiliation(s)
| | - Samantha Scott
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
| | - Vilok Desai
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
| | - Lara Reichert
- Albany Medical College, Albany, NY 12208, USA; (A.S.); (S.S.); (V.D.)
- Department of Otolaryngology, Albany Medical Center, Albany, NY 12208, USA
- Correspondence:
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Diagnostic Value and Application of Prenatal MRI and Ultrasound in Fetal Cleft Lip and Palate. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9410161. [PMID: 35655725 PMCID: PMC9132648 DOI: 10.1155/2022/9410161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
Abstract
Objective The purpose was to explore the diagnostic value and application of prenatal magnetic resonance imaging (MRI) and ultrasound (US) in fetal cleft lip and palate. Methods From January 2018 to December 2019, 39 pregnant women without normal fetal maxillofacial structure or with fetal maxillofacial deformity under US examination in our hospital were selected as the study subjects. Not knowing the clinical data of the pregnant women, MRI and US physicians performed diagnostic analysis on the MRI or US images of all the study subjects and analyzed the results of prenatal MRI and US diagnosis and postpartum follow-up to compare the diagnostic efficacy and confidence of MRI and US. Results The follow-up found that there were 20 cases of cleft lip, 15 cases of cheilopalatognathus, 3 cases of cleft palate, and 1 case of unilateral cleft lip with alveolar cleft, with a total of 39 cases having cleft lip and palate deformity. MRI and US had the same efficacy in the diagnosis of cleft lip. As for cleft palates, the diagnostic accuracy of MRI (94.87%) was significantly better than that of US (48.72%, P < 0.001). The diagnostic confidence of fetal cleft lip and palate by MRI (89.73%) was significantly better than that of US (43.59%, P < 0.001). The AUC of US (0.597) was significantly less than that of MRI (0.940), indicating that the diagnostic accuracy of US was not as good as that of MRI (P < 0.05). The sensitivity and 1 − specificity of MRI were significantly higher than those of US. Conclusion MRI is more accurate than US in the diagnosis of fetal cleft lip and palate, and MRI can be the preferred method for prenatal detection of cleft lip and palate, thus providing more accurate opinions and information for perinatal pregnant women.
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Werner H, Castro P, Fazecas T, Peixoto-Filho FM, de Mello PP, Araujo Júnior E. Fetal virtual bronchoscopy in bronchial atresia: correlation with postnatal bronchoscopy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 59:693-695. [PMID: 34542200 DOI: 10.1002/uog.24776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- H Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
| | - P Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
| | - T Fazecas
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, Brazil
| | - F M Peixoto-Filho
- Department of Fetal Medicine, Fernandes Figueira Institut, Rio de Janeiro, Brazil
| | - P P de Mello
- Department of Fetal Medicine, Fernandes Figueira Institut, Rio de Janeiro, Brazil
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul, Bela Vista Campus, São Paulo, Brazil
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Castro PT, Werner H, Fazecas T, Matos AP, Maia F, de Mello PP, Araujo Júnior E. Pre and postnatal diagnosis of a third branchial cleft cyst by sonography and magnetic resonance imaging with three-dimensional virtual reconstruction. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:966-968. [PMID: 34085293 DOI: 10.1002/jcu.23025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
Branchial cleft cysts (BCCs) are common causes of cervical tumors in children and adulthood; however, prenatal diagnosis of BCC is rare. In neonates, these cysts can suddenly increase in size, causing airway obstruction and becoming a life-threatening condition. In this case report, we describe the prenatal diagnosis of a third BCC at the 25th week of pregnancy using ultrasound, magnetic resonance imaging, and three-dimensional virtual models, as well as the perinatal outcomes of this rare condition.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Tatiana Fazecas
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Ana Paula Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Fernando Maia
- Department of Fetal Medicine, Fernandes Figueira Institut (FIOCRUZ), Rio de Janeiro, Brazil
| | - Paulo Pires de Mello
- Department of Fetal Medicine, Fernandes Figueira Institut (FIOCRUZ), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical Course, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
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Surgical management of palatal teratoma (epignathus) with the use of virtual reconstruction and 3D models: a case report and literature review. Arch Plast Surg 2021; 48:518-523. [PMID: 34583437 PMCID: PMC8490109 DOI: 10.5999/aps.2021.00318] [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: 02/10/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
Epignathus is a rare congenital orofacial teratoma that arises from the sphenoid region of the palate or the pharynx. It occurs in approximately 1:35,000 to 1:200,000 live births representing 2% to 9% of all teratomas. We present the case of a newborn of 39.4 weeks of gestation with a tumor that occupied the entire oral cavity. The patient was delivered by cesarean section. Oral resection was managed by pediatric surgery. Plastic surgery used virtual 3-dimensional models to establish the extension, and depth of the tumor. Bloc resection and reconstruction of the epignathus were performed. The mass was diagnosed as a mature teratoma associated with cleft lip and palate, nasoethmoidal meningocele that conditions hypertelorism, and a pseudomacrostoma. Tridimensional technology was applied to plan the surgical intervention. It contributed to a better understanding of the relationships between the tumor and the adjacent structures. This optimized the surgical approach and outcome.
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Matos APP, Werner H, Castro PT, Fazecas E Costa TM, Nogueira RDA, Peixoto-Filho FM, Marchiori E, Araujo Júnior E. Venolymphatic malformations: prenatal diagnosis using magnetic resonance imaging, perinatal outcomes and long-term follow-up. Pediatr Radiol 2021; 51:1243-1252. [PMID: 33512539 DOI: 10.1007/s00247-020-04939-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/21/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Venolymphatic malformations are benign. Fetal MRI can more precisely demonstrate an infiltrative pattern of malformations than US. OBJECTIVE To evaluate perinatal outcomes and long-term follow-up of fetal venolymphatic malformations treated in different medical facilities using fetal MRI. MATERIALS AND METHODS This retrospective cohort study evaluated 20 pregnant women between 22 weeks and 37 weeks of gestation who were referred from different institutions. They presented with fetuses with various diagnoses of cystic masses on routine US. The cases were studied using MRI. We analyzed prenatal data, perinatal outcomes and long-term follow-up. RESULTS We reviewed the MRI scans of 20 patients with venolymphatic malformation. Referral diagnosis was changed in 40% (8/20) of cases, with postnatal concordance of 100% (20/20). Moreover, 65% (13/20) presented with venolymphatic malformation in more than one body segment. The neck was affected in 70% (14/20) of fetuses, while the head and thorax were affected in 30% (6/20) and 45% (9/20), respectively. There were intrathoracic lesions in 35% (7/20), lesions in the abdomen in 30% (6/20), and lesions in the perineum and extremities in 10% (2/20) each. Tracheal displacement, neck deflection and anatomical displacement caused by tumoral compression were present in 15% (3/20) of cases. Moreover, 25% (5/20) of newborns required neonatal intensive care unit admission, and all presented with cervical or thoracic venolymphatic malformation. Furthermore, 50% (10/20) of cases presented with complete resolution after medical therapy. The intrathoracic and cervical residuals (35%, 7/20) were monitored and treated. CONCLUSION MRI showed good correlation with postnatal examination of venolymphatic malformation, was useful in the differential diagnosis of fetal cysts on US, and presented a significant postnatal correlation with thoracic infiltration. The outcomes of prenatally diagnosed venolymphatic malformations are good despite the varying protocols among medical facilities.
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Affiliation(s)
- Ana Paula Pinho Matos
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil.,Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Pedro Teixeira Castro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CPDI), Rio de Janeiro, RJ, Brazil.,Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | | | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil. .,Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, SP, Brazil.
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Crivelli L, Millischer AE, Sonigo P, Grévent D, Hanquinet S, Vial Y, Alamo L. Contribution of magnetic resonance imaging to the prenatal diagnosis of common congenital vascular anomalies. Pediatr Radiol 2021; 51:1626-1636. [PMID: 33891148 PMCID: PMC8363547 DOI: 10.1007/s00247-021-05031-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/08/2020] [Accepted: 02/21/2021] [Indexed: 10/29/2022]
Abstract
BACKGROUND Screening ultrasound (US) has increased the detection of congenital vascular anomalies in utero. Complementary magnetic resonance imaging (MRI) may improve the diagnosis, but its real utility is still not well established. OBJECTIVES We aimed to describe the imaging findings on prenatal US and MRI of the most frequent congenital vascular anomalies (lymphatic malformations and congenital hemangiomas) to assess the accuracy of prenatal US and MRI exams for diagnosis and to evaluate the relevance of the additional information obtained by complementary fetal MRI. MATERIALS AND METHODS All confirmed postnatal congenital vascular anomalies detected in the last 10 years at 3 university hospitals were retrospectively identified. The prenatal diagnosis was compared with the final diagnosis for both methods and the clinical relevance of additional MRI information was evaluated. A second MRI in advanced pregnancy was performed in fetuses with lesions in a sensitive anatomical location and the clinical relevance of the additional information was evaluated. RESULTS Twenty-four cases were included in the study, 20 lymphatic malformations and 4 hemangiomas. MRI slightly improved the diagnosis of lymphatic malformation, 85% vs. 80% at US, especially for abdominal lesions. Both methods had a low identification rate (25%) for tumors. MRI performed late in five fetuses with lymphatic malformation allowed optimized management at birth. CONCLUSION MRI improves the diagnosis of congenital lymphatic malformations whereas hemangiomas remain difficult to identify in utero. The main role of MRI is to provide high-defined anatomical data to guide management at birth.
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Affiliation(s)
- Laurence Crivelli
- Department of Diagnostic and Interventional Radiology, CHUV - Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011, Lausanne, Switzerland.
| | - Anne-Elodie Millischer
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Pascale Sonigo
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - David Grévent
- grid.412134.10000 0004 0593 9113Department of Pediatric Radiology, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Sylviane Hanquinet
- grid.150338.c0000 0001 0721 9812Department of Radiology, HUG – Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Yvan Vial
- grid.8515.90000 0001 0423 4662Department of Gynecology and Obstetrics, CHUV – Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Leonor Alamo
- grid.8515.90000 0001 0423 4662Department of Diagnostic and Interventional Radiology, CHUV – Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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