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Ece B, Aydın S, Kantarci M. Antenatal imaging: A pictorial review. World J Clin Cases 2022; 10:12854-12874. [PMID: 36569012 PMCID: PMC9782949 DOI: 10.12998/wjcc.v10.i35.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/17/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Today, in parallel with the use of imaging modalities increases in all fields, the use of imaging methods in pregnant women is increasing. Imaging has become an integral component of routine pregnancy follow-up. Imaging provides parents with an early opportunity to learn about the current situation, including prenatal detection of anomalies or diseases, etiology, prognosis, and the availability of prenatal or postnatal treatments. Various imaging modalities, especially ultrasonography, are frequently used for imaging both maternal and fetal imaging. The goal of this review was to address imaging modalities in terms of usefulness and safety, as well as to provide demonstrative examples for disorders. And this review provides current information on selecting a safe imaging modality to evaluate the pregnant and the fetus, the safety of contrast medium use, and summarizes major pathological situations with demonstrative sonographic images to assist radiologists and obstetricians in everyday practice.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, Kastamonu 37150, Turkey
| | - Sonay Aydın
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
| | - Mecit Kantarci
- Department of Radiology, Erzincan University, Erzincan 24142, Turkey
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2
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Gkalonaki I, Anastasakis M, Patoulias I. Atypical locations for cystic lymphangiomas. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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3
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Liu YP, Huang YL, Tsai PS, Lin DC, Chen CP. Prenatal diagnosis of abdominal lymphatic malformations. Taiwan J Obstet Gynecol 2021; 60:13-19. [PMID: 33494985 DOI: 10.1016/j.tjog.2020.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/09/2023] Open
Abstract
Abdominal lymphatic malformations (LM) are rare congenital malformations of the lymphatic system, representing only 2% of all LM in newborns. They may arise from intra-abdominal solid organs (such as the liver, pancreas, kidneys, spleen, adrenal glands, and gastrointestinal tract), mesentery, omentum, and retroperitoneum. Mesenteric LM are the most commonly seen, with retroperitoneal LM being the second most common. Fetal abdominal LM could be associated with karyotypic or other abnormalities, including skin edema, hydrops fetalis, and polyhydramnios, and prenatal diagnosis and perinatal counseling for these LM are important. Prenatal ultrasound (US) and magnetic resonance imaging (MRI) have led to an increased diagnosis of abdominal LM and improved monitoring and intervention postnatally. This article provides an overview of fetal abdominal LM, including the prenatal diagnoses, differential diagnoses, comprehensive illustrations of the imaging findings, treatments, and fetal outcomes.
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Affiliation(s)
- Yu-Peng Liu
- Department of Radiology, Mackay Memorial Hospital, Hsinchu, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Yen-Lin Huang
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Pei-Shan Tsai
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan
| | - Dao-Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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4
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Gowda M, Godipelli L, Gangadhar L, Jindal B, Deodar K, Yadav M. Management of Isolated Fetal Lymphangiomas Following Prenatal Diagnosis: Case Series. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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5
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Song S, Chang D, Li H, Li B, Xu K, Liu C, Cui Y. Rare cystic lymphangioma in the chest wall of an adult patient: A case report and comprehensive review of the literature. Thorac Cancer 2020; 11:3388-3390. [PMID: 32986288 PMCID: PMC7606011 DOI: 10.1111/1759-7714.13659] [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: 08/08/2020] [Revised: 08/30/2020] [Accepted: 08/30/2020] [Indexed: 12/03/2022] Open
Abstract
Lymphangiomatosis is a rare, benign, hyperproliferative hamartoma composed of dilated lymphatic vessels. Cystic lymphangioma (CL) in the chest wall in an adult patient is rare, but we focus on this type of patient in our present case study. A 54‐year‐old female patient with a painless mass in her chest wall went without treatment for two years following diagnosis. After consenting to treatment, Doppler color flow imaging (DCFI), chest CT, and MRI revealed a cystic lesion with multiple thin septula in the left chest. Surgical resection was performed, and histopathological examination identified a cystic lymphangioma. The patient did not experience recurrence during the follow‐up period.
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Affiliation(s)
- Shuai Song
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dong Chang
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bowen Li
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kaikai Xu
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chunquan Liu
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yong Cui
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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6
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Niwa Y, Imai K, Kotani T, Nakano T, Ushida T, Moriyama Y, Kikkawa F. A pitfall in diagnosing fetal abdominal lymphangioma: A report of two cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:494-496. [PMID: 31287158 DOI: 10.1002/jcu.22756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 06/09/2023]
Abstract
Typical ultrasound findings of fetal abdominal lymphangioma include thick-walled, multiseptated anechoic masses. Although a majority of cases can be suspected promptly by ultrasound examination, the two cases presented herein did not meet the standard criteria and were misleading. Both cases involved unilocular cysts without clear septations, but in retrospect were atypical findings of fetal abdominal lymphangioma. A few reports of misleading cases have been described previously; however, the precise characteristics have not been reported in detail. Therefore, in this case report, we focused predominantly upon the difficulties encountered in the prenatal diagnosis of abdominal lymphangioma based on ultrasound morphology alone.
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Affiliation(s)
- Yuri Niwa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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7
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Saccone G, Di Meglio L, Di Meglio L, Zullo F, Locci M, Zullo F, Berghella V, Di Meglio A. Prenatal ultrasound diagnosis of fetal chest wall cystic lymphangioma: An Italian case series. Eur J Obstet Gynecol Reprod Biol 2019; 236:139-142. [PMID: 30909010 DOI: 10.1016/j.ejogrb.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 12/14/2022]
Abstract
Fetal lymphangioma is a rare congenital malformation of lymphatic system that involve the skin and the subcutaneous tissue. The vast majority of the lymphangioma occurs in the neck. More rarely lymphangiomas may occur in the axillary region, including chest wall. Our consecutive case series study included three cases of fetal chest wall cystic lymphangiomas. In our cohort, fetal chest wall cystic lymphangiomas were the 18.8% of the all cases of lymphangiomas of axillary region. In all the three cases no other fetal abnormalities were evaluated, and the chest wall cystic lymphangiomas were unilateral, honeycombed in appearance, with multiple echo-free area of varying size in the mass, with no color flow on Doppler sonography, and with a trend to increase during the gestation. The incidence of chromosomal abnormalities was 33.3%, with one case out of the three being trisomy 21.The literature review revealed only seven cases of fetal chest wall cystic lymphangiomas. The cases were not associated with other abnormalities, nor with abnormal karyotype and only one case of fetal death was reported. Three women delivered vaginally. In summary, fetal chest wall cystic lymphangioma is a very rare malformations with only seven cases reported in the literature. This malformation is usually not associated with abnormal karyotype or other abnormalities and the neonatal outcome is favorable after surgical removal. Spontaneous vaginal delivery may be a safe approach for delivery women with fetal chest wall cystic lymphangioma. CONDENSATION: Fetal chest wall cystic lymphangioma is a very rare malformations with only seven cases reported in the literature. This malformation is usually not associated with abnormal karyotype or other abnormalities and the neonatal outcome is favorable after surgical removal. Spontaneous vaginal delivery may be a safe approach for delivery women with fetal chest wall cystic lymphangioma.
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Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Diagnosi Ecografica e Prenatale di A.Di Meglio, Naples, Italy.
| | - Lavinia Di Meglio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Diagnosi Ecografica e Prenatale di A.Di Meglio, Naples, Italy
| | - Letizia Di Meglio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Diagnosi Ecografica e Prenatale di A.Di Meglio, Naples, Italy
| | - Fabrizio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Aniello Di Meglio
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Diagnosi Ecografica e Prenatale di A.Di Meglio, Naples, Italy
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8
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Cystic Lymphangioma of the Chest Wall in a 5-Year-Old Male Patient: A Rare and Atypical Localization-A Case Report and Comprehensive Review of the Literature. Case Rep Pediatr 2017; 2017:2083204. [PMID: 29201481 PMCID: PMC5672607 DOI: 10.1155/2017/2083204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/23/2017] [Indexed: 11/23/2022] Open
Abstract
Lymphangioma is a benign congenital malformation. The extremely rare and atypical localization of a lymphangioma in the chest wall was the real motive for the present case study. A 5-year-old boy was admitted to the Emergency Department of the 1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, due to the presence of a mildly painful swelling in the left lateral chest wall, which was first noticed three months ago, after a blunt injury during sport. Physical examination revealed the presence of a palpable, spherical, painful, nut-sized subcutaneous lesion in the left lateral chest wall, respectively, with the anterior axillary line, at the height of the 6th to 7th intercostal space. Presence of ecchymosis on the overlying skin was also noticed. During palpation, we did not notice fluctuation, while transillumination was not feasible. Performance of ultrasonography, including Doppler color flow imaging, followed, depicting a subcutaneous cystic lesion, 2.1⁎3.2 cm in dimensions, without extension to the thoracic cavity. Scheduled surgical excision of the lesion was decided. Histopathological examination documented the diagnosis of cystic lymphangioma. Patient is still followed up on a 6-month basis. He remains asymptomatic, after 2 years, without indication of relapse.
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9
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Durukan H, Gözükara İ, Cevikoglu M, Dilek TUK. Isolated fetal lymphatic malformation of the thigh: prenatal diagnosis and follow-up. AUTOPSY AND CASE REPORTS 2017; 7:49-53. [PMID: 28536688 PMCID: PMC5436922 DOI: 10.4322/acr.2017.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/17/2017] [Indexed: 01/04/2023] Open
Abstract
Fetal lymphatic malformation can be found in different parts of the fetal body. It occurs most frequently in the nuchal and axillary region and less frequently in the abdomen or inguinal areas. Lymphatic malformation has been associated with fetal aneuploidy, hydrops fetalis, structural malformations, and intrauterine fetal death. A 31-year-old gravida 3, para 2 woman was admitted to our hospital at 22 weeks of gestation (confirmed by ultrasonographic examination). The fetus was alive, and had a mass derived from the left inguinal region extending to the anterior left leg with fluid-filled cavities about 3–5 cm in size. There was no evidence of intra-abdominal extension of the mass. Amniocentesis was performed. Fetal magnetic resonance imaging revealed a left inguinal cystic mass, which extended to the left thigh. Antenatal follow-up was uneventful. The mother gave birth at term with a cesarean section. Postnatal clinical examination and imaging examination confirmed the diagnosis of lymphatic malformation. Fetal lymphatic malformation carries a high risk of aneuploidy and fetal malformations. Patients diagnosed with lymphatic malformation in antenatal follow-up should be assessed in terms of coexistent anomalies. Fetal karyotyping should be done and the fetus should be monitored for fetal hydrops.
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Affiliation(s)
- Huseyin Durukan
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mersin University, Mersin - Turkey
| | - İlay Gözükara
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mustafa Kemal University, Hatay - Turkey
| | - Murside Cevikoglu
- Department of Obstetrics and Gynecology - Faculty of Medicine - Mersin University, Mersin - Turkey
| | - Talat Umut Kutlu Dilek
- Department of Obstetrics and Gynecology - Faculty of Medicine - Acıbadem Atakent University Hospital, Istanbul - Turkey
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10
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Ersoy AO, Oztas E, Saridogan E, Ozler S, Danisman N. An Unusual Origin of Fetal Lymphangioma Filling Right Axilla. J Clin Diagn Res 2016; 10:QD09-11. [PMID: 27134953 PMCID: PMC4843338 DOI: 10.7860/jcdr/2016/18516.7513] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/27/2016] [Indexed: 01/30/2023]
Abstract
Fetal lymphangioma is a hamartomatous congenital anomaly of the lymphatic system, which is embracing the fetal skin (sometimes mucous membranes) and the subcutaneous tissue. The general consensus is that it occurs as a result of failure in lymphatic drainage. A 36-year-old pregnant woman was referred to our perinatology clinic at 22 weeks' gestation, because of a fetal right-sided axillary mass revealed by ultrasonography. The mass measuring 5x7x7cm in three dimensions had a multilocular structure without colour Doppler flow and well-circumscribed borders. Amniocentesis revealed a normal constitutional karyotyping. Lymphangioma was considered as prediagnosis. A healthy female baby weighing 3470 grams was delivered at term. Neonatal examination and the postnatal MRI confirmed the diagnosis. The baby is still on follow-up with the medical treatment of Sirolimus an anti-proliferative drug, and the mass got smaller significantly in 8 months after delivery.
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Affiliation(s)
- Ali Ozgur Ersoy
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Efser Oztas
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Erdinc Saridogan
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Sibel Ozler
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
| | - Nuri Danisman
- Medical Doctor, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women’s Healthcare, Training and Research Hospital, Ankara, Turkey
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11
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Imaging evaluation of fetal vascular anomalies. Pediatr Radiol 2015; 45:1218-29. [PMID: 25492302 DOI: 10.1007/s00247-014-3248-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/29/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Abstract
Vascular anomalies can be detected in utero and should be considered in the setting of solid, mixed or cystic lesions in the fetus. Evaluation of the gray-scale and color Doppler US and MRI characteristics can guide diagnosis. We present a case-based pictorial essay to illustrate the prenatal imaging characteristics in 11 pregnancies with vascular malformations (5 lymphatic malformations, 2 Klippel-Trenaunay syndrome, 1 venous-lymphatic malformation, 1 Parkes-Weber syndrome) and vascular tumors (1 congenital hemangioma, 1 kaposiform hemangioendothelioma). Concordance between prenatal and postnatal diagnoses is analyzed, with further discussion regarding potential pitfalls in identification.
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12
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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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13
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Cho FN, Liu CB, Carey JR, Liou WS. Cavernous lymphangioma of fetal thigh. Taiwan J Obstet Gynecol 2014; 53:432-4. [DOI: 10.1016/j.tjog.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 01/10/2023] Open
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Ben Hamouda H, Gasmi O, Wannes S, Korbi A, Belguith M, Jerbi S, Soua H, Souissi MM, Hamza H, Nouri A, Sfar MT. [Prenatal diagnosis of a giant cystic lymphangioma in the axillothoracic wall]. Arch Pediatr 2014; 21:1011-5. [PMID: 25089042 DOI: 10.1016/j.arcped.2014.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 11/30/2022]
Abstract
Cystic lymphangiomas are benign malformative tumors of the lymphatic vessels, rare but potentially serious and usually located in the cervical region. The diagnosis is usually easy, but the treatment is sometimes difficult because of their location and extension into the surrounding tissue. We report a case of giant cystic lymphangioma of the right axillary-thoracic wall diagnosed by prenatal ultrasound at 20 weeks gestation. The male infant was born at 37 weeks gestation with a large, swelling, lateral parietal right chest. Ultrasound soft tissue and chest CT scan confirmed the diagnosis of giant cystic lymphangioma of the right axillary-thoracic wall. Surgical excision was performed on the 21st day after birth and the mass was excised incompletely. The postoperative course was uncomplicated. Ultrasound soft tissue follow-up showed the persistence of multiple cystic structures in the axilla. Prenatal diagnosis of these tumors is essential for planning multidisciplinary management in early postnatal care.
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Affiliation(s)
- H Ben Hamouda
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie.
| | - O Gasmi
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - S Wannes
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - A Korbi
- Service de gynéco-obstétrique, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - M Belguith
- Service de chirurgie pédiatrique, CHU Fattouma Bourghuiba, 5000 Monastir, Tunisie
| | - S Jerbi
- Service de radiologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - H Soua
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - M M Souissi
- Service de gynéco-obstétrique, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - H Hamza
- Service de radiologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
| | - A Nouri
- Service de chirurgie pédiatrique, CHU Fattouma Bourghuiba, 5000 Monastir, Tunisie
| | - M T Sfar
- Service de pédiatrie et de néonatologie, CHU Tahar Sfar, 5111 Mahdia, Tunisie
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15
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Noia G, Pellegrino M, Masini L, Visconti D, Manzoni C, Chiaradia G, Caruso A. Fetal cystic hygroma: the importance of natural history. Eur J Obstet Gynecol Reprod Biol 2013; 170:407-13. [DOI: 10.1016/j.ejogrb.2013.07.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 06/08/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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16
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Koelblinger C, Herold C, Nemec S, Berger-Kulemann V, Brugger PC, Koller A, Tonnhofer U, Bettelheim D, Prayer D. Fetal magnetic resonance imaging of lymphangiomas. J Perinat Med 2013; 41:437-43. [PMID: 23314507 DOI: 10.1515/jpm-2012-0226] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 12/04/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the fetal magnetic resonance imaging findings of lymphangiomas. METHODS The magnetic resonance scans of eight fetuses with lymphangiomas were evaluated. Magnetic resonance evaluation included: number; size; signal intensities of the lesions; thickness of the septae; configuration of the margins; presence of blood breakdown products; change in size or signal intensity (in four patients with multiple examinations); exact expansion of the lesions to the adjacent anatomical structures; and concomitant pathological findings. Results were compared with postpartum clinical assessment and imaging in seven patients and with autopsy in one patient. RESULTS Two retroperitoneal, three thoracic, and three cervical lymphangiomas (diameters between 3.3 and 15.6 cm) were included. All lesions consisted of macrocysts, and additional microcystic parts were found in three lymphangiomas. Blood breakdown products were found in one lesion. Agreement with postpartum imaging was excellent. One patient received intrauterine drainage for chylothorax, and one pregnancy was terminated. CONCLUSIONS Fetal lymphangiomas display the same magnetic resonance imaging features as postnatal lymphangiomas. Intrauterine magnetic resonance characterization of lymphangiomas provides the exact delineation, detection of associated and/or concomitant pathologies, and differential diagnosis among other cystic pathologies. Patient management may be altered with respect to the type and/or time of treatment, and with regard to the continuation or termination of pregnancy.
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Affiliation(s)
- Claus Koelblinger
- Department of Radiology, Medical University of Vienna, WaehringerGuertel 18-20, A-1090 Vienna, Austria.
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17
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Inde Y, Yamagishi E, Kawabata I, Sekiguchi A, Nakai A, Takeshita T. Morphological changes observed via fetal ultrasound in prenatally diagnosed and isolated congenital lymphangiomas: three case reports. J Med Ultrason (2001) 2012; 40:265-9. [DOI: 10.1007/s10396-012-0421-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/31/2012] [Indexed: 11/30/2022]
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18
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Temizkan O, Abike F, Ayvaci H, Demirag E, Görücü Y, Isik E. Fetal axillary cystic hygroma: a case report and review. Rare Tumors 2011; 3:e39. [PMID: 22355494 PMCID: PMC3282444 DOI: 10.4081/rt.2011.e39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 07/27/2011] [Indexed: 12/05/2022] Open
Abstract
Cystic hygroma (CH) is a lymphatic malformation occurring different parts of fetal body, typically in the region of the fetal neck and axillary, abdominal wall, mediastinal, inguinal and retroperitoneal areas. CH has been associated with fetal aneuploidy, hydrops fetalis, structural malformations and intrauterine fetal death. A 24-year-old gravida 1, para 1 was admitted to our hospital at 28 weeks of gestation. Ultrasonographic examination determined 28 weeks of gestation, singleton, alive fetus who had a mass derived from the right axillary region which was extending to the anterior and posterior thoracic wall with fluid-filled cavities about 12 cm in size. There was no evidence of intrathorasic or intraabdominal extension of mass. Cordocentesis was performed and karyotype examination was normal 46 XY. The fetal demise was found after the first visit. The patient was delivered vaginally after labor induction with oxytocin infusion. The fetal autopsy confirmed the diagnosis of CH. The fetal CH carries high risk of aneuploidy and fetal malformations. Patients that have been diagnosed with CH in antenatal follow-ups should be assessed in terms of other anomalies. Fetal karyotyping should be done and the patient should be monitored for fetal hydrops. The birth should be planned in a multidisciplinary hospital and as neonatal resuscitation could be needed, pediatricians should be consulted.
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Affiliation(s)
- Osman Temizkan
- Department of Obstetrics Gynecology, Sisli Etfal Education and Research Hospital, Istanbul
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Congenital fetal lymphangioma causing shoulder dystocia and uterine rupture. Int J Gynaecol Obstet 2011; 112:248. [DOI: 10.1016/j.ijgo.2010.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 09/03/2010] [Accepted: 11/26/2010] [Indexed: 11/23/2022]
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Le Pimpec-Barthes F, Cazes A, Bagan P, Badia A, Vlas C, Hernigou A, Pricopi C, Riquet M. [Mediastinal cysts: clinical approach and treatment]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:52-62. [PMID: 20207297 DOI: 10.1016/j.pneumo.2009.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal cysts (MC), mainly from embryonic origin, are benign and rare malformative lesions, gathering several varieties according to tissue origin. Diagnosis is mostly obtained thanks to tomodensitometry performance and sometimes by magnetic resonance imaging. It may be more difficult in some atypical topographies and in case of bulky MC. The most frequent, springing from division abnormality from embryonic foregut ("foregut cysts" in English literature), are primarily bronchogenic cysts (50 to 60 % of MC), which are symptomatic in 30 to 80 % of cases. Coelomic cysts, lined by a mesothelium, result from embryologic abnormality by incomplete fusion of mesenchymal coelomic lacunae. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30 % of MC. Thymic cysts, around 15 % of MC, are most often asymptomatic. Cystic lymphangiomas (CL) are congenital lymphatic malformations more frequent and symptomatic in children. Diagnosed in older patients, they are most often acquired and asymptomatic. The only radical and definitive treatment is complete surgical resection of the cyst. It allows suppression of symptoms, procurement of a formal diagnosis and prevention of complications. This resection, generally indicated for all symptomatic cysts, large-sized even asymptomatic and in case of non formal diagnosis, is now recommended for all kinds of cysts except for asymptomatic PPC. This strategy is justified considering morbidity and mortality rising rates in patients treated by surgical resection at time of local complications of the cyst. Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC and CL. The more conventional thoracotomy is performed in surgery for cysts, which are adhesive to nearby structures. PPC just need a simple follow-up, and surgery is required only in case of symptoms and increasing size. In total, surgical indications for MC are large and accepted because of null postoperative mortality and very low rate of morbidity thanks to mini-invasive surgery. This militates for early surgery, without waiting for cystic complications leading to peroperative difficulties and increasing risks. This review presents the characteristics of those different cysts and the strategies currently acknowledged for the treatment.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de Chirurgie Thoracique, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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Brasseur A, Seryer D, Plancq M, Krim G, Lanta S, Le Blanche A. Lymphangiome kystique thoraco-brachial dans le syndrome de Protée : diagnostic anténatal et suivi par IRM. ACTA ACUST UNITED AC 2009; 90:608-11. [DOI: 10.1016/s0221-0363(09)74028-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Case report of fetal axillo-thoraco-abdominal cystic hygroma. Arch Gynecol Obstet 2009; 281:111-5. [DOI: 10.1007/s00404-009-1068-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
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Sannoh S, Quezada E, Merer DM, Moscatello A, Golombek SG. Cystic hygroma and potential airway obstruction in a newborn: a case report and review of the literature. CASES JOURNAL 2009; 2:48. [PMID: 19144130 PMCID: PMC2631536 DOI: 10.1186/1757-1626-2-48] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/13/2009] [Indexed: 11/17/2022]
Abstract
Background Cervical cystic hygroma is a benign congenital malformation of the lymphatic system. Incidence of cystic hygroma is 1/6000 live births. We present a case of right neck mass with potential respiratory compromise in a newborn. Case presentation The patient was a full term baby girl with an incidental finding of right neck mass which was described on ultrasound and magnetic resonance imaging as a cystic lesion in the nasopharynx and right neck which inferiorly followed the course of the right carotid artery, consistent with cystic hygroma. She started with respiratory compromise, and a follow-up magnetic resonance imaging showed increased size of the cystic hygroma. Dexamethasone was started to reduce fluid build up in the mass. When the cystic hygroma was found to be inseparable from the right half of the thyroid gland, the otolaryngologist performed hemithyroidectomy. Conclusion The patient had neuropraxia involving the marginal mandibular branch of the facial nerve, which was expected to correct with time. Large cervical cystic hygromas may surround or displace neurovascular structures making their identification quite challenging intraoperatively. A team of experienced surgeons will help to ensure a successful surgical outcome.
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Affiliation(s)
- Sulaiman Sannoh
- Division of Neonatology, Children's Regional Hospital, Cooper University Hospital, Camden, New Jersey, USA.
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Ruano R, Takashi E, Schultz R, Zugaib M. Prenatal diagnosis of posterior mediastinal lymphangioma by two- and three-dimensional ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 31:697-700. [PMID: 18435512 DOI: 10.1002/uog.5327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Lymphangioma is a rare benign tumor characterized by proliferating lymph vessels and composed of large cyst spaces with endothelium-lined channels of varying dimensions. The incidence of lymphangioma is approximately one in 6000 pregnancies. Less than 1% of lymphangiomas are purely mediastinal. The great majority of cases are of cystic lymphangioma, but very rarely there is a mixed lesion consisting of multiple cysts of dilated capillary and lymph vessels. We report a case of posterior mediastinal lymphangioma diagnosed at 28 weeks' gestation, in which three-dimensional ultrasonography was helpful in determining the precise location of the tumor. A Cesarean section was performed at 39 weeks and the tumor was resected on the 5(th) day postdelivery; histological examination revealed a mixed cystic lymphangioma.
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Affiliation(s)
- R Ruano
- Obstetrics Department, Faculty of Medicine, University of São Paulo, Brazil.
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Goldstein I, Leibovitz Z, Noi-Nizri M. Prenatal diagnosis of fetal chest lymphangioma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1437-40. [PMID: 17060430 DOI: 10.7863/jum.2006.25.11.1437] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Prenatally diagnosed cystic nuchal hygroma is often associated with chromosomal anomalies and hydrops fetalis. Chest lymphangioma diagnosed later in gestation appears to be a completely different disease, with a low incidence of chromosomal and structural anomalies. METHODS Two chest cavernous lymphangiomas of the fetus are presented. The sonographic images, chromosomal analyses, and macroscopic and microscopic evaluations are described. RESULTS Fetal chest cavernous lymphangiomas were identified at 15 and 22 weeks' gestation. In the first case, the couple decided to interrupt gestation. In the second case, prenatal sonography showed a multilocular, cystic lymphangioma external to the chest wall with no flow on Doppler sonography. Follow-up sonography revealed normal fetal growth and slow enlargement of the cystic mass surrounding the left chest cavity. The neonate was delivered without complications and was treated surgically. CONCLUSIONS The chest lymphangioma appears to be a lesion usually not associated with other congenital abnormalities. The prenatal diagnosis of chest wall lymphangioma is relatively easy sonographically, and the treatment of choice is surgical excision. The outcome is relatively favorable, with a low incidence of chromosomal and structural anomalies.
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Affiliation(s)
- Israel Goldstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, 31096 Haifa, Israel
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