Hydroceles identified prenatally: common physiologic phenomenon?

The Development of Normal Fetal External Genitalia Throughout Gestation

In this review, we describe normal development of fetal genitalia throughout gestation as well as the identification of normal male and female genitalia on ultrasound. We use abnormal and ambiguous genitalia as illustrative tools to assist with the identification of normal genitalia and recognition of some of the most common abnormalities in external genitalia development.

The Term Newborn: Postnatal Screening and Testing

Prenatal genetic screening, including evaluation for inherited genetic disorders, aneuploidy risk assessment, and sonographic assessment, combined with a thorough newborn examination and standard newborn screening, including blood, hearing, and congenital heart disease screening, can reveal conditions requiring further evaluation after delivery. Abnormal prenatal or newborn screening results should prompt additional diagnostic testing guided by maternal fetal medicine, perinatal genetics, or pediatric specialists.

Sonographic evaluation of fetal scrotum, testes and epididymis

External male genitalia have rarely been evaluated on fetal ultrasound. Apart from visualization of the penis for fetal sex determination, there are no specific instructions or recommendations from scientific societies. This study aimed to review the current knowledge about prenatal diagnosis of the scrotum and internal structures, with discussion regarding technical aspects and clinical management. We conducted an article search in Medline, EMBASE, Scopus, Google Scholar, and Web of Science databases for studies in English or Spanish language that discussed prenatal scrotal pathologies. We identified 72 studies that met the inclusion criteria. Relevant data were grouped into sections of embryology, ultrasound, pathology, and prenatal diagnosis. The scrotum and internal structures show a wide range of pathologies, with varying degrees of prevalence and morbidity. Most of the reported cases have described incidental findings diagnosed via striking ultrasound signs. Studies discussing normative data or management are scarce.

Prenatal Diagnosis of a Cyst of the Canal of Nuck Associated With an Ovarian Cyst and Acute Polyhydramnios

In the female, the canal of Nuck is a tubular fold of parietal peritoneum that travels along with the round ligament through the inguinal canal to its attachment on the labia majora. The canal of Nuck is analogous to the processus vaginalis in the male. In embryonic development, this pathway typically obliterates early in life; however, in some cases, it may partially or completely fail to close. This failure to obliterate can lead to complications ranging from a cyst of the canal of Nuck (also known as a female hydrocele) to herniation and incarceration of abdominal and pelvic organs. There is little information available in the medical literature concerning this rare condition; therefore, it is important for sonographers, physicians, and surgeons to be familiar with this developmental abnormality. This report represents the first prenatal case of a cyst of the canal of Nuck, along with the unique combination of a large left fetal ovarian cyst and acute polyhydramnios. The embryology, incidence, differential diagnosis, management, and treatment of these female conditions are discussed.

Foetal inguinoscrotal hernia—its prenatal diagnosis and its spontaneous regression

A foetal inguinoscrotal hernia is a rare abnormality. We report a case of foetal inguinoscrotal hernia diagnosed by ultrasonography at 37 weeks gestation and its spontaneous regression during the perinatal period. The imaging features, differential diagnosis, pregnancy management and outcome are discussed.

Fetal vulvar cysts with spontaneous resolution

Congenital anomalies of the external genitalia occur in 2-3 per 100 infants. These anomalies might bring variable degrees of morbidity to the infant and often constitute diagnostic challenges for health professionals. We present a case report of a fetus with bilateral vulvar cysts diagnosed during the third trimester ultrasound. The cysts spontaneously regressed before birth and the newborn showed no genital anomalies at birth.

Prenatal Presentation of Inguinoscrotal Hernia

Prenatal diagnosis of inguinal hernia is rare and easily confused with other entities, including masses of the scrotum, abdominal wall, and perineum. Pathologic processes of the scrotum rarely result in enlargement beyond 7 cm. Peristalsis can help to indentify bowel within the mass, suggestive of hernia or omphalocele rather than hydroceles or tumors that contain no bowel. Torsions have a double-ring appearance with no testicular blood flow, whereas hydroceles have visible testicles within a fluid-filled scrotum. Doppler evaluation may be helpful, as hernias typically have minimal vascularity, unlike tumors and teratomas, which are vascular with a widely variable appearance. The authors present the sonographic features of a late-presenting fetal mass that was clinically indistinguishable from omphalocele other than its skin thickness and was larger than typically reported for hernias. Skin thickness and subcapsular fluid are useful adjuncts in distinguishing inguinoscrotal hernia from omphalocele in late gestation.

Prenatal evaluation of a scrotal mass using a high-frequency probe in the diagnosis of inguinoscrotal hernia

Whereas inguinal hernia is a common pediatric disease, fetal inguinal hernia is rarely diagnosed because intra-abdominal pressure usually occurs only after birth. We report a case of prenatal diagnosis of a scrotal mass at 35 weeks' gestation. The initial differential diagnosis included hydrocele, testicular teratoma and testicular torsion, but inguinoscrotal hernia was considered the most likely diagnosis when further ultrasound imaging using a high-frequency probe demonstrated bowel loop movements around the mesenteric artery. This diagnosis was confirmed postnatally.

Prenatal 2D ultrasonic diagnosis of fetal complete atrioventricular block and bilateral hydroceles with occult maternal SS-A

OBJECTIVE

We present a case of fetal complete atrioventricular block, diagnosed by the M mode of two-dimensional ultrasound, that was complicated with polyhydramnios and bilateral hydrocele.

CASE REPORT

The fetus was delivered at 38 weeks' gestation by caesarean section. Postpartum autoimmune survey disclosed positive anti-Ro antibodies (SS-A) for both the mother and the newborn. Severe neonatal bradycardia with complete atrioventricular block was identified.

CONCLUSION

Antenatal evaluation for a maternal history of autoimmune disease (especially systemic lupus erythematosus) and prevention of fetal bradycardia by reducing immune-mediated injuries on the cardiac conduction system are important.