Prenatal sonographic diagnosis of abdominal mesenteric lymphangioma

Fetal Cystic Lymphatic Malformations: Systematic Review on Pregnancy and Neonatal Outcomes

OBJECTIVE

Evaluate pregnancy and neonatal outcomes with fetal cystic lymphatic malformations (LMs), excluding those arising from the posterior neck, to facilitate patient counseling.

METHOD

A systematic review was performed in accordance with PRISMA guidance. Case series and case reports published between 2000 and 2022 were included.

RESULTS

Sixty-five studies (96 fetuses) met the inclusion criteria. The average gestational age at diagnosis was 25.5 weeks with the commonest location being the anterior neck (28%). All patients were diagnosed with LM using two-dimensional (2D) ultrasound. Prenatal progression in LM size, presence of intralesional bleeding, or fetal hydrops occurred in 70% (41/59), 9% (5/59), and 3% (2/59), respectively. Chromosomal and structural abnormalities were reported in 4% (2/52) and 2% (2/96), respectively. Overall livebirth rate was 94% (79/84); 12/96 resulted in termination and 5/84 in in utero demise. The average gestational age of delivery was 37.7 weeks. Exactly 19% (15/79) had a vaginal birth, of which shoulder dystocia occurred in one infant. Ex utero intrapartum treatment (EXIT) procedure was performed in 13% (10/79). Postnatal treatment commonly involved surgical excision 38% (30/79), sclerotherapy in 21.5% (17/79), or combination of both in 11.4% (9/79). Of those with reported follow-up, 4 died within 1 year, 1 developed heart failure at 2 years of life, and the remaining 44 had normal developmental outcomes.

CONCLUSION

Fetal cystic LMs, excluding those in the posterior neck, are not commonly associated with chromosomal, or additional structural abnormalities. They usually increase in size before delivery with only a minority developing complications. The good developmental outcome was reported in all survivors.

Prenatal diagnosis of abdominal lymphatic malformations

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.

Mesenteric cystic lymphangioma: A case report

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Mesenteric cystic lymphangiomas are rare benign lesions characterized by lymphatic vessels malformation with an unknown etiology.

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Although, mesenteric cystic lymphangiomas are rare but should be included in the differential diagnosis of abdominal pain.

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Surgical resection of mesenteric lymphangiomas should be performed as fast as possible to avoid many serios complications.

Introduction and importance

Mesenteric cystic lymphangiomas are rare benign lesions of the abdominal cavity characterized by lymphatic vessels malformation with an unknown etiology. Despite the silent clinical course of mesenteric cystic lymphangiomas, they are considered as clinically tricky lesions with an immense spectrum of presentations.

Case presentation

We present a case of abdominal mesenteric cystic lymphangioma in a 1-year 9-month-old female patient, who complained of fever and abdominal pain for 10 days duration. Laboratory investigations, abdominal X-ray, ultrasonography, computed tomography and histopathological examination were all used to establish the diagnosis.

Clinical discussion

A trial of true-cut biopsies performed by an interventional radiologist was not informative, so a multidisciplinary team decision was made to excise the mass. Intraoperative findings include multiloculated fused cystic lesion (8.0 × 5.0 × 4.0 cm) on the descending mesocolon. Histopathological examination revealed the diagnosis of a mesenteric cystic lymphangioma. The postoperative period was not complicated.

Conclusion

Mesenteric cystic lymphangiomas are mostly asymptomatic in nature, yet predisposed to life threating events. Surgical excision is the modality of treatment characterized by low recurrence rate and a non-complicated postoperative period.

A pitfall in diagnosing fetal abdominal lymphangioma: A report of two cases

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.

A reminder of peristalsis as a useful tool in the prenatal differential diagnosis of abdominal cystic masses

With routine antenatal ultrasound and recent advances in ultrasound technology, fetal intraabdominal cystic masses are recognized more often and are better characterized than in the past. They may be classified as solid and cystic, and may originate from multiple structures. When considering the extensive differential diagnosis of cystic masses, the observation of peristalsis narrows the possibilities to the gastrointestinal tract. To find this feature on ultrasound, the examiner must expressly think and look for it, otherwise it may be missed. Our case report illustrates one of those cases.

Diagnosis of neonatal ovarian torsion: Emphasis on prenatal and postnatal sonographic findings

PURPOSE

Our aim was to retrospectively review the imaging findings of patients with neonatal ovarian torsion, emphasizing prenatal and postnatal sonographic findings.

METHODS

Eleven patients who had had neonatal ovarian torsion diagnosed surgically (n = 9) or clinicoradiologically (n = 2) were enrolled. Prenatal and postnatal sonographic features, including sequential postnatal change, were reviewed. Clinical and pathologic features were also investigated.

RESULTS

All patients except one had a fetal ovarian cyst (mean, 5.3 cm) detected on third-trimester sonography, either simple (n = 6) or complex (n = 4). In all 11 patients, initial postnatal sonography had revealed a complex cyst (mean, 4.7 cm) with intracystic clot or debris, the double-wall sign, a fluid-fluid level, and multiple septation. None of the patients had had symptoms or signs related to the ovarian torsion. Follow-up sonography in seven patients had revealed increased echogenicity of the cyst wall with frequent calcification and a decrease in size of the cyst. In two patients, the interval of the change in cyst position was noted, and autoamputation of the torsed ovary had been surgically confirmed. Serous cystadenoma had been identified in one patient.

CONCLUSIONS

Neonatal ovarian torsion most commonly manifests as an asymptomatic complex cyst on sonography due to torsion of a fetal ovarian cyst. Serial monitoring of a fetal ovarian cyst for its resolution or changes in its appearance is mandatory for making an early diagnosis of torsion. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:290-297, 2016.

Mesenteric lymphangioma in adult: a case series with a review of the literature

Mesenteric lymphangioma is a rare benign tumor with nonspecific clinical features. A case series of three adult patients who had mesenteric lymphangioma is reported along with a review of literature. Two patients presented with painless abdominal swelling who were being managed as a case of abdominal tuberculosis and a third one had features of intestinal obstruction. In our cases, preoperative diagnosis of mesenteric lymphangioma was not suspected and all the patients had laparotomy. Peroperative findings revealed mesenteric masses, which were simulating cavitatory form of mesenteric node tuberculosis. It is stressed that mimicking of mesenteric lymphangioma with a cavitatory form of tuberculosis of mesenteric nodes in areas of high prevalence may lead to its misdiagnosis. Histopathology confirmed diagnosis of mesenteric lymphangioma in each case. Although rare and difficult to diagnose preoperatively, surgical resection is to be considered gold standard treatment for mesenteric lymphangioma.