First Description of Fetal Cystic Hygroma Associated With Early Equine Pregnancy Loss

Cystic hygroma (hygroma cysticum) is a malformation that has not yet been described as a cause of early pregnancy loss in equines. The condition is a congenital anomaly occurring during embryogenesis due to a failure in which the primitive lymphatic sac does not reach the venous system at the jugular vein, resulting in a lymphatic stasis that starts in the neck region and continues to the rest of the body. From 2015 to 2020, a total of 5,730 ultrasound examinations were performed in mares from 43 different horse farms and embryo transfer farms when sexing pregnancies. In 12 pregnant mares, a suspected fetal cystic hygroma was diagnosed via transrectal ultrasound performed from day 52 to 75 of pregnancy. Six fetuses were collected and fixed to conduct histopathological and karyotyping. Macroscopic and microscopic analysis supported the suggested diagnosis being the first description of cystic hygroma in equine fetuses and concluded as a cause of pregnancy loss around 65 days of gestation.

A Long-term Follow-up of Mandibular Deviation Caused by Congenital Cervical Lymphangioma Treated with an Orthodontic Approach

AIM

To report a treatment case of mandibular deviation caused by congenital cervical lymphangioma with traditional orthodontic techniques, following-up by 10-year retention.

BACKGROUND

Lymphangiomas, developmental anomalies, can induce various disturbances of swallowing, mastication, speech, breathing, and skeletal deformities as well as psychological stress and anxiety for the patient and their family. Lymphangiomas are benign with virtually no possibility of turning into a malignant lesion, so clinical management aims to treat the patient functionally.

CASE DESCRIPTION

A girl, aged 6 years and 4 months, complained about facial asymmetry and anterior crossbite caused by congenital cervical lymphangioma. Her facial profile was the straight type with an adequate lip position. Anterior and right-side posterior crossbites were observed. On the frontal cephalogram, the menton shifted 3.0 mm to the right. A functional appliance with an expander was placed to correct her dental midline deviation and posterior crossbite. After 2-year treatment, the anterior and right-side posterior crossbites were improved. Multibracket treatment began after the growth spurt. After 44-month active treatment, a functional occlusion, including a Class I molar relationship with a proper interincisal relationship, was achieved. A functional occlusion was maintained during a 10-year retention period, while a mandibular downward growth was observed through the retention period.

CONCLUSION

Conventional orthodontic techniques enable functional and stable occlusion even in patients with mandibular deviation caused by congenital cervical lymphangioma, although only using early orthodontic management by itself may have some limitations.

CLINICAL SIGNIFICANCE

The hybrid technique combining functional appliance and intermaxillary elastics proves to be an effective therapy for correcting occlusal cant and mandibular deviation caused by cervical lymphangioma.

[The multidisciplinary challenge of anesthesia for ex utero intrapartum treatment: a case report]

The Ex- Utero Intrapartum Treatment (EXIT) is a surgical procedure performed in cases of expected postpartum fetal airway obstruction, allowing the establishment of patent airway while maintaining placental circulation. Anesthesia for EXIT procedure has several specific features such as adequate uterine relaxation, maintenance of maternal blood pressure fetal anesthesia and fetal airway establishment. The anesthesiologist should be aware of these particularities in order to contribute to a favorable outcome. This is a case report of an EXIT procedure performed on a fetus with a cervical lymphangioma with prenatal evidence of partial obstruction of the trachea and risk of post-delivery airway compromise.

Immediate operative management of the fetus with airway anomalies resulting from congenital malformations

Prenatal diagnosis has transformed the outcome of fetuses with airway obstruction. The thorough evaluation of prenatal imaging allows for categorizing fetuses with airway compromise into those who will require a special mode of delivery and those who can be delivered without any special resources. The ex-utero intrapartum treatment (EXIT) approach allows accessing the airway while the fetus is under placental support, converting a potentially catastrophic situation into a controlled one. An expert multidisciplinary team is the key to success.

Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure

The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.

Imaging features of cervical lymphangiomas as a cause of respiratory distress and vascular-lymphatic disturbance

OBJECTIVE

Our aim is to present the imaging features of cervical lymphangiomas, which may be related with respiratory and vascular disturbances.

MATERIALS AND METHODS

Nine patients with cervical lymphangioma were evaluated with ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). While one case was a fetus in the second trimester, eight cases with tracheal stenosis were neonates or in childhood.

RESULTS

One case was diagnosed in utero with US. All lymphangiomas were hypoechoic on the US and were of low-density (20-25 HU) on the CT. They showed a heterogeneous hypo- or hyperintense signal on T1-weighted MR images and a heterogeneous hyperintense signal on T2-weighted images. Upon contrast-enhanced CT and MR imaging, mild contrast enhancements were detected, particularly on the thick septations.

CONSLUSION

Cervical lymphangiomas present as cystic lesions with septations, and they may cause respiratory distress or vascular-lymphatic disturbance.