Fig 2 - uploaded by Ankur Gadodia
Content may be subject to copyright.
![A 26-week fetus with chylous ascitis. a Axial grayscale sonogram shows large septated (arrows) cystic lesion Wlling the entire abdominal cavity. Coronal T2 W (b) sequence reveal gross ascitis Wlling the entire abdominal cavity, with Xoating bowel loops. Postnatal photograph (c) shows distended abdomen. Postnatal CT (d) show septated ascitis (arrow) with Xoating bowel loops. Aspirate demonstrated a white-colored Xuid with high triglyceride levels conWrming diagnosis of chylous ascites (Reproduced with permission from [23])](profile/Ankur-Gadodia/publication/26734109/figure/fig2/AS:601729192165378@1520474827199/A-26-week-fetus-with-chylous-ascitis-a-Axial-grayscale-sonogram-shows-large-septated.png)
A 26-week fetus with chylous ascitis. a Axial grayscale sonogram shows large septated (arrows) cystic lesion Wlling the entire abdominal cavity. Coronal T2 W (b) sequence reveal gross ascitis Wlling the entire abdominal cavity, with Xoating bowel loops. Postnatal photograph (c) shows distended abdomen. Postnatal CT (d) show septated ascitis (arrow) with Xoating bowel loops. Aspirate demonstrated a white-colored Xuid with high triglyceride levels conWrming diagnosis of chylous ascites (Reproduced with permission from [23])
Source publication
Our aim was to determine the role of fetal MRI in sonographically detected abdominal cystic masses.
Fifty-six fetuses in 56 women with fetal malformation underwent sonography and MRI. Out of the 56 fetuses, 6 had intra-abdominal cystic masses and formed our study group. MRI findings were compared with ultrasonographic findings regarding detection,...
Context in source publication
Similar publications
Objective: This prospective study was designed to detect the role of magnetic resonance imaging (MRI) in refining the diagnosis of suspected fetal renal anomalies detected during screening sonography.
Material and Methods: 54 pregnant women, with suspected fetal renal anomalies detected during routine ultrasound screening, were rescanned by MRI to...
Objective:
This prospective study was designed to detect the role of magnetic resonance imaging (MRI) in refining the diagnosis of suspected fetal renal anomalies detected during screening sonography.
Material and methods:
54 pregnant women, with suspected fetal renal anomalies detected during routine ultrasound screening, were rescanned by MRI...
Citations
... These lesions commonly arise from various organs and structures in the abdomen and pelvis [2]. Prenatal sonography is highly sensitive in the detection of abdominopelvic cystic masses however, it lacks specificity, and definitive diagnosis is often challenging [1][2][3]. Postnatal sonography is often successful in determining the etiology of cystic lesions, occasionally supplemented by magnetic resonance imaging (MRI). Sonography is the preferred modality in this setting, given its portability, lack of ionizing radiation, low cost, and high resolution in small patients. ...
... The differential diagnosis of abdominopelvic cystic masses in the newborn is broad and can be narrowed by approaching the lesions based on their anatomic location; intraperitoneal, porta hepatis\hepatic, renal\retroperitoneal, splenic, or pelvic. In addition, distinctive sonographic signs, when present, aid in establishing the correct diagnosis [1,3]. ...
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
... For fetuses with abdominal cystic lesions, the correlation between prenatal and postnatal diagnosis ranges from 72.3% to 94.8% overall (34). Fetal MRI has been shown to enhance the fetal diagnosis of intra-abdominal cysts (30,35). In a study by Hugele and colleagues from 2015, fetal MRI was shown to increase the diagnostic accuracy for fetuses with abdominal cystic lesions from 51% to 73.4%; correcting the diagnosis or providing more precise information in 26.5% of cases (36). ...
This article reviews the contemporary diagnosis and management of the most common abdominal neoplasms and cystic lesions diagnosed in the fetus. Fetal tumors discussed include teratomas (sacrococcygeal, cervical or mediastinal), mesoblastic nephroma, nephroblastoma (Wilms' tumor), neuroblastoma, and hepatoblastoma. Fetal abdominal cystic lesions discussed include ovarian cyst, choledochal cyst, intestinal duplication cyst, mesenteric cyst, simple hepatic cyst, and meconium pseudocyst. We discuss the rare indications for fetal intervention or fetal surgery and other perinatal management, including prenatal interventions and fetal surgery for sacrococcygeal teratoma. The lesions reviewed are detected by widespread use of screening ultrasonography during pregnancy. Work-up for these abnormalities may include fetal MRI which enhances the diagnostic accuracy of abdominal tumors and cystic lesions and can aid in characterization of the lesion in relationship to surrounding anatomic structures. Accurate prenatal diagnosis of such lesions permits recommendations for optimal location and timing of delivery, and inclusion of appropriate caregivers and expertise to facilitate postnatal management. Perinatal management of the fetus with a neoplasm requires consideration of the optimal timing and mode of delivery, and pediatric oncology and surgical specialty care. The majority of tumors diagnosed antenatally have good prognosis with current multimodality treatment.
... In ultrasonography, duplication cysts are identified by the presence of the echogenic inner mucosal layer and the hypoechoic muscular layer [6]. Nowadays, CT and MRI are used less frequently in terms of anatomical detail determination and complication research [7,8]. In our case, air fluid levels in small bowel loops in the standing direct abdominal X-ray, and lobular contoured cystic lesion in the right lower quadrant on ultrasonography. ...
... Esophageal and gastric duplication cysts should be treated with cystectomy and other intestinal cysts with either cystectomy or resection anastomosis. In cases where cystectomy is impossible, cystotomy and mucosectomy is an option [8]. Our patient underwent cystectomy. ...
Duplication cysts are one of the rare congenital anomalies of the gastrointestinal tract. Although it can be seen at all levels throughout the gastrointestinal tract, it is most common in the ileum. One of the rarest of duplication cysts is cecal duplication cyst. Clinically, they become present in the form of vomiting, distention, abdominal pain and palpable mass. Rarely, it can cause acute abdomen such as perforation and obstruction. We present a case of cecal duplication cyst requiring urgent surgical treatment that causes obstruction in a 3-month-old baby.
... Peritoneal mesothelial cysts should also be taken into consideration as differential diagnosis. However, MRI has better anatomical localisation and contrast resolution abilities, especially with regard to central nervous system, genitourinary and hepatobiliary anomalies (Gupta et al. 2010). Additionally, MRI would be performed when an abdominal mass was suspected of being a tumour, or to help decide on the appropriate treatment after birth. ...
To assess the accuracy of prenatal diagnosis and the prognosis of fetal-abdominal masses, we reviewed all of the cases which had been diagnosed as having abdominal masses from January 2014 to December 2016. In total, 264 cases were identified as having abdominal masses. Among them, 141 cases (53%) had received specific prenatal diagnoses by prenatal ultrasound (US). MRI had assisted in the diagnosis and prognostic evaluation in 69 cases, increasing the diagnostic rate to 65%. The prenatal diagnoses of 111 cases (65%) were concordant with the postnatal diagnoses. Surgical intervention after birth was needed in 96 cases (39%). Most outcomes were good (89%). We suggest that prenatal US can detect and identify most fetal abdominal masses and that MRI helps to further describe the masses. With early intervention after birth, the prognosis was good in most cases.
• Impact Statement
• What is already known on this subject? Fetal-abdominal masses are commonly detected in antenatal examinations. A prenatal ultrasound is the main screening tool for detecting fetal intra-abdominal cystic lesions.
• What the results of this study add? We suggest that MRI is more helpful in some systems to reveal locations and structures. Even prenatal diagnosis cannot reach before birth, prognosis is quite good and expectant therapy is sufficient.
• What the implications are of these findings for clinical practice and/or future research? Our data strengthens the current knowledge of fetal abdominal masses to help relieve anxious parents by telling them that this congenital malformation has good outcomes. But multidiscipline consultation is necessary.
... In our material there were such abdominal cystic laesions, as: 1 duplication of the small intestine, 1 duplication of the duodenum, 1 mesenteric cyst and 1 cystic teratoma, but in none of these cases the origin of cystic laesion was determined on foetal MRI. In spite of reports in the literature emphasizing the usefulness of MRI in assessing both the origin and nature of foetal abdominal laesions, including cystic ones [20][21][22][23], our experience proves limited possibilities in differentiation of these pathologies. ...
Objectives:
The role of magnetic resonance imaging, similarly to ultrasound, in the evaluation of foetal anomalies is in-disputable. This gives rise to a question, whether prenatal diagnostics can replace postnatal one. To assess the diagnostic accuracy of foetal MRI in children with congenital anomalies by using postnatal MRI, X-ray/US and surgery (histopathol-ogy/autopsy) results as a reference standard.
Material and methods:
110 children were included in the analysis. All of them underwent foetal MRI, and the diagnoses were verified after birth. All the results were analysed both by: 1. evaluation of correctness of the prenatal diagnosis with the reference standard diagnosis of each patient, and 2. statistical evaluation of prenatal diagnosis using standard measures of binary diagnostic tests' abilities.
Results:
The accordance of prenatal and final diagnoses was 70%. Only 3.64% of patients were misdiagnosed. Most of the prenatal diagnoses that were incomplete (23.64%), concerned children who underwent surgery, and among them patients with abdominal cystic laesions of undetermined origin on foetal MRI constituted the majority. In 2.73% of cases prenatal diagnoses remained inconclusive.
Conclusions:
High correlation of prenatal and postnatal tests' results in the study material confirms the high value of foetal MRI in perinatal diagnostics. Comprehensive assessment of the foetus in prenatal MRI is very effective and facilitates impor-tant therapeutic decisions in the prenatal period (in utero treatment) and in perinatal care (application or withdrawal from the EXIT procedure, surgery or backtracking from neonatal resuscitation if it should bear the hallmarks of persistent therapy).
... These findings in a female child confirmed HMC [6,29,30]. Magnetic resonance imaging (MRI) has a supplemental diagnostic value because of its excellent anatomical localization and contrast resolution [9,[31][32][33]. ...
Hydrometrocolpos is a rare condition in which the uterus and the vagina are grossly distended with a retained fluid other than pus or blood. It may present during the neonatal period or later at puberty. Most cases reported earlier were stillbirths and were diagnosed only on autopsy. Antenatal diagnosis is now possible with the advent of ultrasound. An early diagnosis and speedy management is the key to survival. Many previous case reports have focused on the varied clinical presentations, multiple causes, associated syndromes and/or the radiological diagnosis of this condition. However, management options for different types of hydrometrocolpos have not yet been concisely discussed. We have reviewed the literature and tried to summarize the management options applicable to most case scenarios of hydrometrocolpos.
... But, nowadays, diagnostic laparoscopy is widely used. 12 In the cases of neonatal intestinal obstruction, although the diagnosis can be made preoperatively by imaging, it should not delay surgery. ...
We report a rare case of duplication cyst of the caecum responsible for an intestinal obstruction in a 5-day-old newborn. Preoperatively, we suspected the diagnosis of enteric duplication as ultrasonography demonstrated a cystic mass in the right iliac fossa, and laparotomy confirmed an obstructive caecal mass which was resected and an end-to-end anastomosis was performed. The neonate completely recovered with an uneventful follow-up.
... Ultrasonografide kistin intestinal duvarının görülmesi duplikasyon kistini düşündürür. Ultrasonografide duplikasyon kistlerinin ayırıcı tanısında; koledok kisti, mezenter kisti ve over kistleri yer almaktadır (12) . Sunulan 11 olgunun 10'unda abdominal US'de kistik yapı (duplikasyon kisti?, mezenter kisti?, over kisti?, koledok kisti?) tanımlandı. ...
... Enterik sistemle lümen bağlantısı olmayan duplikasyon kistlerinde kistektomi yeterlidir. Kistektominin olanaksız olduğu olgularda ise kistotomi ve mukozektomi (Wreen prosedürü) bir seçenektir (12) . Çalışmamızdaki olguların 6'sında intestinal rezeksiyon anastomoz, 3'ünde kistektomi, 1'inde parsiyel kistektomi ve mukozektomi, 1'inde kistotomi ve mukozektomi yapıldı. ...
... It results from a distal obstruction with accumulation of reproductive secretions at the vagina and/or uterus. Imperforated hymen, midline vaginal septum and vaginal atresia are the most frequently observed causes [16][17][18] (Fig. 3). Severe hydrocolpos/hydrometrocolpos may produce unilateral or bilateral hydronephrosis. ...
... Prenatal diagnosis occurs mostly at late gestation. The distended, fluid-filled vagina usually shows a typical pear-inversed form, with a recognizable uterus on top that may or not be distended [18]. Diagnosis at US is not always evident. ...
The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.
... Results: Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range [19][20][21][22][23][24][25][26][27][28][29][30][31]. Fetal ascites (93.3%) was the most common prenatal US finding. ...
... Fetal MRI has been increasingly used for detecting abdominal cystic masses. MRI was shown to have a supplemental value to US scan in delineating abdominal cystic masses due to improved anatomic localization and contrast resolution [25] . We have not used fetal MRI imaging in our cohort of infants with MP. ...
Objective:
To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally.
Material and methods:
We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014.
Results:
Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally.
Discussion:
A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.
