Fetal Abdominal Cysts: Prenatal Diagnosis and Management

Abstract

Objective: Fetal intra-abdominal cystic masses are quite rare entities and their differential diagnosis is particularly perplexing. These masses encompass many different pathological cysts originating from almost every organ in the abdomen. In female fetuses, ovarian cysts are the primary cause. In our study, we investigated the techniques used in diagnosis, accuracy of methods and management strategies, and tried to summarize postnatal outcomes. Materials and methods: A total of 29 cases were evaluated retrospectively by reviewing their ultrasonography (USG) results, magnetic resonance imaging (MRI) scans, interventions in perinatal period, postnatal follow up and surgical outcomes. Results: Twenty nine (25 female 4 male) cases were included in the study. Mean gestational week at diagnosis was 30,0 ± 6,4 for ovarian cysts and 24,7 ± 7,5 for non-ovarian cysts. Mean diameter of cysts was 41,7 ± 25,4 mm. 17 cysts (56%) were of ovarian origin, 6 (20,7%) were mesenteric cysts, 3 of them (10.3%) originated from kidneys and 3 (10.3%) of the cysts turned out to be choledochal-subhepatic cysts. In postnatal period, 8 cases required surgery which was ovarian and mesenteric cysts. In two incidences, gonads had to be removed. In differential diagnosis of masses, diagnostic accuracy of USG was calculated as 72,4% while that of MRI was 87.5%. Conclusion: Fetal abdominal cysts are seen more frequently in female fetuses and recognized relatively later during the pregnancy. Aspiration of the cysts in masses with larger diameters may be useful in reducing frequency of complications leading to gonad losses. Most common non-ovarian cysts are mesenteric cysts which also cause complications and require surgical interventions. Both USG and MRI are highly accurate imaging techniques in cases with adnexial masses. They have roughly the same accuracy in differential diagnosis of fetal abdominal cystic lesions.