P19.15: A case of fetal intrapericardial teratoma associated with massive pericardial effusion

Abstract

Intrapericardial teratoma, although an exceedingly rare condition, is a well-recognized by pericardial effusion and hydrops fetelis. In the fetus, a large pericardial effusion may eventually lead to significant pulmonary compression, cardiac tamponade and fetal death. We present the prenatal findings of a fetus with an intrapericardial teratoma associated with a massive pericardial effusion. A 36-year-old woman, gravoda 2, para 2, was referred at 25 + 6 weeks of gestation for an evaluation of a fetal chest anomaly. Ultrasonographic examination at referral confirmed a massive pericardial effusion, swinging of the structurally normal heart in the mediastinum and a 10.2 mm × 8.1 mm intrapericardial soft tissue mass in close relation to the external wall of the right atrioventricular junction. The massive pericardial effusion was filled approximately 30% of the fetal chest. There were no other abnormal ultrasound findings and no significant impairment of the fetal circulation. Three-dimensional (3D) ultrasonography was also used to visualize the tumor position more clearly and useful to evaluate the volume change. Follow-up scans demonstrated diminution of the pericardial effusion and the rapid growth of the tumor mainly during the second half of pregnancy. A female weighing 2852 g was delivered by Cesarean section at 37 + 6 weeks of gestation. The infant received an operative thoracotomy and tumor excision. Pathologic examination of the specimen confirmed a mature teratoma, composed of squamous epithelium, skin, fat, cartilage, bone, pancreatic tissue. In conclusion, by means of 3D ultrasonography additional information especially on the position and volume change of the pericardial tumor was obtained.