Fetal Abdominal Mass Research Articles

Fetal Midgut Volvulus with a Cystic Appearance, Accompanying a Sinus Rhythm and an Increased Peak Systolic Velocity without Anemia.

A midgut volvulus rarely occurs in a fetus; however, when it does, it requires an immediate diagnosis and surgery. Thirty-week pregnant was referred to our clinic with a diagnosis of a fetal abdominal cystic mass and preterm labor. The initial ultrasound examination revealed a female fetus with a 55 × 50 mm cystic mass in the lower abdomen, which was preliminarily diagnosed as an ovarian cyst. There was a sinusoidal rhythm on cardiography. The middle cerebral artery peak systolic velocity was 60.4 cm/sec, compatible with 1.49 MoMs that suggested fetal anemia on Doppler examination. Uterine contractions were observed with tocography and maternal hydration was administered for tocolytic treatment. Despite hydration, uterine contractions continued and the infant was delivered. A newborn ultrasonographic evaluation revealed a 6 cm abdominal cyst, and plain abdominal radiographs revealed distended loops of the small bowel on the left side. Emergency surgery was performed. A midgut volvulus leading to dilatation and necrosis of the small bowel without anatomical causes was observed during laparotomy. The necrotic bowel loop was resected and an end-to-end anastomosis was performed. The newborn died due to multiorgan failure. Obstetricians should be familiar with the appropriate diagnosis and management of a fetal volvulus.

Fetal endometriosis: a case report

To report a case of a large fetal pelvic mass diagnosed at 35 weeks' gestation. Report of a unique case of a fetal abdominal mass, emphasizing the wide range of differential diagnoses. Although rare reports of fetal ovarian cysts exist, even fewer describe endometriosis or endometriomas in infants. As of 2014 there have not been any published reports of fetal endometriosis from the United States. Large tertiary community hospital. An 18-year-old pregnant woman diagnosed with a large fetal pelvic mass at 35 weeks' gestation. Diagnosis of a fetal abdominal mass at 35 weeks with documented enlargement at 37 weeks leading to delivery, with subsequent removal of the mass on day of life 2. On day of life 2, a pediatric surgeon performed an exploratory laparotomy and left salpingo-oophorectomy. Final pathology showed a 7.0 × 4.5 cm cyst-like structure consistent with hemorrhagic ovarian cyst wall and focal endometriosis. It can be very difficult to counsel patients regarding an abdominal mass in their unborn child. These difficulties stem from the large list of differential diagnoses and the range of prognoses they portend. As more and more of these cases appear in the literature, we are able to gain a better understanding of how each of these diagnoses present and appear on imaging, allowing us to provide a more accurate diagnosis and counseling antenatally.

Prenatal ultrasonography and postnatal follow-up of a case of McKusick-Kaufman syndrome

ObjectiveMcKusick-Kaufman syndrome (MKS) is a rare autosomal recessive syndrome characterized by hydrometrocolpos (HMC) and postaxial polydactyly (PAP). It is very difficult to diagnose MKS prenatally because of overlapping manifestations and associated anomalies with other syndromes. Herein, we present a case of MKS with prenatal ultrasound illustrating a fetal abdominal cystic mass. Case ReportA 33-year-old woman, gravida 3 para 2, was referred to our obstetrics clinic at 34 weeks’ gestation for fetal abdominal cyst detected by prenatal ultrasound. Our ultrasound illustrated a fetal abdominal cystic mass with two communicating components (suspected HMC) and polydactyly involving both hands and feet. At birth, the gross appearance revealed abdominal distention, vulva edema, and PAP. MKS was highly suspected. Abdominal computed tomography (CT) at 3 days of life showed HMC with a transverse vaginal septum. At 3 months of age, she received colpotomy and vaginal reconstruction to relieve the abdominal distension by HMC. Then she accepted corrections of PAP of both hands and feet at 8 months and 10 months. At 5 years of age, her body and mental development did not show any retardation. Pediatric ophthalmologic examination revealed no specific findings. Given the above evidences, the diagnosis of MKS was finally made at 5 years of age. ConclusionRare syndromes like MKS may need early comprehensive evaluations and consultations. Although prenatal diagnosis might be impossible for MKS, prenatal awareness by fetal ultrasound is very helpful to assist early management and maternal transfer. The final diagnosis and appropriate management of MKS requires the collaboration of obstetricians, geneticists, pediatricians, and ophthalmologists as soon as abnormal signs are detected in utero.

Unilateral huge hydronephrosis necessitating fetal interventions.

Fetal intervention for obstructive uropathy was first performed at the University of California, San Francisco in 1981 [1]. Since then diagnostic criteria for fetal intervention have been laid down to assist in proper patient selection [1-3]. Unilateral fetal hydronephrosis doesn’t require prenatal intervention; but prenatal intervention might be required in selected cases, especially when hydronephrosis compresses adjacent organs [4]. A 26-year-old pregnant woman was referred to our prenatal center for a fetal abdominal cystic mass with severe oligohydramnios detected at 27th week of gestation. Prenatal scan showed a single male fetus with a cystic avascular mass (74×84 mm) located in the left hemi abdomen pushing left hemi diaphragm (Fig. 1).

Biochemical analysis of cystic fluid in the diagnosis of fetal intra‐abdominal masses

The aim of the study was to evaluate a biochemical analysis of fluid sampled in utero from fetal abdominal cystic masses. A retrospective study of 42 intra-abdominal cystic masses [ovarian cysts (n = 22), cloaca (n = 8), urodigestive fistulae (n = 4), and urogenital sinuses (n = 8)] was carried out. The control group (n = 30) consisted of fetal urine. Seven biochemical markers were assayed: sodium, estradiol, β(2) -microglobulin, total proteins and digestive enzymes, gamma-glutamyl transpeptidase, aminopeptidase M, and intestinal alkaline phosphatase isoenzyme. Outcome of pregnancies and final diagnosis of intra-abdominal mass were known in all cases. Biochemical patterns allowed to demonstrate (1) an ovarian origin based on elevated level of estradiol and of total proteins (100% specificity, 100% sensitivity); (2) urodigestive fistula based on the presence of high levels of digestive enzymes (cloaca in female fetuses or recto-urethral fistula in male fetuses); and (3) a renal origin (urinary pattern with low total proteins and absence of digestive enzymes); however, a biochemical pattern could not differentiate between fetal urogenital sinus and megacystis. Etiological diagnosis of a fetal cystic abdominal mass could impact both prenatal and postnatal management providing adapted prenatal counseling by a pediatric surgeon in surgically correctable congenital anomalies.

Misdiagnosis of fetus-in-fetu as meconium peritonitis

Fetus-in-fetu (FIF) is a rare congenital condition in which a fetiform mass is detected in the host abdomen and also in other sites such as the intracranium, thorax, head, and neck. This condition has been rarely reported in the literature. Herein, we report the case of a fetus presenting with abdominal cystic mass and ascites and prenatally diagnosed as meconium pseudocyst. Explorative laparotomy revealed an irregular fetiform mass in the retroperitoneum within a fluid-filled cyst. The mass contained intestinal tract, liver, pancreas, and finger. Fetal abdominal cystic mass has been identified in a broad spectrum of diseases. However, as in our case, FIF is often overlooked during differential diagnosis. FIF should also be differentiated from other conditions associated with fetal abdominal masses.

Prenatal diagnosis of mesoblastic nephroma: A case report

When an abdominal mass is demonstrated on prenatal ultrasonography, the differential diagnosis includes adrenal tumors, ovarian cysts, bowel obstruction, and renal tumors. A 34-year-old pregnant women was referred to our hospital evaluation of a fetal abdominal mass in the left renal fossa. A solid, round, mass on left renal area was noted; the adrenal gland was visualized on the same side. Thus, we suspected an abdominal tumor of renal origin. After birth, a 6.6×4.4 cm round mass replacing the left kidney was demonstrated on ultrasonography and computed tomography. The neonate underwent a left nephrectomy at 9 days of life and confirmed a mesoblastic nephroma. The neonate was well discharged 11 days post-operatively. We report the case with a brief review of the literature.

Elevated levels of aldosterone in the amniotic fluid in two cases of congenital mesoblastic nephroma

We report two cases of congenital mesoblastic nephroma (CMN) in which there were elevated levels of aldosterone in the amniotic fluid in comparison with control cases with polyhydramnios but without CMN. The progression of fetal hydrops due to high-output cardiac failure was also detected in both cases. In the first case, a 37-year-old woman was referred at 30 weeks' gestation owing to the presence of a fetal abdominal mass. The tumor showed hypervascularity (Figure 1a) with a feeding vessel (Figure 1b). The four-quadrant amniotic fluid index (AFI) was 55.2 cm, and amnioreduction (removal of 2 L each time) was performed three times over the course of about 3 weeks. During this period, the cardiothoracic area ratio (CTAR) and preload index deteriorated from 35 to 45% and from 0.43 to 0.64, respectively. Fetal scalp edema also increased from 2.0 to 6.7 mm. Aldosterone levels in the amniotic fluid were found to be high in comparison with controls (385 pg/mL at 30 + 1 weeks vs. mean of 143.7 (range, 52.4–245) pg/mL in five age-matched controls with polyhydramnios). Ultrasound imaging in two cases of congenital mesoblastic nephroma. (a,b) Case 1. (a) Doppler image at 31 + 6 weeks' gestation showing that the mass (M) had high vascularity. (b) Pulsed Doppler image demonstrating that the tumor feeding vessel was an artery. LK, left kidney. (c,d) Case 2. (c) Ultrasound image at 29 weeks' gestation showing fetal scalp edema (arrows). (d) The end-diastolic velocity flow of the umbilical artery was reversed (arrows). After the pharmacological induction of pulmonary maturity at 32 weeks' gestation, premature rupture of membranes occurred spontaneously at 32 + 5 weeks and a male infant weighing 2652 g (1- and 5-min Apgar scores 3 and 6, respectively) was delivered by emergency Cesarean section (owing to a history of previous Cesarean section). A nephrectomy was performed on day 4 after birth because of uncontrolled hypertension. The serum reactive renin and aldosterone levels before surgery were 1400 (mean ± SD in normal neonates, 175 ± 156) pg/mL and 3501 (mean ± SD in normal neonates 626.6 ± 48.5) pg/mL, respectively, but the level of reactive renin after the operation had decreased to 7.56 pg/mL and that for aldosterone had decreased to 1485 pg/mL, in conjunction with stabilization of blood pressure. Follow-up at 4 years identified no recurrence. In the second case, a 35-year-old woman was referred at 25 weeks' gestation and her fetus was diagnosed as having CMN. The AFI was 43.1 cm, and amnioreduction (2 L each time) was performed four times. Aldosterone levels in the amniotic fluid were again found to be high in comparison to controls (374 pg/mL at 26 + 4 weeks). At 29 weeks' gestation, CTAR was 40%, and fetal scalp edema was 8.0 mm (Figure 1c). Moreover, the end-diastolic flow of the umbilical artery was reversed (Figure 1d). After induction of pulmonary maturity, a male weighing 1754 g (1- and 5-min Apgar scores 4 and 6, respectively) was delivered by Cesarean section. Serum aldosterone level was 4000 pg/mL. Nephrectomy was performed 2 days after delivery because of decreased perfusion to the brain secondary to vascular steal phenomenon. Unfortunately, the infant died because of blood loss due to surgical complications during resection of the highly vascular tumor. CMN is generally a benign tumor with a favorable prognosis following surgical resection. However, CMN associated with non-immune fetal hydrops, which is rare, is lethal for the fetus. All five cases previously reported have been fatal1-4, and immediate delivery is recommended2. The pathophysiology of hydrops accompanying CMN remains unknown, but is likely to be caused by high-output heart failure due to vascular shunting in cases with an angiomatous tumor1. This is the first report of elevated levels of aldosterone in the amniotic fluid in CMN cases with developing hydrops, followed by postpartum hyper-reninemia with hypertension5, 6. The calculation of a combined cardiac output would also be effective for the timely detection of the risk of hydrops in fetuses with highly vascular tumors7, 8. We suggest that, following the prenatal diagnosis of CMN, it would be useful to measure aldosterone levels in the amniotic fluid in conjunction with monitoring of cardiac function in order to detect those rare cases with a poor prognosis. T. Kotani*, S. Sumigama*, H. Hayakawa , Y. Mano , H. Tsuda , C. Sugiyama , F. Kawachi , M. Hironaka , T. Kato , K. Kaneko§, M. Hayakawa*, F. Kikkawa , * Maternity and Perinatal Care Center, Nagoya University Hospital, Nagoya, Japan, Department of Obstetrics and Gynecology, Nagoya Graduate University School of Medicine, Nagoya, Japan, Department of Pediatrics, Nagoya Graduate University School of Medicine, Nagoya, Japan, § Department of Pediatric Surgery, Nagoya Graduate University School of Medicine, Nagoya, Japan

Preoperative diagnosis of congenital segmental giant megaureter presenting as a fetal abdominal mass

We describe a case of congenital segmental giant megaureter in a boy that presented as a fetal abdominal mass. He also had bilateral undescended testes, bilateral vesicoureteral reflux, and segmental aniridia. He presented with hypoglycemia in the neonatal period that resolved. Postnatal magnetic resonance imaging, voiding cystourethrography and radionuclide imaging established the diagnosis, and a ureteroureterostomy was performed at 12 months.

Role of MRI in fetal abdominal cystic masses detected on prenatal sonography

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, anatomical localization and tissue characterization. MR findings were considered to have affected management if subsequent treatment was influenced by the MR findings and diagnosis. Final individual diagnoses were: meconium pseudocyst (n = 2), mesenteric cyst, hydrometrocolpos, chylous ascitis, and gross hydronephrosis with pelvic-ureteric junction obstruction (n = 1 each). MRI was superior to sonography and had supplemental value because of better anatomical localization in five cases. MRI better characterized the nature of cystic masses in two fetuses (Chylous ascitis, and hydrometrocolpos). In two patients with meconium pseudocyst, tissue characterization was inferior with MRI. Overall, addition of MRI changed the diagnosis and management in four cases. Our preliminary results suggest that because of its excellent anatomical localization and contrast resolution, MRI has a supplemental value to antenatal sonography in delineation and characterization of abdominal cystic masses.

Late Prenatal Diagnosis of Hydrometrocolpos Secondary to a Cloacal Anomaly by Abdominal Ultrasonography with Complementary Magnetic Resonance Imaging

Prenatal diagnosis of a cloacal anomaly is difficult. Magnetic resonance imaging (MRI) can assist in the identification of the connection and continuity of a cystic mass to confirm the diagnosis of a cloacal anomaly. In the first case, a fetal abdominal cystic mass was observed at 32 weeks of gestation. Ultrasonography revealed a retrovesical septate hypoechoic mass with bilateral hydronephrosis. MRI demonstrated a midline cystic mass connected to a dilated uterus and a possible fistula between the bladder and vagina. In the second case, a fetal abdominal septate cystic mass was identified using ultrasonography at 34 weeks of gestation. MRI was performed and demonstrated hydrocolpos/hydrometrocolpos originating from a uterine didelphis with left dysgenesis and a possible vesicovaginal fistula. After birth, both newborns underwent immediate surgical intervention with good outcomes. MRI facilitated the prenatal diagnosis of cloacal anomalies and allowed additional time for parental counseling and planning of the delivery method with subsequent neonatal intensive care and surgical and urologic consultations.

The Role of Magnetic Resonance Imaging in the Diagnosis of Fetal Malformations

Abstract Even if ultrasonography still remains the primary prenatal investigation technique for the assessment of fetal development, magnetic resonance imaging (MRI) plays an important role for the study of fetal morphology and pathology. MRI has been shown to be particularly useful for the evaluation of the central nervous system (CNS), the latter being a common site of pathology such as cerebral and spinal malformations. MRI is contributive in defining fetal neck, thoracic, abdominal, and pelvic masses. This can be especially helpful when differing opinions exists as to the etiology of a mass. Ultrasonography, a non invasive, low cost, real time technique, still represents the investigation of choice in prenatal screening, not only regarding the CNS. Nevertheless several cases need a diagnostic complement by means of MRI, that increases the diagnostic potential of ultrasound . The additional information from MRI is important in prenatal counseling, delivery planning and planning for pre- or postnatal intervention.

Fetal Abdominal Mass

A near-term, large-for-gestational age female newborn presents with a prenatal diagnosis of a cystic intra-abdominal mass. ### Prenatal History: ### Birth History and Presentation: The mother presented to labor and delivery for elective cesarean section due to the enlarging fetal abdominal mass. The infant was delivered via primary cesarean section under epidural anesthesia. At birth, the infant had a heart rate greater than 100 beats/min but demonstrated poor respiratory effort, necessitating blow-by oxygen. At approximately 3 minutes after birth, she had cyanosis and a heart rate of 60 beats/min that required bag-mask positive pressure ventilation. Her heart rate increased and respiratory effort improved. Apgar scores were …

A Case of Fetal Congenital Mesoblastic Nephroma with Oligohydramnios

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems

Fetuses with features of first‐trimester peritonitis and a favorable outcome

Between 1993 and 2005, five patients were referred to our prenatal diagnosis unit for an evaluation of a fetal abdominal fluid mass discovered on routine ultrasound examination at 12 weeks' gestation. In three cases a paragastric pseudocyst—with a moderate amount of ascites in one case (Figure 1)—was observed. In the other two cases, ascites was extensive and led to abdominal distension in one patient. In addition, we observed calcifications at the periphery of the abdominal effusion in two cases. No other abnormalities were noted and fetal biometry was consistent with gestational age. Coronal ultrasound image of the fetal abdomen at 12 weeks' gestation, showing paragastric pseudocyst with peripheral calcifications. Following multidisciplinary staff discussion, amniocentesis was performed for karyotyping, and infection tests (viral DNA for parvovirus B19, rubella, chickenpox and cytomegalovirus) and digestive enzyme tests were also performed. All patients were immunized for toxoplasmosis infection. Tests for the most common mutations associated with cystic fibrosis were also performed in each parent. All test findings were negative and the pregnancies were monitored with monthly ultrasound scans. Follow-up revealed total resolution of both abdominal fluid and pseudocysts by 24 weeks' gestation in all cases. During the monitoring period, we observed either persistence (two cases) or occurrence of peritoneal calcifications at the left upper edge of the fetal abdomen (thee cases) (Figure 2). All the fetuses were delivered near term and treatment or surgical intervention after birth was not required. Subsequent pediatric follow-up ranging from 4 months to 5 years has been uneventful. Sagittal ultrasound image of the fetal abdomen at 22 weeks' gestation, showing calcification at the upper edge. To our knowledge, features of early peritonitis with favorable outcome have not previously been reported in the literature. The ultrasound findings observed in our series were similar to those of meconium peritonitis as described later on in pregnancy1. In this disease process, ascites is either diffuse or localized and peritoneal calcifications may represent the most typical sign on ultrasound imaging2, 3. The main differential diagnosis was fetal enterolithiasis secondary to a fistula between the urinary and the gastrointestinal tracts but in such cases calcifications are intraluminal and not associated with ascites4. In our series, there was no significant complication and therefore no possibility of surgical confirmation or of pathological tissue samples being obtained for confirmation of peritonitis. Recently, peritoneal calcifications in the left upper quadrant have been reported as an incidental finding with favorable outcome, even if the lesions remain visible after birth5. It has been suggested that these observed calcifications may result in early unknown features of peritonitis as previously described above. In conclusion, when paragastric pseudocysts or free abdominal fluid with or without calcifications are detected in the first trimester, counseling should be in favor of continuation of pregnancy, since the prognosis is likely to be good. M. Brasseur-Daudruy*, D. Eurin*, G. Labadie‡, S. Chouchenne?, A. Diguet†, E. Verspyck†, * Department of Pediatric Radiology, Elbeuf Hospital, Elbeuf, France, † Department of Obstetrics, Rouen University Hospital, 1 rue de Germont, 76031 Rouen, Elbeuf Hospital, Elbeuf, France, ‡ Department of Obstetrics, Belvédère Hospital, Mont-Saint-Aignan, Elbeuf Hospital, Elbeuf, France, ? Department of Obstetrics, Elbeuf Hospital, Elbeuf, France

Liver, meconium, haemorrhage: the value of T1-weighted images in fetal MRI

Ultrafast T2-weighted (T2-W) MRI sequences are currently considered a routine technique for fetal MR imaging. Limited experience exists with fetal T1-weighted (T1-W) imaging techniques. To determine MRI patterns of some fetal abdominal or haemorrhagic disorders with particular respect to the diagnostic value of T1-W images. In addition to standard T2-W single-shot sequences, T1-W single-shot and/or multislice sequences were employed in 25 MR examinations performed in 23 fetuses between 20 and 36 weeks of gestation for more detailed assessment of liver, meconium-filled digestive tract, haemorrhage, or further characterization of a fetal abdominal mass. Diagnostic value and presence of motion artefacts on T1-W images was recorded in each case. T1-W images enabled superior delineation of fetal liver and large intestine. They provided additional diagnostic information in 9 (39%) of 23 fetuses. One false-positive and one false-negative MRI diagnosis of malrotation anomaly were encountered. Use of single-shot T1-W sequences reduced the occurrence of motion artefacts in 64%. Our results suggest that the specific signal properties of methaemoglobin, meconium and liver are sufficiently important for T1-W sequences to become a routine part of fetal MRI protocols when dealing with digestive tract anomalies, diaphragmatic and abdominal wall defects, intraabdominal masses, and fetal haemorrhage.

Mesoblastic Nephroma: A Case Report of Prenatal Detection by MR Imaging

We report a case of mesoblastic nephroma detected prenatally by magnetic resonance (MR) imaging. MR imaging could provide valuable information about the origin and nature of a fetal abdominal mass and help define the relationship of the mass to adjacent structures.

McKusick-Kaufman Syndrome (MK catalogue #236700) Presenting Prenatally as Fetal Abdominal Mass

McKusick-Kaufman Syndrome (MK catalogue #236700) Presenting Prenatally as Fetal Abdominal Mass

Single ectopic ureter inserting into a duplicated imperforate hemivagina: a rare cause of a fetal abdominal mass

We present a unique case of obstructed vaginal duplication with ectopic ureteral drainage of an ectopic dysplastic kidney presenting as an antenatal diagnosis of a pelvic mass.

A new tool for prenatal diagnosis: Ultrafast fetal MRI

The development of ultrafast magnetic resonance imaging scanners and sequences provides a new tool for the diagnosis of fetal anomalies. Magnetic resonance imaging is a valuable adjunct to prenatal ultrasound especially for the evaluation of suspected fetal brain anomalies, chest masses, abdominal masses, and renal diseases.