Fetal Neck Masses Research Articles

Multidisciplinary management of congenital giant head and neck masses: Our experience and review of the literature

BackgroundLarge fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. MethodsThe study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. ResultsThe histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. ConclusionsThe management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. Level of evidenceIV

Persistent Extreme Hyperextension of the Fetal Neck: Clinical and Neuroimaging Findings.

Persistent hyperextension of the fetal craniocervical junction or neck is one of several fetal positions commonly observed on prenatal imaging. Underlying fetal structural etiologies such as fetal neck masses and iniencephaly can be detected as causes of hyperextension. Caesarean delivery is considered in cases of vaginal delivery or obstructed labor for fear of cervical spinal cord injury. In this case series, we describe the prenatal magnetic resonance imaging (MRI) findings and their potential role in obstetric management and discuss postnatal outcomes in fetuses demonstrating prenatal imaging findings of persistent extreme hyperextension of the neck. A retrospective cohort of fetuses with extreme fetal neck hyperextension on prenatal ultrasound and subsequent MRI is described. Persistent extreme neck hyperextension was demonstrated in four pregnancies. One patient showed resolution of head positioning prior to labor. In the other 3 patients, neck hyperextension persisted until labor. In these three pregnancies, caesarean section with early intubation was performed due to concern for airway compromise and cervical cord injury. An underlying structural neck abnormality with airway compromise was noted only in 1 patient (large venolymphatic malformation). No airway compromise, cervical spine, or spinal cord anomaly was identified in the remaining 3 patients. Noncervical fetal anomalies were detected only in 1 patient (arthogryposis multiplex and clubfoot deformities). In patients with no structural neck abnormality, early extubation was performed shortly following labor. Detailed, high-resolution fetal MRI may serve as a valuable secondary imaging modality for clinical decision making regarding management of pregnancy, in utero therapy, mode of delivery, and postnatal care.

The application of ex utero intrapartum treatment (EXIT) procedure for cardiothoracic disorders

The ex utero intrapartum treatment (EXIT) procedure was primarily devel-oped to reverse temporary tracheal occlu-sion in patients with fetal surgery for con-genital diaphragmatic hernia. Nowadays, it is widely used to resect fetal neck masses and to maintain an unobstructed airway. It is indicated for the management of several cardiothoracic diseases, including medi-astinal or lung mass resection, drainage of pleural effusions, palliative treatment of critical congenital heart disease and establishment of EXIT-to-extracorporeal membrane oxygenation (ECMO). EXIT has been attempted successfully in many centers, and it has been proven that moth-ers and babies tolerate the procedure well. Maternal and fetal surveillance during an-esthesia is important to maintain maternal blood pressure and placental blood flow and fetal oxygenation. The aim of this arti-cle is to discuss the application of the EXIT procedure for the management of fetal car-diothoracic diseases.

P09.03: MR of fetal neck and face masses: prediction of high morbidity neonatal outcome, including ex utero intrapartum therapy (EXIT)

P09.03: MR of fetal neck and face masses: prediction of high morbidity neonatal outcome, including ex utero intrapartum therapy <b>(</b>EXIT)

Ex Utero Intrapartum Treatment (EXIT) for a Large Fetal Neck Mass.

A 23-year-old primigravida was referred to our hospital at 36 + 5 weeks gestation with scan showing gross polyhydramnios and fetus having a large neck mass. She had no antenatal risk factors. An anomaly scan done at 22-week gestation was told to be normal. Repeat scan done here showed gross polyhydramnios with the amniotic fluid index (AFI) being 44 cm. The fetus was growth restricted with an estimated fetal weight of 1.8 kg. There was a 8 × 6 cm left anterolateral mass on the fetal neck, which was solid, well defined with minimal vascularity (Fig. 1). There seemed to be no retrosternal extension of the mass. There was no other structural abnormality to account for the fetal growth restriction (FGR) with polyhydramnios. Her glucose tolerance test at fifth month was normal. Open in a separate window Fig. 1 Prenatal USG of 37-week fetus showing 8 × 6 cm cervical mass, lying next to fetal head. The mass appeared solid, with heterogenous appearance and minimal vascularity on Color Doppler

Nursing care of the ex-utero intrapartum treatment in one case fetal neck mass oppressing airway

Objective To explore nursing care of the ex-utero intrapartum treatment (EXIT) in fetal neck mass oppressing airway. Methods A case of EXIT in which a fetal neck mass was diagnosed on ultrasound was fully prepared supplies and carried out. Nursing care was well implemented and vital signs of the puerpera and fetus were observed in preoperative and intraoperative surgery. Results The EXIT procedure was successful performed and vital signs of the puerpera and fetus were steadied. The score of Apgar was seven to eight. Conclusions Adequate equipment, multi-department collaboration, preoperative exercise and close cooperation are the important guarantee for the success of ex-utero intrapartum treatment. Key words: Fetus; Nursing care; Ex-utero intrapartum treatment; Neck mass

Neck

ABSTRACTCystic hygroma (CH) is the most frequently seen fetal neck mass on the first-trimester ultrasound (US). Overall prognosis is poor with a high association with chromosomal and structural anomalies. When diagnosed prenatally, fetal karyotyping and detailed US evaluation should be offered. Prenatal and postnatal surgical or nonsurgical treatment options are available. Fetal goiter (FG) and fetal thyroid masses are rare fetal conditions and may occur as part of a hypothyroid, hyperthyroid, or euthyroid state. Screening for FGs should be carried out in pregnancies of mothers with thyroid disease. If a FG is detected, a detailed US examination should be performed. Congenital high airway obstruction syndrome (CHAOS) is characterized by bilaterally enlarged lungs, flat or inverted diaphragms, dilated tracheobronchial tree, and massive ascites. It is usually a lethal abnormality. Fetuses with suspected CHAOS should be referred to a fetal medicine center able to perform ex utero intrapartum treatment (EXIT) delivery. Neck teratomas are associated with high mortality rates. Prenatal US diagnosis of cervical teratoma can be made at 15 and 16 weeks of gestation. Planning of delivery in a tertiary center allows the performance of EXIT. Lymphangioma of the neck usually diagnosed in late pregnancy could be traditionally referred to as CH, but there is a different prenatal history and outcome.How to cite this articleVladareanu R, Vladareanu S, Berceanu C. Neck. Donald School J Ultrasound Obstet Gynecol 2016;10(3): 256-270.

A Rare Cause of Fetal Neck Mass: Cervical Lymphangioma

A Rare Cause of Fetal Neck Mass: Cervical Lymphangioma

Prenatal diagnosis and management of a fetal neck mass.

We report the case of a benign mesenchymal spindle-cell tumor located on fetal neck, diagnosed during prenatal ultrasound and magnetic resonance investigation. A 30-year-old woman (gravida 2, para 1) was referred to our perinatology unit for evaluation of a fetal neck mass that had been identified on ultrasonography at 29 weeks gestation. A right lateral neck mass was observed (size: 42×40 mm) that extended from the preauricular region to right clavicula. Fetal MRI revealed a solid heterogeneous mass arising from the right lateral neck and there was no invasion around tissue and no extension of the mass into the chest. At 37 weeks after birth, we observed that the mass was subcutaneous and there was no invasion to the surrounding tissue. The trachea was not compressed and there was no extension of the mass into the chest. Then, the neck mass was completely resected after birth without any complications. Histopathological examination of tumor was consistent with mesenchymal spindle-cell tumor. Immunohistochemical staining with CD34 and actin was positive; however, caldesmone, epithelial membrane antigen (EMA), and S-100 was negative. Fetal MRI performed during the pregnancy for investigation of fetal neck masses detected on ultrasound gives compatible results observed in the neonate after birth and maintains adequate findings for follow-up and planning of treatment.

Abnormal Fetal Cystic Left Neck Mass.

An abnormal fetal cystic left neck mass was found on ultrasonography at 18 weeks gestation in a young woman. Fetal magnetic resonance imaging (MRI) demonstrated a large cystic anterior neck mass (Figure, A, sagittal view, and Figure, B, axial view, on T2-weighted half-Fourier acquired single turbo spin-echo [HASTE] MRI). The tracheoesophageal displacement index (TEDI) was found to be 24 mm. The neonate did well at the cesarean delivery (scheduled owing to the mother’s previous cesarean delivery) and had initial Apgar scores of 7 (1 minute) and 9 (5 minutes). Subsequently, the infant was intubated owing to increased difficulty with milky oral secretions and respiratory distress. Examination of the infant revealed a 5-cm, soft, fluctuant, and mobile neck mass that caused the head to deviate to the right with no cutaneous involvement. On day 2 of life, the mass had an air-fluid level and was markedly hyperintense on axial T2-weighted MRI with fat saturation (Figure, C). It appeared to be predominantly in the retropharyngeal space, anterior to the left carotid artery, and extended to abut themedial aspect of the right carotid sheath.Onday8of life, direct laryngoscopydemonstratedbulging in the left lateralpharyngealand retropharyngealwalls.Whentheneckmasswascompressed,air and fluid escaped froma communicating sinus lateral to the arytenoids in the left pyriform sinus (Figure, D). The mass was excised. A tract was isolated and ligated at the pyriform sinus, deep to the left thyroid lobe. The thyroid lobe was uninvolved. The patient was extubated on day 9 of life and had no problems breathing. What is your diagnosis? 80 mm 80 mm A B

PFM.56 Fetal or Neonatal Haemangioma and Lymphangioma: Noteworthy differences in clinical significance and outcome

The aim of this study was to review the clinical outcomes of congenital haemangiomas and lymphangiomas in our unit.MethodsRetrospective cohort study.ResultsBetween January 2004 and March 2013, over 67,000 infants delivered...

Sonographic Features of Rare Posterior Fetal Neck Masses of Vascular Origin

The purpose of this series is to describe the grayscale and color Doppler sonographic characteristics as well as the histopathologic features of rare solid posterior neck masses identified on prenatal sonography in pregnant patients. We conducted a retrospective review of detailed fetal sonographic examinations of second- and third-trimester pregnancies referred to the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia for suspected fetal neck masses from June 1998 to December 2011. Eight predominately solid posterior neck masses were identified on 139 studies performed during the study period. Of the 7 cases in which follow-up was available, 6 were confirmed as hemangiomas, and 1 was confirmed as a kaposiform hemangioendothelioma with Kasabach-Merritt syndrome. The most common sonographic features were hypervascularity (7) and calcifications (5). Posterior solid fetal neck masses are rare anomalies. Hemangioma is the most common etiology and should be suggested as the likely diagnosis rather than teratoma, even in the presence of calcifications.

Sonographic Features of Rare Posterior Fetal Neck Masses of Vascular Origin

The purpose of this series is to describe the grayscale and color Doppler sonographic characteristics as well as the histopathologic features of rare solid posterior neck masses identified on prenatal sonography in pregnant patients. We conducted a retrospective review of detailed fetal sonographic examinations of second- and third-trimester pregnancies referred to the Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia for suspected fetal neck masses from June 1998 to December 2011. Eight predominately solid posterior neck masses were identified on 139 studies performed during the study period. Of the 7 cases in which follow-up was available, 6 were confirmed as hemangiomas, and 1 was confirmed as a kaposiform hemangioendothelioma with Kasabach-Merritt syndrome. The most common sonographic features were hypervascularity (7) and calcifications (5). Posterior solid fetal neck masses are rare anomalies. Hemangioma is the most common etiology and should be suggested as the likely diagnosis rather than teratoma, even in the presence of calcifications.

Ultrasound Diagnosis of Fetal Neck Masses: A Case Series

Fetal neck masses are rare and may not be apparent during the second trimester fetal anomaly screening scan. It is essential to distinguish the different pathologies as it influences prenatal counseling, antenatal, and postnatal management. Furthermore, some causes may be amenable to in utero treatment. Others have a poor prognosis due to their association with congenital syndromes and aneuploidies. Differentiating the various neck masses and reaching an accurate diagnosis are a challenge. This requires a systematic approach, time and patience, together with an experienced sonographer. Ancillary investigations like karyotyping and magnetic resonance imaging may be used as well. It is important to attain an accurate diagnosis and to follow up the fetus with serial scans as this affects antenatal counselling and prognosis as well as the mode of delivery. Here, we present four cases of fetal neck masses that were seen at our antenatal diagnostic centre and highlight the distinguishing ultrasound features of each. This will enable one to approach the ultrasound diagnosis of fetal neck masses in a methodical and logical manner.

Multidisciplinary diagnosis and treatment for fetal neck mass

Objective To investigate the effect of multidisciplinary diagnosis and treatment including ex-utero intrapartum treatment (EXIT) procedure to improve the prenatal survival rate of fetus with neck mass.Methods Multidisciplinary diagnosis and treatment model were carried out in four pregnancy women with fetal neck mass from September 2007 to February 2010.The model included prenatal assessment and monitoring,EXIT procedure during cesarean section,neonatal reassessment and surgical treatment by the cooperation of obstetricians,neonatologists,children surgeons,sonographers and anesthetists.Results All patients underwent cesarean section after 37gestational weeks.Mean delivery time was 37+4 weeks (37-38+3 weeks); mean birth weight was 2972 g (2600-3250 g); mean operation time was 4 min (2-7 min).The gestational age of primary diagnosis of fetal neck mass was 24-34 gestational weeks.After delivery,the size of neck mass was from 3.0 cm × 2.0 cm × 1.0 cm to 6.2 cm× 5.8 cm × 6.8 cm.The tracheal compression and displacement were found by color doppler ultrasound scan and magnetic resonance imaging in all cases.Two of them were completed with polyhydramnios and the others with normal volume of amniotic fluid.EXIT procedure was successfully carried out during cesarean section.Neonatal reassessment showed the trachea of three infants were obviously compressed and lapsed by enhanced CT; the infants relied on mechanical ventilation after birth and underwent operation on day 6 to 8.Tracheal impression was not presented in one infant and trachea cannula was removed on the second day,operation was not performed.All of those infants had good outcomes.Conclusions The multidisciplinary diagnosis and treatment model,including EXIT procedure,is a safe,efficient and feasible strategy,which is necessary for fetus with neck mass. Key words: Head and neck neoplasms; Lymphangioma; Cysts; Fetal diseases; Paracentesis; Intubation, intratracheal

EXIT procedure for fetal neck masses

The ex-utero intrapartum treatment (EXIT procedure) can be life-saving for fetuses with large neck masses. Advances in fetal imaging and access to prenatal care have improved the ability to anticipate and plan for the treatment of these fetuses. This review will highlight advances in imaging techniques, modification of anesthesia and case selection for the EXIT procedure. Long-term maternal and fetal outcomes will also be discussed. There have been relatively few articles published on this subject in the past 18 months. A better understanding of the effect of inhalational anesthetics on fetal cardiac function and some insight into the pharmacokinetics of narcotics while on uteroplacental support has been gained. Imaging characteristics that may improve patient selection have been proposed. The long-term outcomes of mothers undergoing fetal surgical procedures in general and specifically those undergoing EXIT procedures suggest that the EXIT procedure can be performed with minimal maternal morbidity in skilled hands. Furthermore, long-term neonatal outcomes appear to be improving, but further studies are needed. The EXIT procedure can be performed safely in a skilled multidisciplinary setting with minimal maternal and fetal morbidity and excellent fetal outcomes. Recent reports have helped further identify which fetuses will benefit from the EXIT procedure.

Two cases of fetal goiter

Introduction:Anterior fetal neck masses are rarely encountered. Careful routine ultrasound screening can reveal intrauterine fetal goiters (FGs). The incidence of goitrous hypothyroidism is 1 in 30,000-50,000 live births. The consequences of both FG and impaired thyroid function are serious.Aims and Objectives:To emphasize role of ultrasound in both invasive and non-invasive management of FG.Materials and Methods:Two pregnant patients, during second trimester, underwent routine antenatal ultrasound revealing FG, were investigated and managed.Results:Case 1: Revealed FG with fetal hypothyroidism. Intra-amniotic injection l-thyroxine given. Follow-up ultrasound confirmed the reduction of the goiter size. At birth, thyroid dyshormogenesis was suspected and neonate discharged on 50 mcg levothyroxine/day with normal growth and development so far. Case 2: Hypothyroid mother with twin pregnancy revealed FG, in twin 1, confirmed on magnetic resonance imaging (1.5 × 1.63 cm). The other twin had no thyroid swelling. Cordocentesis confirmed hypothyroidism in twin 1. Maternal thyroxine dose increased as per biochemical parameters leading to reduction in FG size. Mother delivered preterm and none of the twins had thyroid swelling. Fetal euthyroidism was confirmed on biochemical screening.Conclusion:FG during pregnancy should be thoroughly evaluated, diagnosed and immediately treated; although in utero options for fetal hypothyroidism management are available, emphasis should be laid on non-invasive procedures. Newer and better resolution techniques in ultrasonography are more specific and at the same time are less harmful.

Prenatal ultrasonographic diagnosis of fetal neck teratoma

Teratomas and other germ cell tumors are common pediatric neoplasms. They may have gonadal and extragonadal locations. Congenital teratomas of the neck are unusual.Imaging provides early diagnosis, which is crucial for planning the delivery, definitive treatment and that of associated complications. This report describes the prenatal sonographic features of fetal neck teratoma and its role in early diagnosis and treatment.A 30-year-old gravid woman presented with polyhydramnios in 31weeks. Ultrasound scan revealed fetal complex neck mass of heterogenous texture and marked polyhydramnios. The mass was excited in the early neonatal period and teratoma was confirmed on histology.

P21.06: Ultrasound and MRI assessment of large fetal neck masses: planning mode of delivery

P21.06: Ultrasound and MRI assessment of large fetal neck masses: planning mode of delivery

Utility of Ultrasound to Guide Fetal Therapy for Antenatally Diagnosed Congenital Hypothyroidism

Ultrasound was used for evaluation, diagnosis and to guide subsequent therapy of an antenatally detected fetal neck mass. A 30-year-old pregnant woman was referred for evaluation of a fetal neck mass, described as a cystic hygroma. Targeted ultrasound and Doppler interrogation of the mass demonstrated characteristics consistent with the diagnosis of a fetal goiter. Fetal therapy was initiated for suspected fetal hypothyroidism.