Prenatal diagnosis of anterior sacral meningocele

Revisiting Ultrasound of Fetal Abdominal Cysts; the Common, the Uncommon and the Rare: A Pictorial Review

Fetal abdominal cysts are rare. The significance of antenatally discovered abdominal cysts can range from an innocuous finding to serious conditions needing surgery. It is often difficult to arrive at a correct diagnosis based on ultrasonography, as different types of cysts can have similar appearances. A more specific diagnosis is possible if fetal sex, age at appearance, location of the cyst, shape and appearance of the walls, and contents are considered. This review presents an extensive spectrum of fetal abdominal cysts. The common as well as the very rare causes that have only a few reports are discussed. Ultrasound images of confirmed cases are also presented. An algorithmic approach that enables a more specific diagnosis in many cases has been developed.

Avoiding the antenatal counselling faux pas: bridging the gap between prenatal prognostication and postnatal outcome of closed spina bifida

PURPOSE

Closed spina bifida (CSB) is rare in prenatal literature, and various lesions are grouped under this broad nosological entity CSB, leading to confusing and misleading prognostic conclusions.

METHODS

This is a retrospective observational cohort study of prenatally detected CSB cases using two-dimensional ultrasound, complemented by three-dimensional ultrasonography and foetal MRI in indicated cases, from October 2014 to October 2021 in a tertiary-level single centre.

RESULTS

The most common upper vertebral level of CSB was lumbar in 66.6% (10/15). The sub-classification of lesions based on prenatal ultrasound showed an agreement in 53% of the cases. Sixty percent had associated abnormalities identified postnatally, the most common being anorectal malformation seen in 33.3%. On postnatal follow-up, 46.6% had bowel incontinence and bladder dysfunction, and 33.3% developed lower limb deformities.

CONCLUSIONS

All CSBs do not have a uniformly favourable prognosis. The prognosis of CSB depends on the pathological type, the presence of associated abnormalities and the management.

Caudal cell mass developmental aberrations: an imaging approach

The objective of this review is to describe antenatal and postnatal imaging criteria, which allow diagnosis and aid workup, prognostication and treatment of developmental anomalies of the caudal cell mass. The lower spinal cord (conus medullaris), filum terminale and inferior lumbar and sacral nerve roots develop from the caudal cell mass, a remnant of the embryologic primitive streak composed of undifferentiated pluripotential cells. Anomalous caudal cell mass development can manifest as tight filum terminale, caudal dysgenesis, terminal myelocystocele, anterior sacral meningocele or sacrococcygeal teratoma. Lower spinal cord development occurs simultaneously and in topological proximity to the developing lower gastrointestinal and genitourinary tracts, leading to coexistent malformations. We review the embryology of the caudal cell mass, describe the role of antenatal and postnatal imaging for diagnosing, staging, prognosticating and guiding intranatal or postnatal intervention for developmental anomalies of this region and briefly discuss clinical manifestations and treatment goals and strategies. An overview of antenatal imaging diagnosis of associated multisystem abnormalities will be provided where applicable.

The clinical relevance of fetal MRI in the diagnosis of Type IV cystic sacrococcygeal teratoma--a review

The introduction of fetal magnetic resonance imaging (MRI) has improved the prenatal evaluation of uterine, placental and fetal anatomy. However, its utilization has mostly been restricted to fetal central nervous system anomalies. We review how adjunct fetal MRI was performed and diagnosis of cystic type IV sacrococcygeal teratoma was made. We also discuss the clinical relevance of fetal MRI in differentiating this lesion from other selected abdominal/pelvic cystic malformations and lesions.

Prenatal diagnosis of a paraurethral cyst

Paraurethral cysts arising from Skene's gland are a rare cause of urogenital masses in the neonate. We report the case of a pelvic mass noted at the vaginal introitus on prenatal ultrasound that following delivery was found to be a paraurethral cyst. On prenatal ultrasound, there was no evidence of involvement of the urinary, gastrointestinal, or upper genital tract. Serial ultrasounds demonstrated slight enlargement of the cyst without other changes. The patient delivered at 33 weeks and postnatal evaluation demonstrated a paraurethral cyst. The cyst was managed expectantly and drained spontaneously on the second day of life with complete resolution.