Fetal Hepatomegaly: Causes and Associations

Clinical and Imaging Features of Syphilis from Head to Toe

Syphilis, a bacterial infection caused by Treponema pallidum, is resurging globally. It is classified as acquired or congenital syphilis. Acquired syphilis progresses through primary, secondary, and tertiary stages. Pathologically, acquired syphilis is characterized by vasculopathy, perivascular infiltrates in syphilitic lesions, and reactive lymphadenopathy. Primary and secondary syphilis frequently manifest with cutaneous and mucosal lesions accompanied by extensive lymphadenopathy at the initial sites of sexual contact, such as the genitalia, oropharynx, and anorectum. These manifestations may mimic malignancies. Tertiary syphilis encompasses cardiovascular syphilis, late neurosyphilis, and gummas, each manifesting distinct imaging characteristics. Most acquired cases are suspected on the basis of dermatologic signs and patient history and are confirmed serologically. Imaging findings alone may not be diagnostic and can overlap with those of other infectious, inflammatory, or neoplastic conditions, necessitating clinical correlation and laboratory testing. However, in patients with atypical clinical presentations, imaging has an important role in providing valuable diagnostic clues and guiding appropriate clinical treatment. The incidence of congenital syphilis is also increasing in parallel with the overall increase in syphilis infections. A comprehensive understanding of the diverse imaging manifestations in multiple organ systems is vital for radiologists to accurately diagnose and guide appropriate management in the era of resurgent syphilis. The authors provide an overview of acquired and congenital syphilis, detailing the epidemiologic and pathophysiologic characteristics, diagnostic approaches, clinical courses, and imaging features. ©RSNA, 2025 Supplemental material is available for this article.

Infected congenital pericardial cyst with mass effect on adjacent structures, a rare presentation in an infant in LMIC setting: a case report and review of literature

BACKGROUND

Giant pericardial cysts are rare mediastinal lesions that can lead to significant morbidity if complicated by infection, compression of adjacent structures, or secondary complications such as right-sided heart failure. This case report highlights the diagnostic and therapeutic challenges of managing an infected giant pericardial cyst in a resource-limited setting in Africa.

CASE PRESENTATION

A 2 months old infant presented with symptoms of fast breathing, dyspnea, fever, and signs of right-sided heart failure, including peripheral edema and ascites. Imaging studies, including chest X-ray and computed tomography (CT), revealed a large cystic mass in the pericardial region compressing the right heart chambers. Emergency Surgical excision was performed, and histopathological analysis confirmed the diagnosis of an infected pericardial cyst. Postoperatively, the patient recovered well, with resolution of symptoms, including signs of right-sided heart failure, and no recurrence at follow-up.

CONCLUSION

This case underscores the importance of considering pericardial cysts in the differential diagnosis of mediastinal masses, particularly in the presence of infectious symptoms or cardiac compression leading to right-sided heart failure. It also demonstrates the feasibility of successful management through timely surgical intervention, even in resource-limited settings. This report contributes to the sparse literature on infected pericardial cysts and provides valuable insights into their management in low-resource environments.

CLINICAL TRIAL NUMBER

Not applicable.

Prenatal diagnosis of mucopolysaccharidosis type I on hepatosplenomegaly and coarse features: a case-report

BACKGROUND

Mucopolysaccharidosis type I (MPS I - IDUA gene) is a rare autosomal recessive lysosomal storage disorder. Clinical symptoms, including visceral overload, are progressive and typically begin postnatally. Descriptions of hepatosplenomegaly associated with lysosomal pathology are uncommon during the prenatal period. The most prevalent etiologies are infections, anemia, and neoplasms.

CASE PRESENTATION

A pregnant woman at 26.5 gestational weeks was referred to our center for fetal ultrasound findings of hepatosplenomegaly, distinct facial features, and liver, spleen and thymus echogenic spots. Whole exome sequencing after amniocentesis identified two likely pathogenic IDUA gene variants (in trans), raising suspicion of a diagnosis of MPS I. MPS I was confirmed by the deficiency of α-L-iduronidase activity in amniotic cells. A medical pregnancy termination was carried out due to the severe prognosis. After termination of pregnancy, external examination of the fetus confirmed hepatosplenomegaly and coarse dysmorphic features.

CONCLUSION

Lysosomal storage diseases (LSD) are a rare cause of prenatal hepatosplenomegaly, but this has not been described in MPS I according to our literature search. The genetic variants identified in this case prompted early diagnosis through genome-wide studies. This rare presentation of MPS I highlights the expanding role of genomic analyses in diagnosing conditions during pregnancy.

Congenital hepatoblastoma: Expanding knowledge, improving outcomes

Hepatoblastoma (HB) is a rare liver tumour, and its congenital counterpart (CHB) is even less frequent. CHB has a clinically challenging management and a generally perceived worse outcome. This study aims to review the literature on CHB to better define presentation, diagnosis, available treatments and management options. The analysis of outcomes suggests that a significant portion of mortality is unrelated to the malignant nature of the tumour. Key factors influencing overall outcomes were identified: mortality linked to the 'mass effect' during both the prenatal (22%) and perinatal (32%) stages, as well as 'oncological' mortality encompassing tumour and/or treatment-related factors (46%). Overall, after birth, CHB does not seem to confer a worse oncological prognosis per se, and should be managed similarly to older children, if patients are stable enough to undergo proper staging and treatment. A deeper knowledge and better outcomes would come from a large, homogeneous, collection of data possibly allowing a global protocol, focusing on a comprehensive management of CHB.

Hepatomegaly and Splenomegaly: An Approach to the Diagnosis of Lysosomal Storage Diseases

Clinical findings of hepatomegaly and splenomegaly, the abnormal enlargement of the liver and spleen, respectively, should prompt a broad differential diagnosis that includes metabolic, congestive, neoplastic, infectious, toxic, and inflammatory conditions. Among the metabolic diseases, lysosomal storage diseases (LSDs) are a group of rare and ultrarare conditions with a collective incidence of 1 in 5000 live births. LSDs are caused by genetic variants affecting the lysosomal enzymes, transporters, or integral membrane proteins. As a result, abnormal metabolites accumulate in the organelle, leading to dysfunction. Therapeutic advances, including early diagnosis and disease-targeted management, have improved the life expectancy and quality of life of people affected by certain LSDs. To access these new interventions, LSDs must be considered in patients presenting with hepatomegaly and splenomegaly throughout the lifespan. This review article navigates the diagnostic approach for individuals with hepatosplenomegaly particularly focusing on LSDs. We provide hints in the history, physical exam, laboratories, and imaging that may identify LSDs. Additionally, we discuss molecular testing, arguably the preferred confirmatory test (over biopsy), accompanied by enzymatic testing when feasible.

Assessing Intrauterine Retention according to Microscopic Stillbirth Features: A Cluster Analysis Approach

Background: Previous studies identified microscopic changes associated with intrauterine retention of stillbirths based on clinical time of death. The objective of this study was to utilize unsupervised machine learning (not reliant on subjective measures) to identify features associated with time from death to delivery. Methods: Data were derived from the Stillbirth Collaborative Research Network. Features were chosen a priori for entry into hierarchical cluster analysis, including fetal and placental changes. Results: A four-cluster solution (coefficient = 0.983) correlated with relative time periods of "no retention," "mild retention," "moderate retention," and "severe retention." Loss of nuclear basophilia within fetal organs were found at varying rates among these clusters. Conclusions: Hierarchical cluster analysis is able to classify stillbirths based on histopathological changes, roughly correlating to length of intrauterine retention. Such clusters, which rely solely on objective fetal and placental findings, can help clinicians more accurately assess the interval from death to delivery.

Magnetic resonance imaging of fetal abdominal pathology: a complementary tool to prenatal ultrasound

Fetal magnetic resonance imaging (MRI) is increasingly being used worldwide as a complementary tool to prenatal ultrasound (US) for multiple fetal pathologies. The aim of this article is to describe and illustrate how MRI can help US to evaluate fetal abdominal anomalies, based on cases performed in a tertiary public university hospital. Prenatal US, fetal MRI and postnatal imaging of these cases will be shown side-by-side to describe and illustrate the added value of fetal MRI in the different organs/systems and its impact on clinical management.

Indications for magnetic resonance imaging of the fetal body (extra-central nervous system): recommendations from the European Society of Paediatric Radiology Fetal Task Force

The indications for fetal body MRI are amplifying because of the expanding possibilities of fetal and perinatal therapy. However, huge heterogeneity regarding the indications for fetal body MRI is seen among different European countries that is mostly related to local use of US, but also to local fetal MRI expertise and legislation on pregnancy termination. The purpose of this article is to summarize the precise indications for fetal MRI, excluding the central nervous system. MRI indications arise from the sonographic findings, based on the operator's experience and the various practices in the countries and institutions represented on the European Society of Paediatric Radiology Fetal Task Force. We also highlight the strengths and weaknesses of fetal US and MRI of the fetal body.