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Annac G, Yassa M. Is congenital dacryocystocele a benign, self-limited disorder? A review of the literature with four new cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:813-821. [PMID: 34235752 DOI: 10.1002/jcu.23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
Congenital dacryocystocele (CD) is a rare disorder about which little is known. A nonsystematic review was performed with an addition of four new cases. Thirty-seven studies were reviewed. The mean gestational age at evaluation was 32 ± 1.09 weeks suggesting that CD is a disorder of late second and third trimester. The mean diameter of dacryocystocele was 7.5 ± 1 mm. The overall associated fetal anomaly rate was 10.7%. In-utero resolution, neonatal resolution, and surgical management was concluded in 62% (n = 108), 29% (n = 52), and 8% (n = 14), respectively. In conclusion, the need for surgical correction and rate of accompanying fetal anomaly was found high.
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Affiliation(s)
- Gokce Annac
- Radiology Department, Bartin State Hospital, Bartin, Turkey
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Prof Dr Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey
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Cruciat G, Nemeti GI, Popa-Stanila R, Florian A, Goidescu IG. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins - a review of the literature. J Perinat Med 2021; 49:837-846. [PMID: 33882202 DOI: 10.1515/jpm-2020-0566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/18/2021] [Indexed: 12/28/2022]
Abstract
Brain injury of the surviving twin from monochorionic pregnancies following intrauterine fetal demise during the second and third trimesters is a rare but severe complication. Monochorionicity and gestational age at the time of stillbirth seem to be decisive factors in terms of long-term neurologic outcome prediction for the survivor. Magnetic resonance imaging (MRI), diffusion weighted imaging (DWI) in particular, seem to bring the earliest and most accurate diagnosis. Ultrasound detection of brain damage is possible in later stages of fetal brain injury. It is essential to provide early diagnosis and multidisciplinary counsel to the parents to ensure informed decision making. For couples who choose to terminate pregnancy legislation related to late abortion might lead to further distress. Our paper aims to stress the importance of MRI DWI in the evaluation of surviving twins following single intrauterine fetal demise in monochorionic pregnancies and the delicate context of the medical professionals and parents facing this clinical situation, sometimes complicated by legal constraints.
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Affiliation(s)
- Gheorghe Cruciat
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Georgiana Irina Nemeti
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Popa-Stanila
- Department of Radiology, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andreea Florian
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulian Gabriel Goidescu
- Obstetrics and Gynecology I, Mother and Child Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Naleini F, Farshchian N, Mehrbakhsh M, Kamangar PB. A Case Report of a Massive Epignathus. J Med Life 2020; 13:435-438. [PMID: 33072221 PMCID: PMC7550148 DOI: 10.25122/jml-2019-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Epignathus is a rare congenital orofacial teratoma. Teratomas are tumors that originate from all three germs cell layers. Tumor size is an important prognostic factor, and we describe the case of massive epignathus identified by sonography at 25 weeks. Our case was a 35-year-old pregnant woman that was subjected to a routine ultrasound at 25 weeks of gestation, and epignathus was diagnosed. Labor pain started in the 28th week of the pregnancy, so the dead fetus was aborted, and curettage was conducted. A pathologic sample was sent to the laboratory, and benign teratoma was diagnosed. Because fetal epignathus has a wide range of outcomes, early prenatal diagnosis is essential for optimal management.
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Affiliation(s)
- Farhad Naleini
- Department of Radiology, Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nazanin Farshchian
- Department of Radiology, Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahmood Mehrbakhsh
- Department of Radiology, Clinical Research Development Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Cash H, Bly R, Masco V, Dighe M, Cheng E, Delaney S, Ma K, Perkins JA. Prenatal Imaging Findings Predict Obstructive Fetal Airways Requiring EXIT. Laryngoscope 2020; 131:E1357-E1362. [PMID: 32770766 DOI: 10.1002/lary.28959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/02/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Detection of fetal airway compromise through imaging raises the possible need for ex utero intrapartum treatment (EXIT) procedures. Despite EXIT procedures involving massive resource utilization and posing increased risk to the mother, decisions for EXIT are usually based on anecdotal experience. Our objectives were to analyze prenatal consultations with potential fetal airway obstruction for imaging and obstetric findings used to determine management strategy. METHODS Retrospective chart review was performed for prenatal abnormal fetal airway consults between 2004-2019 at a quaternary pediatric facility. Data collected included demographics, imaging characteristics, delivery information, and airway management. Our primary outcome was EXIT performance and the secondary outcome was postnatal airway management. Fisher's exact test was used to compare management decisions, outcomes, and imaging findings. RESULTS Thirty-seven patients met inclusion criteria. The most common diagnoses observed were lymphatic malformation, teratoma, and micrognathia. Of the imaging findings collected, only midline neck mass location was associated with EXIT procedure performance. Factors associated with invasive airway support at birth were mass-induced in-utero neck extension and neck vessel compression, polyhydramnios, and micrognathia. CONCLUSIONS Multidisciplinary input and interpretation of prenatal imaging can guide management of fetal airway-related pathology. EXIT is an overall safe procedure and can decrease risk due to airway obstruction at birth. We identified in-utero neck extension, neck vessel compression, micrognathia, and polyhydramnios as better indicators of a need for invasive airways measures at birth and suggest use of these criteria in combination with clinical judgement when recommending EXIT. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1357-E1362, 2021.
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Affiliation(s)
- Harrison Cash
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Randall Bly
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Vanessa Masco
- Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Manjiri Dighe
- Department of Radiology, Prenatal Imaging, University of Washington, Seattle, Washington, U.S.A
| | - Edith Cheng
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Shani Delaney
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Kimberly Ma
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Jonathan A Perkins
- Department of Otolaryngology - Head & Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, U.S.A
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Paolini B, Sterrett M, Jones R. Ectopic tooth buds and parotid aplasia are diagnostic features of partial facial duplication on pre- and postnatal MRI: Case report and literature review. Int J Pediatr Otorhinolaryngol 2020; 133:109920. [PMID: 32092604 DOI: 10.1016/j.ijporl.2020.109920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/30/2020] [Indexed: 10/25/2022]
Abstract
Craniofacial duplication is a rare congenital anomaly. A case of hemi-mandibular duplication with an accessory oral cavity is presented with along with first-time reported pre- and postnatal MRI, surgical approach and a literature review. MRI clearly depicts the ectopic tooth buds and parotid aplasia in this condition, features that are diagnostic of partial facial duplication. MRI is diagnostic for this condition and can be useful to avoid misdiagnosis of a facial mass.
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Affiliation(s)
- Brielle Paolini
- Department of Radiology and Radiological Sciences, 96 Jonathan Lucas St. MSC 323, Charleston, SC, 29425, USA.
| | - Mary Sterrett
- Department of Obstetrics and Gynecology, 96 Jonathan Lucas St. MSC 619, Charleston, SC, 29425, USA.
| | - Richard Jones
- Department of Radiology and Radiological Sciences, 96 Jonathan Lucas St. MSC 323, Charleston, SC, 29425, USA.
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Jiang S, Yang C, Bent J, Yang CJ, Gangar M, Nassar M, Suskin B, Dar P. Ex utero intrapartum treatment (EXIT) for fetal neck masses: A tertiary center experience and literature review. Int J Pediatr Otorhinolaryngol 2019; 127:109642. [PMID: 31479918 DOI: 10.1016/j.ijporl.2019.109642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/17/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery. METHODS We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status. RESULTS Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention. CONCLUSION With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.
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Affiliation(s)
- Sydney Jiang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA; Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Catherina Yang
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - John Bent
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA
| | - Mona Gangar
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA
| | - Michel Nassar
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA
| | - Barrie Suskin
- Department of Obstetrics and Gynecology, Stamford Hospital, One Hospital Plaza, Whittingham Pavilion, Stamford, CT, 06902, USA
| | - Peer Dar
- Division of Fetal Medicine and OB-Gyn Ultrasound, Albert Einstein College of Medicine / Montefiore Medical Center, 1695 Eastchester Road Room L4, Bronx, NY, 10461, USA
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Abstract
RATIONALE Fetal carotid-jugular fistula is an extremely rare clinical entity that presents as an abnormal passage between the carotid artery and the jugular vein. It is difficult to treat and the chance for a cure is very low. The fetal carotid-jugular fistula causes congestive heart failure and death of the fetus. PATIENT CONCERNS We report a case of fetal carotid-jugular fistula diagnosed at 27 weeks of pregnancy. She had no history of viral infection, no history of toxic and radiation exposure, no trauma during pregnancy, and no known family history of malformations or genetic disease. DIAGNOSES Ultrasound revealed fetal left carotid-jugular fistula formation, massive reflux in the fetal tricuspid, a large amount of fetal pericardial effusion, fetal left ear microtia and full heart enlargement. INTERVENTIONS The pregnant patient experienced termination of the pregnancy at 27 weeks. OUTCOMES There were no complications in the patient. Post-termination, diagnosis of carotid-jugular fistula and left ear microtia was confirmed in the fetus. LESSONS Our case indicated that the congenital neck artery and venous fistula of the fetus are extremely rare, and its most serious clinical symptom is congestive heart failure leading to intrauterine cessation of pregnancy. In addition, it is difficult to treat and the chance for a cure is very low. At present, there is no treatment record related to the fetal carotid artery and venous fistula, so it is very important to make a correct diagnosis as early as possible for the health of pregnant women.
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Taghavi K, Beasley S. The ex utero intrapartum treatment (EXIT) procedure: application of a new therapeutic paradigm. J Paediatr Child Health 2013; 49:E420-7. [PMID: 23662685 DOI: 10.1111/jpc.12223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 12/15/2022]
Abstract
The ex utero intrapartum treatment (EXIT) procedure is a term given to a technique that can transform a potentially fatal neonatal emergency to a controlled intervention with an improved outcome. It has revolutionised the care of prenatally diagnosed congenital malformations in which severe upper airway obstruction is anticipated. An extended period of utero-placental circulation can be utilised to avoid profound cardiopulmonary compromise. Its therapeutic applications have been broadened to include fetuses with congenital diaphragmatic hernia after tracheal plugging, high-risk intrathoracic masses, severe cardiac malformations and conjoined twins. It requires the co-ordination of a highly skilled and experienced multidisciplinary team. The recent enthusiasm for the EXIT procedure needs to be balanced against maternal morbidity. Specific indications and guidelines are likely to be refined as a consequence of ongoing advances in fetal intervention and antenatal imaging.
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Kapoor MC, Rangachari V. Airway management in neonates and infants with congenital airway lesions. J Anaesthesiol Clin Pharmacol 2012; 28:285-6. [PMID: 22869931 PMCID: PMC3409934 DOI: 10.4103/0970-9185.98318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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O'Connor SC, Rooks VJ, Smith AB. Magnetic resonance imaging of the fetal central nervous system, head, neck, and chest. Semin Ultrasound CT MR 2012; 33:86-101. [PMID: 22264906 DOI: 10.1053/j.sult.2011.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance imaging (MRI) has become an important tool in the assessment of fetal anomalies. Although ultrasound remains the modality of choice for screening, MRI offers several advantages that permit optimal characterization of anomalies in certain situations. Accurate recognition and characterization of fetal anomalies guides decisions about pregnancy management and coordination of postnatal care. This article will briefly review safety and practical aspects of fetal MRI. We will then provide a concise summary of the most common indications for fetal MRI, and discuss the differential diagnosis and role of MRI in assessment of fetal brain, head, neck, spine, and chest anomalies.
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Affiliation(s)
- Stephen C O'Connor
- Department of Radiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA. Stephen.o'
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Bonilla-Musoles F, Castillo JC, Jimenez LC. Congenital Dacryocystocele: A Rare and Benign Nasolacrimal Duct Cyst Condition. ACTA ACUST UNITED AC 2012. [DOI: 10.5005/jp-journals-10009-1247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Dacryocystocele is an uncommon congenital obliteration of the nasolacrimal drainage system. Based on a case diagnosed at 30 weeks gestation using two-dimensional (2D) and threedimensional (3D), its ultrasound characteristics as well as the evolution and therapeutic options applied in the scarce existing literature are described.
How to cite this article
Bonilla-Musoles F, Jimenez LC, Castillo JC. Congenital Dacryocystocele: A Rare and Benign Nasolacrimal Duct Cyst Condition. Donald School J Ultrasound Obstet Gynecol 2012;6(3):233-236.
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Ocaranza M, Rompel SM, Gutierrez J, Sepulveda W. Forehead hemangioma: a rare location for a large vascular tumor in a fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1158-1161. [PMID: 21795495 DOI: 10.7863/jum.2011.30.8.1158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Calda P, Novotná M, Cutka D, Břešt'ák M, Hašlík L, Goldová B, Vítková I, Vaněčková M, Seidl Z. A case of an epignathus with intracranial extension appearing as a persistently open mouth at 16 weeks and subsequently diagnosed at 20 weeks of gestation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:164-168. [PMID: 21387329 DOI: 10.1002/jcu.20762] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 09/20/2010] [Indexed: 05/30/2023]
Abstract
We report a rare case of oral mass (epignathus) with intracranial extension originally suspected antenatally at 16 weeks' gestation because of a persistent open mouth. Postmortem MRI and pathologic examination of the fetus confirmed an oral teratoma with bilateral ventricular dilatation, corpus callosum agenesis, and a neuroepithelial intracranial cyst. The relevant literature regarding this anomaly is reviewed.
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Affiliation(s)
- Pavel Calda
- Charles University in Prague, First Faculty of Medicine, Department of Obstetrics and Gynecology of the First Faculty of Medicine and General University Hospital, Apolinářská 18, 128 51, Prague 2, Czech Republic
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Tonni G, Centini G, Inaudi P, Rosignoli L, Ginanneschi C, De Felice C. Prenatal Diagnosis of Severe Epignathus in a Twin: Case Report and Review of the Literature. Cleft Palate Craniofac J 2010; 47:421-5. [DOI: 10.1597/08-224.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A prenatal ultrasound diagnosis of epignathus in a dichorionic-diamniotic twin pregnancy is reported. A complex mass protruding from the fetal face was seen at week 19. Amniocentesis resulted in a 46,XX fetus with elevated alpha-fetoprotein (α-FP). An increase in tumor size and severe polyhydramnios ensued. Selective feticide performed at 22 weeks led to untreatable uterine contractions with iatrogenic abortion and early neonatal mortality of the healthy cotwin. Without development of polyhydramnios and tumor growth, weekly scan and transvaginal cervical assessment would have been carried out and cesarean section planned at around 32 weeks. Necroscopy and histology aided the ultrasound-based prenatal diagnosis.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Service, Division of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio, Emilia, Italy
| | - Giovanni Centini
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Pieraldo Inaudi
- Department of Pediatric, Obstetric, and Reproductive Medicine, University of Siena, Italy
| | - Lucia Rosignoli
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Chiara Ginanneschi
- Service of Human Pathology and Oncology, Pathologic Anatomy Unit, Policlinic Hospital “Le Scotte,” University of Siena, Italy
| | - Claudio De Felice
- Neonatal Intensive Care Unit, Policlinic Hospital “Le Scotte,” University of Siena, Italy
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Tonni G, De Felice C, Centini G, Ginanneschi C. Cervical and oral teratoma in the fetus: a systematic review of etiology, pathology, diagnosis, treatment and prognosis. Arch Gynecol Obstet 2010; 282:355-61. [PMID: 20473617 DOI: 10.1007/s00404-010-1500-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the study was to produce a systematic review about etiology, pathology, diagnosis, prognosis and clinical management regarding oral and cervical teratomas. MATERIALS AND METHODS A systematic review of Pubmed/Medline using the following keywords was made: epignathus, cervical teratoma, fetus, oral teratoma, prenatal diagnosis, prognosis, treatment, ultrasound. CONCLUSION The following clinical conclusions can be reached: (1) teratomas are rare, usually benign congenital tumors which recognized multifactorial etiology; (2) prenatal ultrasound diagnosis can be made early in pregnancy (15-16 weeks); (3) 3D ultrasound and MRI may enhance the accuracy of the antenatal diagnosis (location, extension and intracranial spread) and may aid in the selection of patients requiring treatment; (4) prenatal karyotype and search for associated abnormalities is mandatory in all teratomas; (5) delivery should involve elective Cesarean section with ex utero intrapartum treatment procedure or resection of the tumor mass, which may be performed on placental support operation on placental support procedure to increase the chances of postnatal survival.
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Affiliation(s)
- Gabriele Tonni
- Division of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Guastalla, Italy.
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Odeh M, Ophir E, Ardekian L, Bornstein J. Normal fetal salivary glands at 14-16 weeks of gestation as observed by transvaginal ultrasound imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:395-397. [PMID: 20069685 DOI: 10.1002/uog.7546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Absence or congenital anomalies of the parotid glands are associated with significant long-term morbidity. To date there are no published data on ultrasonographic detection of these defects in early pregnancy. We set out to demonstrate and measure the fetal parotid and submandibular salivary glands at 14-16 weeks using transvaginal ultrasound imaging. METHODS During a routine fetal anomaly detection scan in 30 consecutive patients, an attempt was made to examine the fetal parotid and submandibular glands. The fetal head was scanned in transverse sections just below the fetal ears, and the area of the parotid and submandibular glands was inspected. The examination time was not prolonged for the purpose of measuring the salivary glands. The fetal biparietal diameter and the femur length were also documented. RESULTS The median gestational age was 15.4 (range, 14.4-16.5) weeks. In all 30 patients examined, at least one pair of parotid and submandibular glands was clearly visualized and measured. In seven patients the parotid and submandibular glands were visualized on both sides. The median length of the parotid gland was 7.5 (range, 5.5-11.5) mm and that of the submandibular gland was 5.4 (range, 3.7-8.5) mm. CONCLUSIONS The fetal salivary glands can be demonstrated by transvaginal ultrasound imaging at 14-16 weeks of gestation. This is the first reported study presenting the normal values of salivary gland measurements, which may be important in detecting fetuses with congenital absence or other malformations of the glands.
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Affiliation(s)
- M Odeh
- Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel.
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Bornstein E, Boozarjomehri F, Monteagudo A, Santos R, Milla SS, Timor-Tritsch IE. Diagnostic and prognostic aspects in the sonographic evaluation of a fetus with an oral mass. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:689-693. [PMID: 19389910 DOI: 10.7863/jum.2009.28.5.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Eran Bornstein
- Division of Obstetric and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, New York University Medical Center, New York, NY 10016, USA.
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Mulliken J, Bischoff J, Kozakewich H. Multifocal rapidly involuting congenital hemangioma: A link to chorangioma. Am J Med Genet A 2007; 143A:3038-46. [DOI: 10.1002/ajmg.a.31964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sherer DM, Perenyi AR, Glick SA, Dalloul M, Zigalo A, Gupta R, Abulafia O. Prenatal sonographic findings of extensive low-flow mixed lymphatic and venous malformations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1469-73. [PMID: 17060437 DOI: 10.7863/jum.2006.25.11.1469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- David M Sherer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203-2098 USA.
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Pires P, Pereira M, Machado L, Bonilla-Musoles F. Prenatal diagnosis of a ranula with 2- and 3-dimensional sonography and sonographically guided aspiration. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1499-502. [PMID: 17060443 DOI: 10.7863/jum.2006.25.11.1499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Pedro Pires
- Serviço de Medicina Fetal, Centro Integrado de Saúde Amaury de Medeiros/Universidade de Pernambuco, Recife, Brazil
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21
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Martino F, Avila LF, Encinas JL, Luis AL, Olivares P, Lassaletta L, Nistal M, Tovar JA. Teratomas of the neck and mediastinum in children. Pediatr Surg Int 2006; 22:627-34. [PMID: 16838188 DOI: 10.1007/s00383-006-1724-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2006] [Indexed: 11/27/2022]
Abstract
This retrospective study reviews a series of teratomas of the neck and mediastinum aiming at defining the features of these particular locations. We recorded prenatal diagnosis, perinatal management, clinical and radiologic features, pathology, surgical strategies and results in cervical and mediastinal teratomas treated over the last 10 years. During this period we treated 66 children with teratoma of which 11 (6 male and 5 female) had cervicomediastinal locations. Five babies had cervical teratomas extended into the anterior mediastinum in two cases. Prenatal diagnosis was made in three (two with polyhydramnios). Four babies were born by C-section and only one had a successful EXIT procedure. The diagnosis was confirmed by imaging and increased AFP. Surgical treatment involved total tumor removal and in one case subsequent removal of lymph node metastases. All children survived except one in whom airway could not be cleared at birth. Two children bear mild hypothyroidism. During the same period six patients aged 0-17 years were treated for mediastinal teratoma. Only one was prenatally diagnosed and only two had some dyspnea. Removal was performed either by median sternotomy, thoracotomy, or thoracoscopy. They all survive and are free of disease. Teratomas of the neck may cause fetal disease and unmanageable neonatal airway obstruction. Prenatal diagnosis and planned multidisciplinary management are mandatory at birth. In contrast, only some mediastinal tumors cause respiratory embarrassment. Although benign, these tumors are sometimes immature and may metastasize to regional lymph nodes. Total surgical removal is curative. Thyroid insufficiency may be present at birth in cervical teratomas and may be aggravated by surgery.
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Affiliation(s)
- Francesca Martino
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
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22
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De Biasio P, Scarso E, Prefumo F, Odella C, Rossi A, Venturini PL. Prenatal diagnosis of a nasal glioma in the mid trimester. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:571-3. [PMID: 16570265 DOI: 10.1002/uog.2754] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We report a case of fetal nasal glioma diagnosed at 21 weeks of gestation. The glioma appeared as a moderately hypoechoic mass arising from the junction between the medial aspect of the left orbit and the lateral aspect of the nose, and showing no internal vascularization on color and power Doppler ultrasonography. Fetal magnetic resonance imaging (MRI) excluded the possibility of an encephalocele by ruling out underlying bone defects. After an uneventful pregnancy, the nasal glioma was resected without complications at 4 months of age. The differential diagnosis of fetal paranasal facial masses is discussed.
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Affiliation(s)
- P De Biasio
- U.O. Ostetricia e Ginecologia, Istituto G. Gaslini, Università di Genova, Italy
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23
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Chen M, Ho WK, Hsieh TC, Lee CS, Hsiao CC, Chang SP, Lee DJ, Yang AD. Huge duplication cyst of small intestine: ultrasonographic features and prenatal aspiration. Prenat Diagn 2005; 26:86-8. [PMID: 16374896 DOI: 10.1002/pd.1324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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24
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Kashima H, Unno N, Hyodo H, Hyodo HM, Takagi K, Nakamura T, Kondoh Y, Noguchi M, Konishi I. Antenatal sonographic and magnetic resonance images of a giant hemangioma of the fetal skull. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:522-523. [PMID: 15846768 DOI: 10.1002/uog.1842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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25
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Sepulveda W, Wojakowski AB, Elias D, Otaño L, Gutierrez J. Congenital dacryocystocele: prenatal 2- and 3-dimensional sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:225-230. [PMID: 15661955 DOI: 10.7863/jum.2005.24.2.225] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The purpose of this series is to present our experience with cases of dacryocystocele diagnosed prenatally. The role of prenatal 3-dimensional sonography, as an adjunct to 2-dimensional sonography, in the prenatal assessment of these cases is emphasized. METHODS A retrospective review of cases was conducted. Information was obtained by reviewing the sonographic reports and medical records. Outcomes were obtained from the referring obstetricians or directly from the parents. RESULTS Ten fetuses had the diagnosis of a congenital dacryocystocele at a median gestational age of 30.1 weeks (range, 27-33 weeks). In 6 cases, the cystic lesion was unilateral, and in 4 it was bilateral, with a mean largest diameter at the time of diagnosis of 7.5 mm (range, 4-11 mm). There were no other associated findings. Three-dimensional sonography, carried out in 3 cases, clearly depicted the anomaly, the degree of intranasal extension, and swelling below the medial canthal area. Spontaneous resolution was documented prenatally in 5 fetuses, and 1 additional case resolved between the last prenatal scan and the delivery. There were no reported long-term complications associated with this finding, although 1 infant required probing at 2 months of age to resolve the dacryocystocele. CONCLUSIONS Prenatal diagnosis of dacryocystocele is straightforward. A considerable number of lesions are bilateral, and many resolve in utero spontaneously or neonatally after minimal intervention. For those not resolving by the time of the delivery, ophthalmologic or rhinologic consultation is warranted because of potential complications. Three-dimensional sonography may provide a noninvasive method for evaluating these cystic masses and may contribute to the avoidance of additional diagnostic techniques in the neonatal period.
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Affiliation(s)
- Waldo Sepulveda
- Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Casilla 208, Santiago 20, Chile.
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26
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Abstract
Rapid postnatal growth and slow involution in childhood characterize the common infantile hemangioma. There are other rare vascular tumors that present fully grown at birth and behave quite differently, as designated by the acronyms: rapidly involuting congenital hemangioma (RICH) and noninvoluting congenital hemangioma (NICH). RICH and NICH have similarities in appearance, location, size, equal sex ratio, and both have overlapping radiologic and histologic features with infantile hemangioma. However, neither type of congenital tumor immunostains for glucose transporter-1 protein, a marker of infantile hemangioma. This raises the question of whether these congenital vascular lesions are variations in a spectrum of hemangioma or are entirely different tumors. We describe two groups of patients that suggest a linkage between postnatal and congenital vascular tumors: Link I (n=5), children who had either RICH or NICH coexisting with infantile hemangioma, and Link II (n=10), children initially diagnosed as having RICH, but regression was incomplete and the residuum was that of NICH. We conclude that these infants exhibit "missing links" between the rare RICH and NICH, and the common infantile hemangioma.
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Affiliation(s)
- John B Mulliken
- Division of Plastic Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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27
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Bianchini E, Zirpoli S, Righini A, Rustico M, Parazzini C, Triulzi F. Magnetic Resonance Imaging in Prenatal Diagnosis of Dacryocystocele. J Comput Assist Tomogr 2004; 28:422-7. [PMID: 15100551 DOI: 10.1097/00004728-200405000-00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of cystic dilation of the lacrimal drainage system (dacryocystocele) in the fetus must be differentiated from less benign paraocular masses. Three cases of dacryocystocele studied during fetal life by ultrasound and magnetic resonance (MR) imaging are reported. The accuracy of prenatal MR imaging facilitated a definite diagnosis depicting the characteristic triad of dacryocystocele: paraocular cystic mass in the medial canthus region, nasolacrimal duct enlargement, and intranasal cyst.
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Affiliation(s)
- Elena Bianchini
- Department of Radiology and Neuroradiology Hospital V. Buzzi, Istituti Clinici di Perfezionamento, Milan,
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28
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Chen CP, Shih JC, Huang JK, Chin DTH, Tzen CY, Lin YH, Wang W. Two- and three-dimensional ultrasound demonstration of a giant epignathus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2003; 21:407-409. [PMID: 12704754 DOI: 10.1002/uog.70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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29
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Im SH, Wang KC, Kim SK, Lee YH, Chi JG, Cho BK. Congenital intracranial teratoma: prenatal diagnosis and postnatal successful resection. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:57-61. [PMID: 12426690 DOI: 10.1002/mpo.1351] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- So-Hyang Im
- Department of Neurosurgery and Laboratory for Fetal Medicine Research in Clinical Research Institute, Seoul National University Hospital, Korea
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30
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Chmait RH, Pretorius DH, Hull AD. Nasal glioma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 20:417-418. [PMID: 12383332 DOI: 10.1046/j.1469-0705.2002.00811.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- R H Chmait
- Department of Reproductive Medicine, University of California, San Diego, La Jolla, California, USA
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31
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Jones ED. Fetal Lingual Dermoid Cyst. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2002. [DOI: 10.1177/875647930201800205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A case study of a fetal lingual dermoid cyst is presented. The cystic mass was seen protruding from the base of the tongue through the open fetal mouth. Teratomas, although usually benign, can result in a poor neonatal outcome if the respiratory tract is obstructed. The perinatal diagnosis of an oral mass will alert the obstetrician to the possible need to deliver at a tertiary-care center where a team of specialists can be available to aid in the establishment of the newborn's airway.
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Affiliation(s)
- E. Diana Jones
- Springfield Perinatology Center, Springfield, Missouri; 1900 South National Avenue, Suite 2900, Springfield, MO 65804
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32
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Clement K, Chamberlain P, Boyd P, Molyneux A. Prenatal diagnosis of an epignathus: a case report and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 18:178-181. [PMID: 11530004 DOI: 10.1046/j.1469-0705.2001.00456.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
An epignathus is an extremely rare form of teratoma that arises from the oral cavity, most commonly from the palate. We describe a case identified sonographically at 17 weeks' gestation after a raised maternal serum alpha-fetoprotein was recorded. This pregnancy was terminated but we review the literature over the last 10 years and describe the management options available in such cases.
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Affiliation(s)
- K Clement
- Ultrasound and Prenatal Diagnosis Unit, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
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Ward VM, Langford K, Morrison G. Prenatal diagnosis of airway compromise: EXIT (ex utero intra-partum treatment) and foetal airway surgery. Int J Pediatr Otorhinolaryngol 2000; 53:137-41. [PMID: 10906519 DOI: 10.1016/s0165-5876(00)00323-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Four cases of potential airway obstruction diagnosed in the early antenatal period are presented. Their management is outlined, and the need for a multidisciplinary team approach to these problems is highlighted. The experience of the ex-utero intrapartum treatment (EXIT) procedure is presented, and the first attempt at intra-uterine tracheal surgery is introduced.
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Affiliation(s)
- V M Ward
- Department of ENT, Guys & St Thomas' Hospital, London, UK
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34
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Viora E, Grassi Pirrone P, Comoglio F, Bastonero S, Campogrande M. Ultrasonographic detection of fetal cranio-facial hemangioma: case report and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2000; 15:431-434. [PMID: 10976488 DOI: 10.1046/j.1469-0705.2000.00117.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A case of an isolated cranio-facial vascular anomaly, extending from the left parietal bone to the lateral margin of the omolateral orbit is presented. Detection and differential diagnosis of fetal hemangioma is important for a variety of reasons. First, it allows the prenatal growth of the mass to be evaluated. Second, it enables appropriate arrangements for delivery to be made including its timing and selection of the appropriate clinical team necessary to support the neonate. After birth these cranio-facial anomalies can regress spontaneously, but plastic surgery is often necessary.
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Affiliation(s)
- E Viora
- Centro di Ecografia e Diagnosi Prenatale, Ospedale Sant'Anna, Torino, Italy
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35
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Salvetat ML, D'Ottavio G, Pensiero S, Vinciguerra A, Perissutti P. Prenatal sonographic detection of a bilateral dacryocystocele. J Pediatr Ophthalmol Strabismus 1999; 36:295-7. [PMID: 10505836 DOI: 10.3928/0191-3913-19990901-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M L Salvetat
- Department of Ophthalmology, Children's Hospital, Trieste, Italy
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36
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Powell SM, Yankowitz J, Robinson RA. Prenatal diagnosis of a fetal head and neck neoplasm: differential diagnosis, management, and histology. Prenat Diagn 1997; 17:1071-6. [PMID: 9399357 DOI: 10.1002/(sici)1097-0223(199711)17:11<1071::aid-pd185>3.0.co;2-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A fetal head and neck malignancy was prenatally diagnosed. The parents allowed the fetus to die during labour, due to the poor prognosis. We discuss the corresponding pathology findings, differential diagnosis, and management of this rare entity. Prenatal diagnosis of fetal neoplasms theoretically improves outcome, although this was not true in our case.
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Affiliation(s)
- S M Powell
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, USA
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