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Diaz-Primera R, Sánchez-Jimenez R, Marin-Concha J, Mena R, Garrido-Mendez J, Mariñez M, Mena-Rivas R, Lopez A, Diaz-Rodriguez A, Mogena-Sanchez O, Almanzar R, Soto-Ravelo R. Prenatal Diagnosis of Fetal Lymphangioma: A Case Series. J Ultrasound Med 2022; 41:1019-1026. [PMID: 34288011 DOI: 10.1002/jum.15783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 06/13/2023]
Abstract
Fetal lymphangioma is an uncommon congenital malformation that is mainly comprised of the subcutaneous tissue of the neck. This malformation can develop in other areas like the thoracic and axillary regions, though rarely. We report 6 consecutive cases of lymphatic malformation in a fetal center in Dominican Republic. In our case series fetal chest lymphangiomas were present in 2 fetuses. In addition, 2 cases of axillary lymphangiomas also involved the thoracic region. Adequate management by a multidiciplinary team is necessary to provide a better approach to delivery.
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Affiliation(s)
- Ramiro Diaz-Primera
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Raúl Sánchez-Jimenez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Julio Marin-Concha
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Rafael Mena
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Jose Garrido-Mendez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Manuel Mariñez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Ramon Mena-Rivas
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Ashley Lopez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Agustin Diaz-Rodriguez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Orlando Mogena-Sanchez
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Rafael Almanzar
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
| | - Rodolfo Soto-Ravelo
- Department of Maternal Fetal Medicine, Dominican Fetal Center, Centro de Obstetricia y Ginecología, Santo Domingo, Dominican Republic
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Abstract
Abdominal lymphatic malformations (LM) are rare congenital malformations of the lymphatic system, representing only 2% of all LM in newborns. They may arise from intra-abdominal solid organs (such as the liver, pancreas, kidneys, spleen, adrenal glands, and gastrointestinal tract), mesentery, omentum, and retroperitoneum. Mesenteric LM are the most commonly seen, with retroperitoneal LM being the second most common. Fetal abdominal LM could be associated with karyotypic or other abnormalities, including skin edema, hydrops fetalis, and polyhydramnios, and prenatal diagnosis and perinatal counseling for these LM are important. Prenatal ultrasound (US) and magnetic resonance imaging (MRI) have led to an increased diagnosis of abdominal LM and improved monitoring and intervention postnatally. This article provides an overview of fetal abdominal LM, including the prenatal diagnoses, differential diagnoses, comprehensive illustrations of the imaging findings, treatments, and fetal outcomes.
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Affiliation(s)
- Yu-Peng Liu
- Department of Radiology, Mackay Memorial Hospital, Hsinchu, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Yen-Lin Huang
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Pei-Shan Tsai
- Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medical College, New Taipei, Taiwan
| | - Dao-Chen Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Gasparella P, Beqo BP, Haxhija EQ, Castellani C, Arneitz C, Sorantin E, Kampelmühler E, Singer G, Till H. Chylous content might determine the optimal surgical approach for mesenteric lymphatic malformations in childhood. J Vasc Surg Venous Lymphat Disord 2021:S2213-333X(21)00303-6. [PMID: 34171533 DOI: 10.1016/j.jvsv.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mesenteric lymphatic malformations (LMs) represent rare congenital anomalies that can include chylous or nonchylous content. The pathologic mechanisms explaining this phenomenon are poorly understood and not yet described. Furthermore, the current management approach does not consider the contents of the mesenteric LMs. In the present study, we have defined the relationship between the lymphatic mesenteric cyst content and the histologic evidence of LMs within the bowel wall. METHODS We retrospectively investigated all patients with mesenteric LMs treated surgically at our department from 1999 to 2018. RESULTS A total of 11 patients (6 girls and 5 boys) were included in our analysis. Seven patients had presented with LMs located in the jejunal mesentery, three in the ileocecal region, and only one in the mesocolon transversum and omentum. Of the 11 children, 7 had had LMs with nonchylous content and 4 had presented with chylous content LMs. Intestinal resection was performed in all 4 patients with chylous content LMs and 4 patients with nonchylous content LMs. Histopathologic evaluation of the surgical specimens determined that only the LMs with chylous content displayed malformed lymphatic channels throughout the bowel wall. The resected small bowel of four patients with nonchylous content showed no LM extension throughout the intestinal wall. CONCLUSIONS LMs with chylous content seem to develop from malformed lymphatic channels within the bowel wall. In such cases, segmental intestinal resection is mandatory. In contrast, mesenteric LMs with nonchylous content can potentially be treated without bowel resection if the blood supply can be preserved. This finding is, to the best of our knowledge, reported in the present study for the first time.
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Li J, Zhong W, Geng X, Liu X, Zhang X, Wang Y, Li H. Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study. BMC Pediatr 2020; 20:441. [PMID: 32950065 PMCID: PMC7501610 DOI: 10.1186/s12887-020-02337-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background To explore the imaging features, key diagnostic points, classification, treatment, and prognosis of cervical lymphatic malformation. Methods Overall, 320 patients diagnosed with cervical lymphatic malformation were retrospectively analysed in our hospital between 1 January 2014 and 31 December 2017. Imaging modalities included colour Doppler ultrasound, magnetic resonance imaging, and contrast-enhanced computed tomography. Cervical lymphatic malformations were classified by cyst diameter. Treatments included interventional therapy, surgery, and expectant treatment. Results Cervical lymphatic malformation was identified in 320 of 1192 patients with lymphatic malformation. Four were excluded due to misdiagnosis by ultrasonography. Cervical lymphatic malformation was classified as mixed, macrocystic, and microcystic in 184 (57.5%), 117 (36.56%), and 19 (5.94%) patients, respectively. Sixty-four (20%), ten (3.12%), seven (2.19%), and three (0.94%) patients experienced intracystic haemorrhage, infection, concurrent intracystic haemorrhage and infection, and calcification, respectively. Among 260 (81.25%) patients who underwent interventional sclerotherapy, 163 (50.94%) received it once and 96 (30%) received it two or more times. Twenty-eight (8.75%), five (1.56%), and 27 (8.44%) patients underwent surgical resection, interventional sclerotherapy plus surgery, and expectant management, respectively. Conclusions Ultrasonography is useful for diagnosing definite cervical lymphatic malformation. Interventional therapy is the first choice for children with confirmed cervical lymphatic malformation.
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Affiliation(s)
- Jiaoling Li
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China.
| | - Wei Zhong
- Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiuping Geng
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiaofang Liu
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiangxiang Zhang
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Yurun Wang
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Haibo Li
- Department of Invasive Technology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
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Niwa Y, Imai K, Kotani T, Nakano T, Ushida T, Moriyama Y, Kikkawa F. A pitfall in diagnosing fetal abdominal lymphangioma: A report of two cases. J Clin Ultrasound 2019; 47:494-496. [PMID: 31287158 DOI: 10.1002/jcu.22756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/21/2019] [Accepted: 06/23/2019] [Indexed: 06/09/2023]
Abstract
Typical ultrasound findings of fetal abdominal lymphangioma include thick-walled, multiseptated anechoic masses. Although a majority of cases can be suspected promptly by ultrasound examination, the two cases presented herein did not meet the standard criteria and were misleading. Both cases involved unilocular cysts without clear septations, but in retrospect were atypical findings of fetal abdominal lymphangioma. A few reports of misleading cases have been described previously; however, the precise characteristics have not been reported in detail. Therefore, in this case report, we focused predominantly upon the difficulties encountered in the prenatal diagnosis of abdominal lymphangioma based on ultrasound morphology alone.
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Affiliation(s)
- Yuri Niwa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Nakano
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Moriyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Li JL, Hai-ying W, Liu JR, He QM, Chen KS, Yang J, Qian F. Fetal Lymphangioma: Prenatal diagnosis on ultrasound, treatment, and prognosis. Eur J Obstet Gynecol Reprod Biol 2018; 231:268-273. [DOI: 10.1016/j.ejogrb.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/25/2018] [Accepted: 10/06/2018] [Indexed: 10/28/2022]
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Flanagan SM, Rubesova E, Jaramillo D, Barth RA. Fetal suprarenal masses--assessing the complementary role of magnetic resonance and ultrasound for diagnosis. Pediatr Radiol 2016; 46:246-54. [PMID: 26589304 DOI: 10.1007/s00247-015-3470-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/25/2015] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the value and complementary roles of fetal MRI and US for characterization and diagnosis of suprarenal masses. MATERIALS AND METHODS We conducted a multi-institutional retrospective database search for prenatally diagnosed suprarenal masses between 1999 and 2012 and evaluated the roles of prenatal US and fetal MRI for characterization and diagnosis, using postnatal diagnosis or surgical pathology as the reference standard. Prenatal US and fetal MRI were assessed for unique findings of each modality. RESULTS The database yielded 25 fetuses (gestational age 20-37 weeks) with suprarenal masses. Twenty-one fetuses had prenatal US, 22 had MRI, 17 had both. Postnatal diagnoses included nine subdiaphragmatic extralobar sequestrations, seven adrenal hemorrhages, five neuroblastomas (four metastatic), two lymphatic malformations, one duplex kidney with upper pole cystic dysplasia, and one adrenal hyperplasia. Ultrasound was concordant with MRI for diagnoses in 12/17 (70.6%) cases. Discordant diagnoses between US and MRI included three neuroblastomas and two adrenal hemorrhages. In the three neuroblastomas US was equivocal and MRI was definitive for neuroblastoma, demonstrating heterogeneous, intermediate-signal solid masses and liver metastases. In the two cases of adrenal hemorrhage US was equivocal and MRI was definitive with signal characteristics of hemorrhage. In 2/4 neuroblastomas, Doppler US demonstrated a systemic artery suggesting extralobar sequestration; however MRI signal characteristics correctly diagnosed neuroblastoma. All cases of extralobar sequestration were correctly diagnosed by US and MRI. CONCLUSION US and MRI both accurately detect suprarenal masses. MRI complements US in equivocal diagnoses and detects additional findings such as liver metastases in neuroblastoma.
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Affiliation(s)
- Siobhan M Flanagan
- Department of Radiology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Erika Rubesova
- Department of Radiology, Stanford University, Lucile Packard Children's Hospital, 725 Welch Road, MC 5913, Stanford, 94305, CA, USA.
| | - Diego Jaramillo
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Richard A Barth
- Department of Radiology, Stanford University, Lucile Packard Children's Hospital, 725 Welch Road, MC 5913, Stanford, 94305, CA, USA
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Manganaro L, Saldari M, Bernardo S, Vinci V, Aliberti C, Sollazzo P, Giancotti A, Capozza F, Porpora MG, Cozzi DA, Catalano C. Role of magnetic resonance imaging in the prenatal diagnosis of gastrointestinal fetal anomalies. Radiol Med 2015; 120:393-403. [PMID: 25348138 DOI: 10.1007/s11547-014-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/05/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE This study was done to evaluate the role of fetal magnetic resonance imaging (MRI) in the study of gastrointestinal malformations in comparison to prenatal ultrasound (US). MATERIALS AND METHODS A prospective (2010-2012) study of 38 fetal MRI scans was performed on 38 fetuses between 24 and 38 weeks of gestation. All the fetuses had a US diagnosis of gastrointestinal anomalies. T2-weighted HASTE, T1-weighted fast gradient echo, TrueFISP and diffusion-weighted images of the fetal abdomen were obtained on a 1.5-Tesla magnet. All fetal MRI diagnoses were compared with postnatal US findings, autopsy or surgical reports. RESULTS Fetal MRI was able to confirm the sonographic findings in nine of 38 fetuses (23.7%), to provide additional information in 23 of 38 fetuses (60.6%), to exclude the US diagnosis in five cases (5.2%) and to change it in two cases (5.2%). It was not able to characterize a case of gastric duplication and a case of abdominal cystic lymphangioma (5.2%). CONCLUSIONS Fetal MRI can be used as a complementary imaging modality to US in prenatal evaluation of gastrointestinal anomalies and can be considered a valuable tool not only for confirming or excluding but also for providing additional information to fetal ultrasonographic findings.
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