Purpose: To explore the performance of prenatal ultrasonography in the differential diagnosis of cystic biliary atresia (CBA) and choledochal cyst (CC).Methods: Fetuses diagnosed with hepatic hilar cyst in the 2 nd trimester were included in this study. A series of prenatal ultrasound examinations were performed in the 2 nd and 3 rd trimester. The diameter of the gall bladder (GB) and hepatic cyst were measured, as well as the wall thickness of the GB. The GB-cyst connection, visibility of the right hepatic artery (RHA), and other concomitant abnormalities were carefully evaluated.Neonatal transabdominal ultrasound examination was performed within 1 week after birth, and clinical data were followed up to 6 months after birth.
Objectives To assess the diagnostic accuracy of prenatal ultrasound in detecting intra‐abdominal masses derived from different systems. Methods Fetuses diagnosed with abdominal cystic masses during prenatal ultrasound were included in this study. The basic biological parameters of the fetus were measured in addition to the location of the cystic mass, the shape and size of the mass, the thickness of the cystic wall, dynamic changes, blood supply of the mass, and relationship with the surrounding organs. Whether the fetus also had other malformations was also recorded. Clinical data were followed up to 6 months after birth. Results Between January 1, 2019 and January 1, 2021, 247 fetuses were included, most of which contained renal/adrenal cystic masses (n = 93, 37.7%), followed by hepatobiliary system (n = 48, 19.4%), gastrointestinal tract (n = 45, 18.2%), reproductive system (n = 29, 11.7%), and ureter and bladder (n = 27, 10.9%) masses, respectively. The minority were masses in other systems (n = 5, 2.0%). The overall prenatal diagnostic accuracy was 90.7%. There were significant differences in each system (χ2 = 13.0, P < .05). The most accurate type of cyst was diagnosed from renal and adrenal (96.8%) cases, followed by ureter and bladder (92.6%) cases, gastrointestinal tract (91.1%), hepatobiliary system (85.4%), and reproductive system (82.8%). Other systems (60.0%) were the least accurate type. Conclusions A wide variety of cystic masses can be accurately detected in the fetal abdomen, and most of these lesions can be accurately diagnosed during pregnancy.
Background Congenital megaduodenum is a rare disorder; however, its prenatal diagnosis has not been reported previously. We report the case of an abdominal cystic mass in a fetus that was later diagnosed as megaduodenum. Case presentation An abdominal cystic mass was found during ultrasonography of a fetus at 11 weeks of gestation. The mass progressively enlarged with gestation. The amniotic fluid volume decreased and then returned to normal. During the last prenatal ultrasound examination, the mass was observed communicating with the stomach; therefore, duodenal dilation was suspected. Finally, the patient was diagnosed with megaduodenum caused by a developmental defect in the nerve plexus. Conclusions Congenital megaduodenum is a differential diagnosis of massive fetal abdominal cystic masses. Ultrasound examinations of such masses communicating with the stomach may help determine the diagnosis.
Objective To explore the diagnostic performance of prenatal ultrasound in the prediction of biliary atresia (BA). Methods We prospectively collected cases of suspected biliary abnormalities in the 2nd trimester of pregnancy and performed a series (at least 3) of prenatal ultrasound examinations in the 2nd and 3rd trimester. The presence of the gallbladder was examined each time, and its size and shape were assessed if the gallbladder was visible. The existence of other abnormalities was carefully evaluated. Neonatal ultrasound examination was conducted within 1 month after birth, and clinical data were followed-up for 6 months after birth. Results Among the 41 895 patients, 298 were suspected to have biliary abnormalities, while 82 patients were excluded due to loss to follow-up or induced labor caused by other abnormalities. A total of 216 patients were included in this study, and 15 were diagnosed with BA. We summarized the ultrasound findings of the gallbladders and defined a high-risk gallbladder for the prenatal diagnosis of BA. This was demonstrated to have the best diagnostic performance as a single parameter, with an area under the curve of 0.914 (95 %CI: 0.869–0.948). In addition, higher incidences of biliary cysts, right hepatic artery dilation, echogenic bowel, and ascites were observed in BA fetuses. Logistic regression analysis showed that the combination of 5 parameters had better diagnostic performance, with an area under the curve of 0.995 (95 %CI: 0.973–0.999). Conclusion The fetal gallbladder was found to be a critical feature for the identification of BA. Concomitant abnormalities could be helpful to improve the accuracy of the diagnosis.
Objectives: Echogenic and/or dilated bowel is often encountered on prenatal ultrasound and may represent a feature of gastrointestinal pathology, chromosomal abnormality or sign of prenatal infection. Prenatal differentiation between transient, physiological versus pathological manifestation is often difficult and remain uncertain. As a consequence, patients' counselling and timely involvement of pediatric surgeons is challenging. We aimed to review prenatal cases with echogenic or/and dilated bowel and analyse their neonatal outcomes. Methods: This is a retrospective observational study. All ultrasound scans demonstrating fetal echogenic and/or dilated bowel were retrieved from the viewpoint and grouped into three categories: 1. echogenic; 2. dilated and 3. combined cases. Bowel echogenicity has been defined as grade 1 to 3, in relation to the surrounding liver or bone echogenicity. Bowel dilatation is defined as the largest diameter measuring >7mm during second and third trimester. Results: Out of 26,353 screened prenatal ultrasound scans: 30, 3 and 8 cases were identified with bowel echogenicity (grade 2 or 3), dilatation and their combination respectively. 9/41 (21%) neonates had confirmed gastrointestinal related pathologies; 5 with echogenic and 2 from each, dilated and combined bowel abnormalities group. 3/30 (10%) cases with echogenic and 1/8 (13%) case with dilated bowel required postnatal intestinal surgery. None among neonates with combined echogenic and dilated bowel exhibited structural intestinal abnormality that needed surgical correction. Conclusions: Prenatal diagnosis of isolated echogenic and/or dilated bowel carries overall favourable neonatal outcomes. However, still minority of cases with fetal echogenic or dilated bowel may elucidate of possible gastrointestinal abnormalities that require thorough parents' counselling, prenatal work up and multidisciplinary team involvement. Further research is needed to more precisely define prenatal ultrasound features of severe gastrointestinal abnormalities that require neonatal interventions. VP09.08 Cystic biliary atresia or choledochal cysts: is it possible to be accurately differentiated prenatally?
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