First‐trimester diagnosis of fetal hepatic cyst

Abstract

Fetal intra-abdominal cysts seen on antenatal sonography pose a diagnostic problem as they may have many etiological origins. We present a case of a hepatic cyst measuring 11 x 7 x 7 mm that was diagnosed at 13 weeks' gestation by transvaginal sonography. The cyst increased in proportion with the growth of the fetus. Ultrasound-guided needle aspiration of the cyst at 22 weeks' gestation helped to clearly identify the formerly displaced gall bladder and demonstrated the intrahepatic location of the cyst. The aspirated fluid was identified as bile. After aspiration the fluid reaccumulated rapidly. Shortly prior to delivery the cyst measured 75 x 44 x 46 mm. At 39 weeks of gestation a female infant was delivered by forceps (3610 g; Apgar 9/10/10 at 1, 5 and 10 min, respectively). Increasing cyst size and concomitant feeding problems prompted surgery on the 14th day postpartum. A large hepatic cyst was partially excised and marsupialized, confirming the prenatal diagnosis. The postoperative course was complicated by cholangitis, septicemia and recurrence of the cyst. Therefore Roux-en-Y hepatojejunostomy was performed in the second month of life. The postoperative period was uneventful and the child was doing well at the time of writing.

Mesenchymal Hamartoma of Liver in a Neonate

“…By using the ultrasound, mobile thin walls or hyper-echo nodules in the cyst are strongly in favor of the diagnosis of MHL. Differential diagnosis of abdominal cystic mass in infants are included mesenteric Cyst, duplication cyst, hepatoblastoma, teratoma, linfangioma, colloid cyst, neoplastic solitary cyst and renal Cyst [4,[7][8][9][10][11]. Mesenteric and duplication cysts are mobile but the duplication has specified internal walls [9].…”

“…[9,10]. Diagnosis of sub-hepatic cystic large pedicle (variant of MHL) before the surgery of can be difficult [4,[7][8][9][10][11][12][13]. Infection and relapse are common and occur followed by percutaneous drainage of the large cyst.…”

The diagnostic and therapeutic approach for the congenital solitary liver cysts

“…Hilar yerleşimli, safra yollarıyla bağlantılı büyük kistlerin cerrahisinde biliyer diversiyon yöntemleri uygulanır (9) . Parsiyel eksizyon sonrası kolanjit, sepsis, kistin tekrarlaması gibi karmaşaların görülmesi de hepatikojejunostomi, hepatik rezeksiyon gibi girişimleri gerektirir (2,13) . Perkütan drenajda yineleme oranları çok yüksektir ve yalnızca tanısal amaçlı ve yakınmaların acil kontrolü için kullanılmalıdır (3,20) .…”

“…Böbrek ve karaciğe-rin doğmalık polikistik hastalığı, intrahepatik safra yollarının doğmalık genişliği (Caroli hastalığı) gibi durumlarda görülen çoklu kistlerden farklıdır, başka organlarda izlenen kistlere eşlik etmez (16) . Etiyolojiyle ilgili ileri sürülen teoriler fetal dönemde, aberran safra yollarında inflamasyona bağlı gelişen tıkanma veya vasküler sorunlar şeklinde bilinmektedir (2) . Bu kistler histopatolojik tanı gerekliliği, yakınmaların giderilmesi ve infeksiyon, kist rüptürü, kanama, neoplazi gibi karmaşaların önlenmesi için cerrahi sağaltım gerektirmektedir.…”

Prenatal Diagnosis of Hydro(metro)colpos: A Series of 20 Cases

“…In the prenatal setting, hydro(metro)colpos typically presents as a retrovesical, sometimes septate hypoechogenic mass with accumulation of debris within the cyst within the lower fetal abdomen. Differential diagnosis of intraabdominal cystic masses most often is difficult and includes hydronephrosis, fetal ovarian cysts, anterior cystic teratoma, cloacal malformation [1], megacystis with lower urinary tract obstruction [2], hepatic cysts [3], fetal sacrococcygeal teratoma [4], anterior meningocele, and hydro(metro)colpos.…”