Prenatal Diagnosis of a Ranula With 2- and 3-Dimensional Sonography and Sonographically Guided Aspiration

Abstract

e describe a case of a rare cystic, exophytic salivary gland tumor diagnosed in a fetus at an estimated gestational age of 25 weeks. The combined use of 2-dimensional (2D) and 3-dimensional (3D) sonography allowed determination of the tumor's origin. Sonographically guided aspiration of the tumor's content produced fluid with the consistency of mucus. Detection of amylase in the fluid confirmed that the lesion was of salivary origin and established the diagnosis of a ranula. Prenatal decompression of the ranula allowed spontaneous vaginal delivery of a full-term girl with excellent Apgar scores at 1 and 5 minutes. Case ReportA 13-year-old pregnant patient was referred to our prenatal diagnostic unit for a sonographic examination. The estimated gestational age based on her last menstrual period was 25 weeks. The patient was found to have a singleton gestation with a female fetus. Biometric measurements with 2D sonography showed the fetal age to be consistent with the patient's last menstrual period and revealed a cystic tumor measuring 5.0 × 4.0 cm protruding through the mouth. The tumor seemed to originate in the sublingual area of the mouth. Color Doppler scanning revealed no vascular flow in the tumor. We were able to observe the wide-open mouth of the fetus and to confirm the sublingual origin of the cyst more precisely with 3D sonography (Figure 1). A sonographic anatomic survey revealed that there was fluid in the stomach of the fetus. All other fetal organs and the amniotic fluid index (14) were normal. Cytogenetic anal-

Prenatal ultrasound and magnetic resonance imaging depiction of a small sublingual ranula

“…Sonographically, a ranula is an anechoic, avascular, cystic mass originating from the floor of the mouth and displacing the tongue upward. 2 MRI of simple sublingual ranulas shows a low to intermediate signal on T1weighted images, and a signal as high as that of cerebrospinal fluid on T2-weighted images, with the appearance of a well-defined homogeneous mass on both sequences. 8 Differential diagnosis of sublingual cystic masses includes dermoid, epi- dermoid, thyroglossal duct cysts, vallecular cysts, and enteric duplication cysts.…”

“…To the best of our knowledge, only 6 cases have been published in English literature. [2][3][4][5][6][7] Tumors located in the fetal oral cavity can cause a swallowing disorder, mogiarthria, and respiratory obstruction. When upper airway obstruction is recognized at birth, attending physicians are faced with difficulty in establishing a patent airway immediately and the neonate may suffer from hypoxic-ischemic brain insult.…”

Prenatal diagnosis and management of a ranula

“…The extrauterine intrapartum treatment (EXIT) technique should be available in the delivery room when an oral cavity mass is diagnosed prenatally because of the risk of airway obstruction. The EXIT procedure allows fetal gas exchange by partial Cesarean delivery of the fetus while the umbilical cord is still attached to the placenta 3 . In this case the cyst did not obliterate the airway so the EXIT procedure was not performed.…”

Recurrent plunging ranula

“…Anecdotal reports of antenatal detection are present in the literature. Pires et al [19] have performed antenatal aspiration for decompression and stated that Ex-utero intra partum (EXIT) procedure may be useful in large swellings.…”