Prenatal sonographic characteristics and Doppler blood flow study in a case of a large fetal mediastinal teratoma

Abstract

Although fetal mediastinal teratomas may result in respiratory distress in the neonatal period and lead to perinatal mortality, they are rarely diagnosed prenatally. Furthermore, their impact on fetal hemodynamics has never been described. We report a case of a large fetal mediastinal teratoma prenatally visualized at 38 weeks' gestation by both two- and three- dimensional ultrasound. We also describe the associated changes in the Doppler flow velocimetry, namely, a decrease in cardiac output, prolonged acceleration time in the pulmonary artery and an increase in the umbilical artery S/D ratio. The baby was well at the 5-month follow-up after an operation in the neonatal period. From our case, we believe that accurate prenatal diagnosis and assessment by two- and three-dimensional ultrasound as well as Doppler flow velocimetry may contribute to a better perinatal outcome.

Prenatal diagnosis of fetal acrania using three-dimensional ultrasound

“…The details of 3-D US scanning have been described previously , 1997cChang CH et al 2000a, 2000b, 2000cChuang et al 2000;Kuo et al 1992;Liang et al 1997aLiang et al , 1997bLiang et al , 1998Lai et al 2000;Lin et al 1998;Wang et al 1999).…”

“…Some ancillary sonographic findings, such as echogenic amniotic fluid in the first trimester, may also be used to help the diagnosis (Cafici and Sepulveda 2003). With the advent of 3-D US, various rendering modes of imaging may help to depict the condition and, actually, we have used this technique in prenatal diagnosis and reported the clinical application of 3-D US in detecting congenital anomalies since 1995 , 1997cChang CH et al 2000a, 2000b, 2000cChang LW et al 2002;Chuang et al 2000;Kuo et al 1992;Liang et al 1997aLiang et al , 1997bLiang et al , 1998Lai et al 2000;Lin et al 1998;Liu et al 2003;Wang et al 1999). Herein, we collected and analyzed the cases of acrania diagnosed by 3-D US retrospectively.…”

Successful management of a large fetal mediastinal teratoma complicated by hydrops fetalis

“…To date, few prenatal cases have been reported [4][5][6][7][10][11][12][13]. Typical findings are a cystic and solid mass in the chest, polyhydramnios, and hydrops fetalis [10][11][12][13]. The mechanisms of polyhydramnios and hydrops have been explained by several previous authors.…”

Management of fetal mediastinal teratoma

“…The prenatal differential diagnosis includes intrapericardial teratoma, rhabdomyosarcoma, cystic adenomatoid malformation, diaphragmatic hernia, pulmonary sequestration, and bronchogenic cyst [4]. There are very few reported cases of fetal mediastinal teratomas in the literature [4][5][6][7][8][9][10] and only one involving prenatal therapy with amnioreductions to control uterine size, followed by intubation at birth and postnatal resection [10]. Our case review is the first description of prenatal management with open fetal surgery or the EXIT procedure (Fig.…”