Role of prenatal imaging in the diagnosis and management of fetal facio-cervical masses

Abstract

Congenital facio-cervical masses can be a developmental anomaly of cystic, solid, or vascular origin, and have an inseparable relationship with adverse prognosis. This retrospective cross-sectional study aimed at determining on the prenatal diagnosis of congenital facio-cervical masses, its management and outcome in a large tertiary referral center. We collected information on prenatal clinical data, pregnancy outcomes, survival information, and final diagnosis. Out of 130 cases of facio-cervical masses, a total of 119 cases of lymphatic malformations (LMs), 2 cases of teratoma, 2 cases of thyroglossal duct cyst, 4 cases of hemangioma, 1 case of congenital epulis, and 2 cases of dermoid cyst were reviewed. The accuracy of prenatal ultrasound was 93.85% (122/130). Observations of diameters using prenatal ultrasound revealed that the bigger the initial diameter is, the bigger the relative change during pregnancy. Magnetic resonance imaging (MRI) revealed that 2 cases of masses were associated with airway compression. In conclusion, ultrasound has a high overall diagnostic accuracy of fetal face and neck deformities. Prenatal US can enhance the management of ambulatory monitoring and classification. Furthermore, MRI provided a detailed assessment of fetal congenital malformations, as well as visualization of the trachea, presenting a multi-dimensional anatomical relationship.

Large congenital facial teratoma

“…However, the surgical treatment was performed at 16 months with successful results. Rapid advances in imaging and instrumentation technology have led to the development of novel tools allowing the surgeon to more accurately locate critical structures, anticipate intraoperative challenges and select the best surgical approach 9. The histopathology in craniocervical teratomas is commonly mature, like our patient.…”

Fetal Endoscopic Tracheal Intubation: Modification of the Fetal Endoscopic Tracheal Intubation Procedure to Establish an Airway in a Fetus with a Congenital Cervical Teratoma

“…Identifying the characteristics of a potentially difficult or non-patent airway and developing a plan for postnatal care is therefore essential. A combination of US and MRI has proven effective in identifying cases requiring an EXIT procedure [9]. The tracheoesophageal displacement index, an MRI-based measurement of fetal airway displacement described by Lazar et al, [10] suggests that the presence of polyhydramnios, teratoma diagnosis, or tracheoesophageal displacement index greater than 12 is predictive of a complicated airway at birth.…”

Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

“…It is a rare consumptive coagulation illness that occurs with certain vascular tumors. 3,4,9,20 Successful management can resolve KMP and make angioma regress. 4 The only case of postnatal death in this study involved a newborn with congenital clustered hemangioma or kaposiform hemangioendothelioma (KHE) related to KMP.…”

“…8 The diagnosis of congenital hemangiomas is mostly based on imaging evaluations, such as magnetic resonance imaging (MRI) and ultrasound examinations. 9 MRI scanning is expensive and cannot provide real-time evaluations. In contrast, ultrasound is a non-invasive bedside convenient test at relatively low cost.…”