Imaging of solid congenital abdominal masses: a review of the literature and practical approach to image interpretation
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FETAL IMAGING
Imaging of solid congenital abdominal masses: a review of the literature and practical approach to image interpretation Krista L. Birkemeier 1 Received: 15 November 2019 / Revised: 27 February 2020 / Accepted: 13 April 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Fetal abdominal tumors are rare, usually benign, and cause a great deal of anxiety for expectant parents and the physicians counseling them. In this paper the author reviews the most common fetal abdominal tumors in the liver (hemangioma, mesenchymal hamartoma, hepatoblastoma, metastases) and the kidney (congenital mesoblastic nephroma, Wilms tumor, malignant rhabdoid tumor, and clear cell sarcoma), and suprarenal mass lesions (adrenal neuroblastoma, adrenal hemorrhage, and subdiaphragmatic extralobar pulmonary sequestration). The author describes the imaging approach, imaging appearance and differentiating features of tumors, and differences between fetal and childhood appearances of tumors. Keywords Abdomen . Adrenal gland . Fetus . Kidney . Liver . Magnetic resonance imaging . Mass . Sequestration
Introduction Solid abdominal masses in the perinatal period are rare and usually benign. In a review of 44,560 pregnancies, only 8 (0.018%) were solid tumors [1]. The purpose of this article is to discuss the differential diagnosis of solid fetal abdominal tumors, the appearance of the most common diagnoses, and appropriate postnatal imaging (Table 1). This review was approved by the institution’s review board. Prenatal ultrasound (US) is the first-line modality, and fetal MRI is indicated for any fetal abdominal mass suspected on ultrasound because MRI adds information that contributes to the differential diagnosis and management. Fetal MRI is beneficial for its soft-tissue contrast, multi-planar imaging, large field of view, and the utility of T1-W imaging for delineating blood and meconium. Fetal MRI is also less constrained by fetal position, maternal soft-tissue attenuation, gestational age, and oligohydramnios. US imaging remains particularly useful to evaluate Doppler flow and calcifications, and to monitor lesion size and complications over time. For evaluating fetal
* Krista L. Birkemeier [email protected] 1
Department of Radiology, Pediatric Section, Baylor Scott and White Health-Temple, McLane Children’s Medical Center, Texas A&M Health Science Center, 2401 S. 31st St., MS-01-W256, Temple, TX 76508, USA
abdominal masses, a combination of US and MRI is optimal. Often, postnatal imaging is necessary to confirm or further delineate the final diagnosis, provide a postnatal baseline study, and evaluate for metastases.
Liver tumors Hepatic tumors account for 5% of all perinatal tumors, with hepatic vascular tumors being the most frequent, followed by mesenchymal hamartoma, hepatoblastoma and metastases [2]. There are rare reported cases of perinatal angiosarcoma [2], hepatic adenoma [2–4], focal nodular hyperplasia [2, 5, 6], germ cell tumors, hepatocellula
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