Cystic Lesions in Abdomen: Prenatal and Postnatal Findings of Ultrasonography

1
Cystic Lesions in Abdomen Prenatal and Postnatal
Findings of Ultrasonography
Hak Jong Lee, Jeong Yeon Cho, Young Ho Lee,
Byoung Hee Han, Mi Jin Song, Jee-Yeon Min,
Soo-Hyun Lee, Jung-Ah Kim, Byung Jae Cho
Department of Radiology Samsung Cheil Hospital,
Sungkyunkwan University School of Medicine
Meconium pseudocyst
Mesenteric cyst
A
B
C
A
B
Prenatal US and pathologic findings of omental
cyst. A B. The coronal and sagittal images of
fetal abdomen show well-marginated large cyst
(arrows) in the antero-inferior portion of the
small bowel. C. The pathology specimen shows a
large cyst on the fetal omentum.
D
C
Prenatal US of meconium peritonitis and
pseudocyst. A B. Prenatal US shows round cystic
lesion with thick calcifications (arrows) in
abdomen. C D. Fetal abdominal US demonstrates
massive ascites (arrows) with dense
calcifications (small arrows). Autopsy reports
revealed meconium peritonitis with pseudocyst.
Meconium pseudocysts have invariably have
calcifications in their walls
Retroperitoneal lymphangioma
H
LV
LK
Duplication cyst
B
A
Prenatal US findings of retroperitoneal
lymphangioma. A B. The axial and coronal images
of fetal abdomen show a large multiseptated
cystic lesion (arrows) in the left
retroperitoneal space. (LK left kidney, LV
liver, H heart)
A
B
Splenic cyst


C
D
Pre- and postnatal US of Duplication cyst. A B.
Prenatal axial (A) and sagittal (B) scan
demonstrate well marginated round cystic lesion
(arrows) in lower abdomen. C D. Postnatal
abdominal US shows well marginated cystic mass.
Note that characteristic appearance of bright
mucosa (small arrows) in gut duplication,
strongly suggest the correct diagnosis.
B
A

• Prenatal US of splenic cyst.
• B. Prenatal axial (A) and sagittal (B) scan
  demonstrates cystic lesion (arrows), located
  posterior aspect of stomach(). Because
  spontaneous resolution has been reported,
  management of small congenital splenic cyst is
  usually anticipated. (ST stomach, ADR adrenal
  gland, LK left kidney)

Adrenal hemorrhage
Simple renal cyst
LK
Prenatal US of simple renal cyst. Sagittal US
scan demonstrates well marginated cystic lesion
of left kidney(arrow). Post-natal follow up US
confirmed left kidney upper pole cyst.
B
A
Prenatal US of adrenal hemorrhage. A B. Cystic
lesion with internal echogenicity is noted in
left suprarenal area (arrows). Postnatal follow
up US revealed nearly complete resorption of the
hemorrhage (not shown). (LK left kidney)
2
Cloacal dysgenesis
Simple hepatic cyst
A
B
A
B
Congenital hepatic cyst arising from aberrant
intrahepatic ducts. A. Prenatal US shows ovoid
shaped cystic lesion in right upper quadrant
(arrows). This cystic lesion is located adjacent
to gall bladder (small arrow), mistaken as
choledochal cyst. B. Postnatal US shows that this
cystic mass is surrounded by liver parenchyma
(small arrows). Surgical resection was done with
the impression of choledochal cyst, but the cyst
was confirmed as simple hepatic cyst.
C
D
Transvaginal US and autopsy specimen of cloacal
dysgenesis. A B. Transvaginal US reveals
markedly dilated cystic structure (arrows),
without evidence of vascular flow signal. C.
Schematic drawings of cloacal dysgenesis. There
is usually single opening on the perineum. This
may result in obstruction of urine outflow with
subsequent dilatation of urinary tract, genital
and gastrointestinal tract. D. Autopsy specimen
reveals markedly dilated cloaca (arrow).
Choledochal cyst
A
B
Bladder outlet obstruction
Pre- and Postnatal US of choledochal cyst. A.
Prenatal US shows relatively round cystic lesion
with tubular structure (arrow), which is
characteristic findings of choledochal cyst. B.
Postnatal US shows similar findings of prenatal
US. If tubular structure (arrows) can be
identified either entering or leaving a right
upper quadrant cyst, the diagnosis of a
choledochal cyst is ensured. This case was
confirmed as choledochal cyst after surgery.
A
B
C
Multicystic dysplastic kidney
Transvaginal US of 13 weeks fetus showing bladder
outlet obstruction. A B. Markedly dilated
bladder (arrows) is noted on transvaginal US. C.
Autopsy specimen revealed markedly dilated
urinary bladder (arrow).
Ovarian cyst
A
B
US and pathologic specimen of MCDK. A. Prenatal
US shows multiple dilated cystic lesions (arrows)
in the left renal fossa. B. Pathologic specimen
revealed multiple cystic mass of left kidney
confirming multicystic dysplastic kidney.
BL
A
B
C
Prenatal (3.3 cm) 1 wk (2.1cm)
5wks (1.5cm)
Serial changes of ovarian cyst in prenatal and
postnatal US. A. Prenatal US demonstrates large
cystic mass (arrow) located in right, superior
aspect of bladder. The gender of the fetus was
female. B C. Serial follow up US scans one
week (B), and 5 weeks (C) after birth show
gradual decrease of the cyst size (arrows). (BL
urinary bladder)
UPJ obstruction
References

• Hill LM. Ultrasound of Fetal Gastrointestinal
  Tract. (In) Callen PW. Ultrasonography in
  Obstetrics and Gynecology, 4th ed. 2000 457-488.
• Sato M, et al. Mesenteric cyst sonographic
  findings. Abdom Imaging 2000 25(3) 306-310.
• Barr LL, et al. Enteric duplications in children
  are their ultrasonographic wall characteristics
  diagnostic? Pediatr Radiol 199020(5) 326-8.
• Ros PR, et al. Mesenteric and omental cysts
  histologic classification with imaging
  correlation. Radiology 1987164(2) 327-32.
• Teele RL, et al. The abdominal mass in the
  neonate. Semin Roentgenol. 1988 Jul 23(3)
  175-84.
• Katsohis CD, et al. Retroperitoneal mesenteric
  cysts. Int Surg. 1989 74(1)28-31.

A
B
Prenatal US of hydronephrosis due to
ureteropelvic junction obstruction. A. Prenatal
US shows marked dilated pelvocalyceal system
(arrows). In some instances, markedly dilated
pelvocalyceal system can mimic abdominal cystic
mass. Note that multicystic lesions (small
arrows) of contralateral kidney, confirmed to be
MCDK. B. Oblique coronal scan demonstrates that
this cystic mass is dilatation of pelvocalyceal
system.