CASE REPORT |
https://doi.org/10.5005/jp-journals-10009-1967 |
Fetal Intrathoracic Cyst at 9 Weeks of Gestation
1,5,6Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan; Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Takamatsu, Kagawa, Japan
2–4Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan
7Department of Pediatric Surgery, Okayama Medical Center, Okayama, Japan
Corresponding Author: Toshiyuki Hata, Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan; Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Takamatsu, Kagawa, Japan, Phone: +810878912174, e-mail: toshi28@med.kagawa-u.ac.jp
Received on: 31 January 2023; Accepted on: 25 February 2023; Published on: 30 June 2023
ABSTRACT
We present the case of a fetal intrathoracic cyst (2.8 x 1.7 mm) detected at 9 weeks and 2 days of gestation. At 11 weeks and 2 days of gestation, cystic hygroma (nuchal translucency = 5.8 mm) with generalized skin edema was identified. HDlive silhouette clearly revealed the location of the intrathoracic cyst. HDlive Flow with HDlive silhouette clearly showed the spatial relationships between the fetal heart and intrathoracic cyst at 13 weeks and 2 days. Cystic hygroma with generalized skin edema was resolved at this time. Chromosome analysis with amniocentesis revealed a normal karyotype (46XY) at 16 weeks and 4 days. The cyst disappeared at 22 weeks and 2 days. The mother delivered a viable, healthy male newborn at 40 weeks and 2 days of gestation. To the best of our knowledge, this is the first report of diagnosing a fetal intrathoracic cyst at 9 weeks of gestation.
How to cite this article: Hata T, Koyanagi A, Kawahara T, et al. Fetal Intrathoracic Cyst at 9 Weeks of Gestation. Donald School J Ultrasound Obstet Gynecol 2023;17(2):121–123.
Source of support: Nil
Conflict of interest: Dr. Toshiyuki Hata is associated as the Scientific Editor of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this Scientific Editor and his research group.
Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.
Keywords: Cystic hygroma, Early gestation, Fetal intrathoracic cyst, HDlive Flow, HDlive silhouette, Pericardial cyst
INTRODUCTION
There have been only two reports of diagnosing fetal intrathoracic cysts in the first trimester of pregnancy.1,2 The intrathoracic cysts in both reports were first detected at 12 weeks of gestation and disappeared at 20 weeks1 and 24 weeks,2 respectively, resulting in healthy neonates. In this report, we present the case of a fetal intrathoracic cyst detected at 9 weeks and 2 days of gestation. To the best of our knowledge, this is the first report of diagnosing a fetal intrathoracic cyst early in the first trimester of pregnancy.
CASE PRESENTATION
A 33-year-old pregnant Japanese woman, gravida 3, para 2, received a routine first-trimester dating scan at 9 weeks and 2 days of gestation, and an oval intrathoracic cyst (2.8 × 1.7 mm) was noted by transvaginal sonography (Fig. 1). At 11 weeks and 2 days of gestation, a round intrathoracic cyst and cystic hygroma (nuchal translucency = 5.8 mm) with generalized skin edema was identified (Fig. 2), which resolved 2 weeks later. HDlive silhouette clearly revealed the location of the intrathoracic cyst (Fig. 3). HDlive Flow with HDlive silhouette clearly showed the spatial relationships between the fetal heart and the irregular shape of the intrathoracic cyst at 13 weeks and 2 days (Fig. 4). Cystic hygroma with generalized skin edema resolved at this time. Chromosome analysis with amniocentesis revealed a normal karyotype (46XY) at 16 weeks and 4 days. The cyst disappeared at 22 weeks and 2 days of gestation. At 40 weeks and 2 days of gestation, the mother delivered a viable male newborn weighing 3728 gm, with a height of 53 cm. The Apgar scores were 9 (1 minute) and 10 (5 minutes), and the umbilical artery blood pH was 7.48. The mother and neonate followed a favorable course after delivery.
Fig. 1: Fetal oval intrathoracic cyst (arrow) at 9 weeks and 2 days of gestation
Fig. 2: Fetal round intrathoracic cyst (small arrow) with cystic hygroma (large arrow) and generalized skin edema (middle arrows) at 11 weeks and 2 days of gestation
Fig. 3: HDlive silhouette image of the intrathoracic cyst (small arrow) and cystic hygroma (large arrows) at 11 weeks and 2 days of gestation
Fig. 4: HDlive Flow with HDlive silhouette image of the intrathoracic cyst (small arrows) at 13 weeks and 2 days of gestation. DAo, descending aorta; LV, left ventricle; RV, right ventricle
DISCUSSION
Bernasconi et al.3 reported three cases of fetal pericardial cysts diagnosed at 19, 20, and 21 weeks which resolved spontaneously before delivery without signs of fetal cardiac compromise, suggesting a benign prognosis. Lewis et al.4 reported a fetal pericardial cyst diagnosed at 14 weeks gestation with no change in size during pregnancy, resulting in a healthy neonate. Only two reports described fetal intrathoracic cysts in the first trimester of pregnancy (at 12 weeks of gestation in both cases), which resolved in the middle of the second trimester, resulting in healthy neonates.1,2 In our case, a round intrathoracic cyst was diagnosed at 9 weeks of gestation and changed to an irregular shape at 11 weeks, which resolved at 22 weeks of gestation. To the best of our knowledge, this is the earliest reported diagnosis of a fetal intrathoracic cyst (suspected pericardial cyst) at 9 weeks of gestation.
Jauniaux et al.1 reported a fetal intrathoracic cyst with increased nuchal translucency and generalized skin edema at 12 weeks and 3 days and considered that these changes were caused by compression of venous return from the vena cava. The skin edema resolved 2 weeks later. In the present case, an intrathoracic cyst was diagnosed at 9 weeks and 2 days of gestation, but increased nuchal translucency was not observed. At 11 weeks and 2 days, cystic hygroma with generalized skin edema was identified, which also resolved 2 weeks later. The venous return from the vena cava may also have been compressed by the intrathoracic cyst in our case. HDlive silhouette generates hologram-like images of the fetus and borders while maintaining a transparent core, as well as fetal body folds and curves and accompanying organs with marked clarity.5-7 It noninvasively shows the borders of the fetus and organs, presenting cores as transparent, and enables examiners to visualize conditions and structures clearly. In the present case, HDlive silhouette clearly showed the change in the shape of an intrathoracic cyst with advancing gestation. Moreover, this technique demonstrated the spatial relationship between the heart and the cyst. HDlive silhouette may provide additional information on fetal intrathoracic echo-free structures in clinical practice.
REFERENCES
1. Jauniaux E, Hertzkovitz R, Hall JM. First-trimester prenatal diagnosis of a thoracic lesion associated with fetal skin edema. Ultrasound Obstet Gynecol 2000;15(1):74–77. DOI: 10.1046/j.1469-0705.2000.00020.x
2. Sepulveda W, Stuardo P. Transient fetal intrathoracic cyst detected during the 11- to 13-week scan: a resolving pericardial cyst? Ultrasound 2022;30(3):255–258. DOI: 10.1177/1742271X211067920
3. Bernasconi A, Yoo S-J, Golding F, et al. Etiology and outcome of prenatally detected paracardial cystic lesions: a case series and review of the literature. Ultrasound Obstet Gynecol 2007;29(4):388–394. DOI: 10.1002/uog.3963
4. Lewis KM, Sherer DM, Goncalves LF, et al. Mid-trimester prenatal sonographic diagnosis of a pericardial cyst. Prenat Diagn 1996;16(6):549–553. DOI: 10.1002/(SICI)1097-0223(199606)16:6<549::AID-PD879>3.0.CO;2-9
5. AboEllail MAM, Kanenishi K, Marumo G, et al. Fetal HDlive silhouette mode in clinical practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4):413–419. DOI: 10.5005/jp-journals-10009-1428
6. AboEllail MAM, Tanaka H, Mori N, et al. HDlive silhouette mode in antenatal diagnosis of jejunal atresia. Ultrasound Obstet Gynecol 2016;48(1):131–132. DOI: 10.1002/uog.15737
7. Tenkumo C, Hanaoka U, AboEllail MAM, et al. HDlive Flow with HDlive silhouette mode in diagnosis of fetal hepatic hemangioma. Ultrasound Obstet Gynecol 2017;49(4):540–545. DOI: 10.1002/uog.16215
________________________
© The Author(s). 2023 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.