ultrasound diagnosis of fatal anomalies

OVARIAN CYSTS
Fig. 7.23 Ovarian cysts. Tilted cross-section of the
lower abdomen of a female fetus at 27 + 5 weeks,
showing two cystic lesions.
Fig. 7.24 Ovarian cysts. Same fetus in the previous
image, using color flow mapping: both umbilical arteries
are seen on either side of the urinary bladder.
A fetal ovarian cyst is seen next to it.
Differential diagnosis: Bowel duplication cysts,
mesenteric cysts, cysts of the liver and the gallbladder.
Clinical management: Further sonographic
screening, including fetal echocardiography.
Karyotyping is advised to exclude cyst formation
due to other causes. As spontaneous remission is
known to occur frequently, aspiration of the
cysts is controversial. Some authors advise intrauterine
aspiration if the cyst is larger than
4 cm, as there is a danger of torsion of this mass.
Procedure after birth: Ultrasound scanning of
the cyst after birth. Surgical treatment is only
then indicated if the lesion is larger than 4–6 cm
(to avoid possible torsion), if intra-abdominal
bleeding is suspected, or if the lesion is causing
bowel obstruction. Frequently, the cyst regresses
spontaneously, but this may take a few months.
Endoscopic removal of the cyst is also an option
in the neonate, as long as an experienced team of
surgeons is available to carry out this procedure.
Histologically, these cysts are theca lutein and
follicle cysts.
Prognosis: This is very good, as frequently the
cyst regresses spontaneously. Endoscopic removal
of the cyst with conservation of the rest of
the ovary is usually possible.
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