CASE OF THE DAY 7 NOV
A 35-year-old woman at 29 ws gestational age with normal 2nd trimester anomaly scan.
What is the best diagnosis?
2) Fetal left adrenal neuroblastoma
▪ Ultrasonography in axial view of fetal abdomen identifying a hyper echogenic mass above the right kidney with internal echogenic foci and vascularity. Fetal magnetic resonance T2-weighted axial and coronal images showing an irregular high signal mass in the site of left adrenal with extension around aorta and inferior deviation of left kidney.
- Fetal neuroblastoma is a type of congenital neuroblastoma.
- Ultrasound, they are typically seen as a solid extra renal mass, however cystic change maybe the predominant feature, around the expected position of the fetal adrenal gland displacing the kidney inferiorly. Hyper echogenic areas maybe observe with micro calcification and distal acoustic shadowing. Color Doppler interrogation often shows diffuse vascularity rather than a single feeding vessel. To help confirm location and exclude adrenal hemorrhage MRI can be complementary. Signal characteristics vary depending on cystic or solid composition. T2-weighted images reveal a marked signal in the cystic component and moderate signal in the solid composition.
- Werner, Heron, et al. “Fetal neuroblastoma: ultrasonography and magnetic resonance imaging findings in the prenatal and postnatal IV-S stage.” Obstetrics & Gynecology Science 59.5 (2016): 407-410.
- Schwärzler, P., et al. “Prenatal diagnosis of fetal adrenal masses: differentiation between hemorrhage and solid tumor by color Doppler sonography.” Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 13.5 (1999): 351-355.
Courtesy of Behnaz Moradi,MD,Assistant Professor Department of Radiology, Yas HospitalTehran University of Medical Sciences.