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Ultrasound Evaluation of Congenital Cervical Teratoma and Therapeutic Management (Ex Utero Intrapartum Treatment)

DOI: 10.1155/2012/597489

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The ultrasound evaluation of the fetal neck has a high importance as a key point of the airway and digestive tract. We report the case of a fetus diagnosed with a cervical teratoma by ultrasound, which generated a compressive effect on airway, requiring a surgical approach EXIT (ex utero intrapartum treatment) to ensure the extrauterine viability. 1. Introduction The ultrasound evaluation of the fetal neck is increasingly important, because it has a high impact on fetal adaptation to extrauterine life. The presence of masses in this location can cause obstructive problems at airway, producing complications during the course of pregnancy, as the development of polyhydramnios. But the biggest problem is after delivery, with the appearance of acute neonatal asphyxia with newborn death, if you do not carry out invasive techniques for resolution. One of these approaches is the realization of EXIT surgery, a technique designed to allow partial fetal delivery by cesarean section, with establishment of a secure airway, using intubation, bronchoscopy, or tracheostomy, while fetal oxygenation is maintained by the uteroplacental circulation. 2. Case Presentation A primigravida, 25-years-old patient, it showed a cervical tumor heterogeneous solid-liquid content of 43 × 44?mm, moderately vascularized, in ultrasound study in week 22 (Figure 1), with male fetus and normal anatomical exploration, visualizing gastric chamber. We propose to make a genetic amniocentesis, but the patient rejected it. Magnetic resonance (MR) was requested in the 25th week of gestation, describing 56 × 43 × 38?mm heterogeneous mass in anterior cervical position, with high bilateral extension, solid-cystic component, without thoracic infiltration (Figure 2). We suspect a congenital cervical teratoma by ultrasound and MR images. Figure 1: Ultrasound at 22 weeks, where heterogeneous tumor is found in cervical position, moderately vascularized. Figure 2: Nuclear magnetic resonance at 25 weeks, showing heterogeneous mass in cervical situation. New ultrasound study in 26 +5 weeks, shows a significant growth of the mass, 69 × 53?mm size (Figure 3). The patient wishes to continue the pregnancy. New MR control in week 29, shows an increase of significant size, high anterior growth, without existing intrathoracic extension. Similar proportion of solid and cystic component, with a sagittal plane measurement of 61 × 63?mm and coronal plane 51 × 93?mm, with partial compression of the air-digestive track, but an adequate fetal stomach fullness. Figure 3: 3D ultrasound. During follow-up controls, we


[1]  F. Y. Lim, T. M. Crombleholme, H. L. Hedrick et al., “Congenital high airway obstruction syndrome: natural history and management,” Journal of Pediatric Surgery, vol. 38, no. 6, pp. 940–945, 2003.
[2]  S. Hirose, R. M. Sydorak, K. Tsao et al., “Spectrum of intrapartum management strategies for giant fetal cervical teratoma,” Journal of Pediatric Surgery, vol. 38, no. 3, pp. 446–450, 2003.
[3]  C. J. Hartnick, M. Rutter, F. Lang, J. P. Willging, and R. T. Cotton, “Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm,” Archives of Otolaryngology—Head and Neck Surgery, vol. 128, no. 5, pp. 567–570, 2002.
[4]  D. Oepkes, A. K. K. Teunissen, M. Van de Velde, H. Devlieger, et al., “Congenital high airway obstruction síndrome successfully managed with ex—utero intrapartum treatment,” Ultrasound in Obstetrics & Gynecology, vol. 22, pp. 437–439, 2003.
[5]  S. Manrique, F. Blasco, F. Munar, E. Andreu, M. D. Mateo, et al., “Dos casos de obstrucción de la vía aérea sometidos a EXIT: implicaciones anestésicas,” Revista Espa?ola de Anestesiología y Reanimación, vol. 54, pp. 45–48, 2007.
[6]  C. Kill, B. Gebhardt, S. Schmidt, J. A. Werner, R. F. Maier, and H. Wulf, “Anesthesiological management of the EXIT procedure. Case report and literature review,” Anaesthesist, vol. 54, no. 11, pp. 1105–1110, 2005.
[7]  H. L. Hedrick, “Ex utero intrapartum therapy,” Seminars in Pediatric Surgery, vol. 12, no. 3, pp. 190–195, 2003.


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