VP13.06: First trimester diagnosis of Sirenomelia associated with an abdominal cyst

Before the use of ultrasound, many ovarian tumors remained undiagnosed until cesarean section oruntil they became symptomatic. Now, many symptomatic or non-symptomatic adnexal tumors arediagnosed by ultrasound during pregnancy follow-up.In most cases, the adnexal tumors discoveredduring pregnancy are benign with a maximum diameter of 5 cm. Approximately 70% of the cysticadnexal tumors identified in the first trimester resorb spontaneously until the beginning of thesecond trimester (usually those are functional cysts). Persistent adnexal tumors larger than 5 cmare generally mature teratomas (dermoid).In this case, at the emergency room a 34 year-old-women came with almost 20 weeks pregnancy, accusing acute abdominal pain, nausea andvomiting. One week before, the patient went for a routine ultrasound for pregnancy and the doctordiscovered a giant tumor larger than 15 cm (due to the size it could not be measured) with fluidcontent. Two days before the symptoms, the patient went for an abdominal MRI where a voluminouspelvic-abdominal cyst with almost 30 cm in diameter was discovered. Differential diagnosis:ovarian torsion or ruptured cyst complicating pregnancy. What is the correct diagnosis and what isto be done since there is a 20 weeks pregnancy?

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Can Anorectal Atresia Be Diagnosed in the First Trimester of Pregnancy? A Systematic Literature Review

Medicina ◽

10.3390/medicina56110583 ◽

2020 ◽

Vol 56 (11) ◽

pp. 583

Author(s):

Liana Ples ◽

Radu Chicea ◽

Mircea-Octavian Poenaru ◽

Adrian Neacsu ◽

Romina Marina Sima ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

First Trimester ◽

Vitro Fertilization ◽

Detailed Evaluation ◽

First Trimester Of Pregnancy ◽

Anorectal Atresia ◽

Abdominal Cyst ◽

First Trimester Scan

Anorectal atresia (ARA) is a common congenital anomaly, but prenatal diagnosis is difficult, late, and unspecific. Utilizing a case of a 46 year old primipara with an egg donation In Vitro Fertilization (IVF) pregnancy, diagnosed at the first trimester scan with an anechoic isolated structure, which indicates anal atresia, we performed a systematic literature review in order to evaluate early prenatal ARA diagnosis. A total of 16 cases were reported as first trimester ARA suspicion, and only three had no associated anomalies. The most frequent ultrasound (US) sign was the presence of a cystic, anechoic pelvic structure of mainly tubular shape, or a plain abdominal cyst. In the majority of cases, structures were thin-walled and delimitated from the bladder. The presence of hyperechoic spots signifying enterolithiasis and peristaltic movements were helpful in order to establish the bowel origin of the lesion. Considering the high eventuality that the lesion is transitory, meaning later in pregnancy the fetus looks normal, early detection of such a sign should prompt further structural detailed evaluation, karyotyping, and appropriate pregnancy and postnatal counselling.

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