Cringu Ionescu

**8.2. Ultrasound diagnosis**

182 Congenital Anomalies - From the Embryo to the Neonate

can be encountered [40].

**8.4. Prenatal management**

**Acknowledgements**

**Figures 3** and **4**.

**8.3. Prognosis**

tissue and located in the previous mediastinum.

angle. The cyst wall may communicate with the pericardial space.

be established sometimes only after perinatal autopsy [43].

EXIT techniques are the treatment options in such cases.

The prenatal diagnosis of esophageal duplication cysts is based on the spherical aspect of the cyst, rarely on the tubular aspect, but with a thick, hyperechogenic wall determined by the presence of the gastric mucosa. Usually, the cyst is connected to the esophagus. If the dimensions of the esophageal duplication cyst are large due to the compression effect on the esophagus, the appearance of polyhidramnios may occur [37, 38]. The thymic cyst is formed from remnants of the thymopharangeal duct; they are usually very small and localized to the anterior mediastinum [38]. The ultrasound aspect is of a transonic mass surrounded by the thymic

Pericardial cyst, originating from the pericardium, appears at ultrasound examination as a thin walled, unilocular, fluid-filled transonic mass in the left or the right of the cardiophrenic

Neurenteric cysts are very rare; only eight cases have been diagnosed in the prenatal stage by the ultrasound [37–39]. If the size of the cyst is large, it can exert cardiac compression with the subsequent appearance of the hydrops. It can also exert compressive phenomena on the bronchi, which causes neonatal respiratory distress. Association with anomalies of the membrane

The differential diagnosis among the described mediastinal masses is sometimes difficult. Several elements should be considered: pericardial cyst is located in the cardiophrenic angle of the right hemothorax, thymic cysts are located in the anterior mediastinum and are surrounded by thymic tissue, and the enteric duplication cyst is in close contact with the esophagus [41, 42]. For differential diagnosis, we can also use fetal MRI. The origin of the mass can

The prognostic thymic cyst is favorable without affecting the condition of the fetus. The pericardial cyst can determine hydrops due to the compression on the heart. However, sometimes even in the case of reduced size, the pericardial cyst can be resorbed. The neurenteric cyst can cause cardiac compression and the appearance of hydrops as secondary effect. The esophageal duplication cyst determines polyhidramnios due to compression on the esophagus. The

The indication of in utero treatment is represented by the presence of hydrops and the presence of compression of the tracheobronchial tree [44]. Puncture with cyst aspiration or the

We would like to thank Rahimian Hadi MD, PhD, Regina Maria Hospital, Bucharest, for

risk of chromosomal anomalies is absent, so karyotyping is not recommended.

Address all correspondence to: antoniuginec@yahoo.com

Department of Obstetrics and Gynecology, Clinical Emergency Hospital St Pantelimon, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
