David Freddy, MD.

Israel

 

A 34-year old woman (P3G4), with unremarkable history, presented to our unit for the first time at 12 week of pregnancy. A cystic structure was observed within the fetal abdomen, under the level of insertion of the umbilical cord. The size of the structure was 11 mm and was separated from the urinary bladder, kidneys and gallbladder. At 17 weeks we noticed calcifications around the intestines and along the abdominal wall. We considered the cystic structure to be of intestinal or peritoneal origin. Toxoplasma IGG, IGM, Varicella IGG, IGM, CMV IGG, IGM and Rubella IGG, IGM, CF, and Fragile X tests were normal.

In our differential diagnostic contemplation we were thinking about:

• Renal origin;

• Ovarian origin (which was excluded, because the gender of the fetus was masculine);

• Gastrointestinal origin, especially from small intestine, which can explain the presence of calcifications around the intestine and along the abdominal wall;

• Gut duplication cyst;

• Choledochal cyst;

• Urachal cyst;

• Teratoma;

• Liver cyst (viral infection, liver tumor);

• Duodenal atresia.

Amniocentesis discovered normal karyotype (46, XY). At 29 weeks the cystic structure disappeared and all further ultrasounds were normal. The woman gave birth to a healthy neonate at 40 weeks of pregnancy (3800 g). The above facts led us to the diagnosis of the transient abdominal cyst.

Images 1, 2. 12 weeks of pregnancy; gray scale and color Doppler images showing sagittal scan through the fetal abdomen with cystic structure between the urinary bladder and insertion of the umbilical cord.

 

Images 3, 4. 12 weeks of pregnancy; gray scale images showing sagittal scan through the fetal abdomen with cystic structure between the urinary bladder and insertion of the umbilical cord.

 

Images 5, 6. 12 weeks of pregnancy; color Doppler sagittal scan (Image 5) and transverse gray scale scan (Image 6) showing fetal abdomen with cystic structure.

 

Images 7, 8. 17 weeks of pregnancy; transverse planes through the fetal abdomen showing cystic structure in the anterior part. Small calcifications were seen around the intestines.