Fetal pulmonary sequestration: a case report
Fetal extra-pulmonary sequestration
A 24-year-old women was referred to our fetal medicine unit (FMU) due to a left subdiaphragmatic mass at the 30weeks routine ultrasound (US). Pregnancy had a late surveillance onset with 1st US performed at 26weeks, described as normal. The evaluation at FMU (30W) confirmed an hyperechogenic subdiaphragmatic left mass with 27x 20mm, with a vessel arising from the descending aorta suggestive of EPS. Differential diagnosis of an adrenal mass such as neuroblastoma was considered. Karyotype and microarrays were normal and cathecolamines level on the amniotic fluid was inconclusive. MRI suggested the diagnosis of suprarenal neuroblastoma more likely than EPS. Mass growth was not identified in follow-up US. Postnatal CT scan confirmed the diagnosis of EPS.
This case reinforces the importance of colour Doppler for the differential diagnosis of fetal masses, in particular for the differential diagnosis of PS. Although MRI allows a better characterisation of the mass, colour and power Doppler are important tools for identifying the systemic vascular supply with convenience, safety and low cost. An accurate prenatal diagnosis of a subdiaphragmatic mass is preponderant for prenatal counselling and management of the pregnancy and birth.