RESUMO
BACKGROUND: The use of the ex utero intrapartum treatment (EXIT) procedure has salvaged many fetuses with giant neck masses. Despite an adequate airway, a subset of these patients die from an inability to achieve adequate gas exchange. METHODS: We reviewed our experience with the EXIT procedure from 1996 to 2004. The EXIT was used to deliver 23 fetuses with giant neck masses. RESULTS: Three fetuses with giant cervical teratomas died of severe pulmonary hypoplasia. On postmortem, these patients had severe airway distortion by the mass. The carina was retracted superiorly to the first or second rib resulting in compression of the lungs in the apices of the chest and pulmonary hypoplasia. Hypoplasia was reflected in the lung weights of 24 vs 38 g and 17 vs 34 g for age-matched normal lung. CONCLUSIONS: Unsuspected obstructive fetal neck masses can be fatal because of an inability to secure an airway. Prenatal ultrasonography can identify fetuses at risk, allowing the fetus to be salvaged using the EXIT procedure. Despite obtaining airway control, a subset of these patients will die because of pulmonary hypoplasia. When counseling patients with large cervical masses it is important to discuss potential pulmonary hypoplasia in these patients.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Pneumopatias/etiologia , Pescoço/patologia , Teratoma/complicações , Obstrução das Vias Respiratórias/terapia , Autopsia , Parto Obstétrico , Evolução Fatal , Humanos , Recém-Nascido , Pneumopatias/congênito , Troca Gasosa Pulmonar , Estudos Retrospectivos , Teratoma/congênito , Resultado do TratamentoAssuntos
Proteínas da Matriz Extracelular/genética , Doenças Fetais/patologia , Doenças Fetais/fisiopatologia , Obstrução do Colo da Bexiga Urinária/patologia , Obstrução do Colo da Bexiga Urinária/fisiopatologia , Animais , Peso Corporal , Colágeno Tipo I/genética , Colágeno Tipo III/genética , Modelos Animais de Doenças , Elastina/genética , Feminino , Doenças Fetais/diagnóstico por imagem , Fibrilinas , Fibronectinas/genética , Expressão Gênica , Hidronefrose/diagnóstico , Ligadura , Masculino , Proteínas dos Microfilamentos/genética , Tamanho do Órgão , Gravidez , RNA Mensageiro/análise , Fatores Sexuais , Ovinos , Ultrassonografia , Bexiga Urinária/patologia , Bexiga Urinária/fisiopatologia , Obstrução do Colo da Bexiga Urinária/diagnóstico por imagemRESUMO
Extrarenal collections of urine have long been associated with obstructive uropathy and may preserve renal function by acting as a "popoff" valve. Although urinary extravasation manifested as urinary ascites carries a favorable prognosis, perinephric urinomas occurring prenatally are associated with poor renal function in most cases. We report the case of a baby girl with a urinoma diagnosed by fetal magnetic resonance imaging and discuss the significance of this radiologic finding.