Case of the Week # 518

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Javier Cortejoso

Case of the week # 518
April 16, 2020 - June 4, 2020

Javier Cortejoso, MD, Phd ; Henar Crespo, MD ; Ana Ferrero, MD.
Spain


Case report
A 40-years-old patient, (G3P1), was referred at 20+1 weeks of gestation for routine obstetrical ultrasound examination. 
Due to the incidental finding, we performed amniocentesis for fetal karyotype, with a normal result. 
The rarity and uncertainty of the prenatal ultrasound findings prompted us to undertake prenatal MRI to define better the finding and its relationship with adjacent organs. 
We obtained the following images:

Images 1-4.
Image 1
Image 2
Image 3
Image 4

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Answer

Answer to the case of the week # 518
April 16, 2020 - June 4, 2020

Javier Cortejoso, MD, PhD ; Henar Crespo, MD ; Ana Ferrero, MD.
Spain


Case report
A 40-years-old patient, (G3-P1), was referred at 20+1 weeks of gestation for routine obstetrical ultrasound examination. 
This detected a 10 x 6 mm cyst in the upper abdomen of the fetus, adjacent to the fetal stomach (images 1 and 2)
Given the finding of an image suggestive of double bubble sign in certain sections, we performed amniocentesis for fetal karyotype, with a normal result. 
On subsequent sonograms obtained during the course of gestation, the image gave the impression of a cyst protruding into the lumen of the stomach. The rarity and uncertainty of the prenatal ultrasound findings prompted us to undertake prenatal MRI to define better the cyst origin and relationship with adjacent organs. T2-weighted sequences showed a round, well-circumscribed, hyperintense 1 cm mass without communication with gastric lumen, below the diaphragm and adjacent to the gastric fundus / gastro-esophageal junction (images 3 and 4). The other abdominal organs appeared to be normal. Omental, mesenteric, choledochal, and neurenteric cysts should be considered in the differential diagnosis.

At 40+2 weeks' gestation, an apparently normal and healthy 4050 gr. girl was delivered with no suggestion of a gastrointestinal obstruction. The newborn was treated by excision of duplication cyst by laparoscopic approach at 14 days of life, being its immediate and long-term evolution without complications. Histologic test confirmed a duplication cystic lesion of the stomach.

Images 1-4: 2D ultrasound and MR T2 images showing the cyst described previously.

Image 5

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