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Abstract：
OBJECTIVE: The differential diagnosis for prenatal suprarenal masses (SRMs) is broad and includes neuroblastoma, adrenal hemorrhage, and subdiaphragmatic extralobar pulmonary sequestration (SEPS). We sought to elucidate the appropriate postnatal management for fetuses found to have an SRM.
METHODS: We conducted a retrospective review of patients prenatally diagnosed with SRM at our institution between 1998 and 2018. Prenatal characteristics, imaging, and neonatal outcomes were collected. We also performed a PubMed literature search and pooled analysis of all patients with a prenatally diagnosed SRM previously described in the literature.
RESULTS: The literature review yielded 32 studies, of which 19 were single case reports. In our case series, 12 patients were included. Seven patients were delivered vaginally, one was terminated. Postnatal diagnoses included: SEPS (n = 5), adrenal hemorrhage (n = 3), polycystic kidney (n = 2), splenic cyst (n = 1), and unknown for one patient. All but two of the final diagnoses had been on the initial diagnostic differential. With the exception of the terminated fetus, all remain alive today. On pooled analysis, patients who underwent operative management were diagnosed later 32 versus 24 weeks and had a significant predominance of left-sided lesions (59.5 versus 39.2%). The published literature demonstrates a trend toward observation versus resection over the past 30 years.
CONCLUSIONS: Patients prenatally diagnosed with an SRM have an excellent prognosis. Our series demonstrates a high incidence of SEPS, which were all resected, and adrenal hemorrhage, which were observed with repeat imaging. These patients can be followed with serial postnatal ultrasounds to determine the diagnosis prior to deciding the appropriate treatment.
METHODS: We conducted a retrospective review of patients prenatally diagnosed with SRM at our institution between 1998 and 2018. Prenatal characteristics, imaging, and neonatal outcomes were collected. We also performed a PubMed literature search and pooled analysis of all patients with a prenatally diagnosed SRM previously described in the literature.
RESULTS: The literature review yielded 32 studies, of which 19 were single case reports. In our case series, 12 patients were included. Seven patients were delivered vaginally, one was terminated. Postnatal diagnoses included: SEPS (n = 5), adrenal hemorrhage (n = 3), polycystic kidney (n = 2), splenic cyst (n = 1), and unknown for one patient. All but two of the final diagnoses had been on the initial diagnostic differential. With the exception of the terminated fetus, all remain alive today. On pooled analysis, patients who underwent operative management were diagnosed later 32 versus 24 weeks and had a significant predominance of left-sided lesions (59.5 versus 39.2%). The published literature demonstrates a trend toward observation versus resection over the past 30 years.
CONCLUSIONS: Patients prenatally diagnosed with an SRM have an excellent prognosis. Our series demonstrates a high incidence of SEPS, which were all resected, and adrenal hemorrhage, which were observed with repeat imaging. These patients can be followed with serial postnatal ultrasounds to determine the diagnosis prior to deciding the appropriate treatment.
摘要：
目的：产前肾上肿块（SRMs）的鉴别诊断广泛，包括神经母细胞瘤，肾上腺出血,和膈下叶外肺隔离症（SEPS）。我们试图阐明发现患有SRM的胎儿的适当产后管理。
方法：我们在1998年至2018年间对我们机构的产前诊断为SRM的患者进行了回顾性回顾。产前特征,成像,并收集新生儿结局。我们还进行了PubMed文献检索，并对所有先前在文献中描述的产前诊断为SRM的患者进行了汇总分析。
结果：文献综述产生了32项研究，其中19例为单例报告。在我们的案例系列中，包括12名患者。七名患者经阴道分娩，一个被终止了。产后诊断包括：SEPS（n=5），肾上腺出血（n=3），多囊肾（n=2），脾囊肿（n=1），对一个病人来说是未知的。除两项最终诊断外，其他所有诊断都是在最初的诊断鉴别上。除了终止的胎儿，今天所有人都还活着。在汇总分析中，接受手术治疗的患者分别在32周和24周之后诊断,且左侧病变占显著优势(59.5%和39.2%).已发表的文献显示了在过去30年中观察与切除的趋势。
结论：产前诊断为SRM的患者预后良好。我们的系列展示了SEPS的高发率，都被切除了，肾上腺出血,用重复成像观察。在决定适当的治疗之前，可以对这些患者进行连续的产后超声检查以确定诊断。
方法：我们在1998年至2018年间对我们机构的产前诊断为SRM的患者进行了回顾性回顾。产前特征,成像,并收集新生儿结局。我们还进行了PubMed文献检索，并对所有先前在文献中描述的产前诊断为SRM的患者进行了汇总分析。
结果：文献综述产生了32项研究，其中19例为单例报告。在我们的案例系列中，包括12名患者。七名患者经阴道分娩，一个被终止了。产后诊断包括：SEPS（n=5），肾上腺出血（n=3），多囊肾（n=2），脾囊肿（n=1），对一个病人来说是未知的。除两项最终诊断外，其他所有诊断都是在最初的诊断鉴别上。除了终止的胎儿，今天所有人都还活着。在汇总分析中，接受手术治疗的患者分别在32周和24周之后诊断,且左侧病变占显著优势(59.5%和39.2%).已发表的文献显示了在过去30年中观察与切除的趋势。
结论：产前诊断为SRM的患者预后良好。我们的系列展示了SEPS的高发率，都被切除了，肾上腺出血,用重复成像观察。在决定适当的治疗之前，可以对这些患者进行连续的产后超声检查以确定诊断。
