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Radiology
Cystic Hygroma
Built from Obstetric Imaging
What’s inside
8 sections · 64 slides
Overview
- What this deck covers
What cystic hygroma is
The commonest neck finding on early fetal scans
- Start with the plain picture
- The formal definition
- Two forms, split by the walls inside
- Do the internal walls matter?
- 1:6000
- Reading those numbers
Why it happens
A missing junction between lymph vessels and veins
- Where lymph is supposed to go
- How lymph drains back into the veins
- The fault that starts it all
- What the scan is actually showing
- Two roads from here
- When the blockage gets worse
- When an escape route opens
- Rarely alone
- Turner syndrome leads the list
- A karyotype showing a single X chromosome
- The rest of the chromosome list
- Why a karyotype is not enough
- When to go further than microarray
- Causes that are not genetic
- A long list of named syndromes
- Genetic and Malformation Syndromes Associated With Cystic Hygroma
- Genetic and Malformation Syndromes Associated With Cystic Hygroma (continued)
- Genetic and Malformation Syndromes Associated With Cystic Hygroma (continued)
- One entry on that list needs unpacking
What happens to the baby
A course that can settle, or slide into hydrops
- The course is not fixed
- 10-20%
- Why hydrops is the turning point
- Planning the delivery
- Life after birth
How it looks on the scan
Dark pockets behind the neck, and no Doppler flow
- The core ultrasound picture
- The classic shape
- Bilateral and split by a ligament
- What the amniotic fluid does
- Search the rest of the fetus
- Is it a hygroma or a thick nuchal translucency?
- Measuring nuchal translucency in the first trimester
- Where the line is drawn in practice
- Where MRI earns its place
What else it could be
Six lookalikes, told apart by position and content
- The lookalikes at a glance
- Two questions that sort most cases
- Brain and meninges pushed through the skull
- A gap in the skull bone points away from hygroma
- The bone gap seen close up
- Cystic masses arising elsewhere
- Masses you can tell apart by texture
- The tail of the list
Treatment
Little to offer before birth, surgery and sclerosants after
- Before birth, the evidence is thin
- Surgery is the postnatal first choice
- Why some lesions come back
- When surgery is not the answer
- What to do the day you see it
Take-home messages
What the referring clinician has to hear
- What the referring physician needs to know
- How to frame the prognosis
- Key points
- The whole topic in five lines
- Suggested readings
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition