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Radiology
Intraabdominal Masses
Built from Obstetric Imaging
What’s inside
11 sections · 101 slides
Overview
- What this deck covers
What an intraabdominal mass is
A space-occupying lesion in the fetal belly - and why it is usually a surprise
- A lump where there should not be one
- Why these masses are almost always a surprise
- Any organ in the belly can make a mass
- Four questions that shorten the list
How common are they
Rare enough that good population numbers are hard to get
- <2%
- Blocked tubes: how often the gut fails to open
- Some lesions belong to one sex only
- The commonest bright mass is bowel itself
- Bright spots in the liver
Why they happen
Development that failed, a blood-supply accident, infection, or a cyst that grew
- Development that never finished
- Do the chromosomes explain it?
- When to reach for gene sequencing
- Small bowel atresia starts as a blood-supply accident
- The same accident, different company
- Why a duplication cyst drags the spine into it
- When a gene makes the bowel look bright
- Infection and perforation leave calcium behind
- Calcium takes weeks to appear
- Three places calcium settles in the liver
- Why liver calcification forms at all
- How a fetal ovarian cyst grows
- When a simple cyst turns complex
- Tumours in the fetus are rare
- What a liver tumour looks like on the screen
When and how they show up
The gut only starts working properly in the third trimester
- The gut matures late, so its problems show late
- How much fluid the fetus swallows
- The double bubble of duodenal atresia
- The lower the block, the quieter the signs
- Ovarian cysts only appear late
The three scan windows
What each routine scan is designed to find, and what it can miss
- Three chances to see the abdomen
- The first-trimester scan
- What happened to five early cysts
- The 20-week anomaly scan
- What to check in the abdomen at 20 weeks
- The third-trimester growth scan
Describing the mass
Angle, plane, settings and Doppler - the four ways to make it declare itself
- Once you see a mass, keep scanning
- Where it sits tells you what it is
- Cystic tubular mass seen in two planes
- Axial view: a single cystic tube behind the belly wall
- Coronal view: the same cyst wraps around the pelvis
- What the second plane changed
- Turn the knobs, not just the probe
- The vocabulary of describing a mass
- A highly vascular pelvic and abdominal teratoma
- Mixed-echogenicity mass distorting the pelvic wall
- Colour Doppler shows the mass is full of vessels
- Why the Doppler picture mattered here
- > 7 mm
- Where those cut-offs come from
- Dilated large bowel found by accident
- Simple against complex ovarian cyst
- A complex ovarian cyst at 32 weeks
- What torsion looks like, and what follows
- A cystic mass that is never alone
- How to call something a calcified focus
- Calcification inside the liver
- The largest series of all
- Imaging does not stop at delivery
What MRI adds
Panoramic pictures, soft tissue contrast, and meconium as a free contrast agent
- Why look beyond ultrasound
- Meconium is its own contrast agent
- What a 32-case series found
- What MRI changed in 38 referrals
- Fetal MRI of a fluid-filled vagina and uterus
- Reading that MRI
Working through the differential
Site, contents and company - the table this diagnosis is built on
- How to use the differential list
- Differential diagnosis: simple cyst
- Differential diagnosis: simple cyst (continued)
- Differential diagnosis: double cyst
- Differential diagnosis: complex cyst
- Differential diagnosis: dilated tubular structure
- Differential diagnosis: dilated tubular structure (continued)
- Differential diagnosis: hyperechogenic bowel
- Differential diagnosis: intraabdominal calcification
- How accurate is prenatal ultrasound here?
- What that means at the bedside
- Reading the case series table
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: who was studied
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: who was studied (continued)
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: what was found
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: what was found (continued)
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: accuracy and outcome
- Case series reporting the diagnosis and outcome of fetuses with intraabdominal masses: accuracy and outcome (continued)
What to do about it
Before birth, after birth, and what the referring doctor needs to hear
- Planning when you cannot name it
- Why not intervene before birth
- Draining an ovarian cyst before birth
- Two situations where action does help
- Where prenatal diagnosis really pays off
- Three principles for the newborn
- What the referring physician needs to know
- Key points
- The five things to carry away
References
The source reference list, reproduced in full
- References
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- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition