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Radiology
Sacrococcygeal Teratoma and Fetus in Fetu
Built from Obstetric Imaging
What’s inside
10 sections · 72 slides
Overview
- What we will build up
What the tumour actually is
A lump at the tailbone built from every kind of tissue
- Start with the lump
- What is inside a teratoma
- Fetus in fetu, in plain words
- 50%
- Six ways a fetus gets into trouble
- How common, and in whom
- How rare fetus in fetu is
- How the tumour begins
- Why these tumours sit in the midline
- What causes it
- Other malformations that travel with it
- Benign, but far from harmless
Reading the ultrasound: three types
How much of it is fluid, and how much blood is going in
- The one question to answer first
- Three types, three outlooks
- Type A: mostly fluid-filled
- Fluid-filled tumour at the fetal tailbone
- Cystic tumour with a completely internal component
- A cystic tumour can still become huge
- Enlarging fluid-filled tumour late in pregnancy
- Draining the cyst before delivery
- Newborn after drainage of the cystic tumour
- Type B: part fluid, part solid
- Solid tumour seen in the second trimester
- Large solid tumour folded back over the fetal spine
- The tumour behaves like a short circuit
- From tumour blood flow to heart failure
- Signs the fetal heart is failing
- Enlarged fetal heart from a high-flow tumour
- Blood stolen away from the placenta
- Bleeding inside the tumour
- Big placenta, extra fluid, and the risk of rupture
- Type C: solid tumour with fetal hydrops
- When the mother becomes ill too
- Turning down the tumour's blood supply
- Measuring the risk with a ratio
- How the prognostic table is used
- Prognostic After Prenatal Diagnosis of Sacrococcygeal Teratoma
Classifying and grading the tumour
How far it extends, and what the pathologist sees
- Why a surgical classification exists
- Classification of Extent of Sacrococcygeal Teratomas According to the American Academy of Pediatrics Surgical Section
- Grading under the microscope
- Grading of Sacrococcygeal Teratomas
Fetus in fetu
The rarer condition that shares the same territory
- Where a fetus in fetu comes from
- Where it sits, and what it contains
- How it looks on imaging
How it shows up in the pregnancy
The signs that bring the fetus to attention
- Clinical presentation
- Two separate reasons for the extra fluid
Imaging technique and findings
Grayscale, 3D, Doppler and MRI, each answering a different question
- Grayscale ultrasound: the workhorse
- The mistake to avoid
- Adding three-dimensional ultrasound
- Surface view of a solid tumour at 18 weeks
- Doppler: reading the blood supply
- Warning signs gathered in one place
- Where MRI adds something ultrasound cannot
- Alpha-fetoprotein testing
What else it could be
Other masses that sit in the same place on a scan
- Look-alikes on the scan
- More on the differential list
- Calcification in the newborn abdomen
Treatment options
Before delivery, at delivery, and after birth
- Before birth: taking pressure off
- When fetal surgery is even considered
- Four ways of operating before birth
- Planning the delivery
- Preterm caesarean delivery of a fetus with a tailbone tumour
- Handling the newborn
- Treating a fetus in fetu
Pulling it together
What the referring physician needs, and the points to keep
- What the referring physician needs to know
- Key points
- Suggested reading
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition