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Prenatal MR imaging of a meconium pseudocyst extending to the right subphrenic space with right lung compression
Alex M Wong1, Cheng-Hong Toh, Reyin Lien
1Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China.
Abstract:
Meconium pseudocyst results from a loculated inflammation occurring in response to spillage of meconium into the peritoneal cavity after a bowel perforation. Certain cystic lesions, such as abscesses and dermoid and epidermoid cysts, are known to show reduced water diffusion on DWI. MRI has recently become a valuable adjunct to ultrasonography for fetal gastrointestinal anomalies. Complementary to ultrasonography, prenatal MRI can help further characterize the lesion and can clearly demonstrate the anatomical relationship between the lesion and adjacent organs. We report a case of meconium pseudocyst that was prenatally imaged with ultrasonography and MRI, postnatally complicated by pneumoperitoneum, and proved by postnatal surgery and histopathology. We emphasize the MRI of the pseudocyst, particularly T1-weighted and diffusion-weighted imaging.
Insights
A meconium pseudocyst, a rare fetal anomaly, can be diagnosed prenatally using MRI. This imaging technique aids in characterizing the lesion and its relation to surrounding organs.
Area of Science:
- Medical imaging
- Fetal medicine
- Pediatric surgery
Background:
- Meconium pseudocysts arise from fetal bowel perforation and peritoneal spillage.
- Prenatal diagnosis of fetal gastrointestinal anomalies is crucial for timely intervention.
- Magnetic Resonance Imaging (MRI) is increasingly used alongside ultrasonography for fetal anomaly assessment.
Observation:
- This case highlights a meconium pseudocyst diagnosed prenatally via ultrasonography and MRI.
- The condition postnatally presented with pneumoperitoneum, necessitating surgical intervention.
- Histopathology confirmed the diagnosis of meconium pseudocyst.
Findings:
- Prenatal MRI effectively characterizes the meconium pseudocyst, detailing its anatomical context.
- Diffusion-weighted imaging (DWI) and T1-weighted sequences are particularly valuable for pseudocyst evaluation.
- Reduced water diffusion on DWI is a characteristic feature of certain cystic lesions, including meconium pseudocysts.
Implications:
- Prenatal MRI complements ultrasonography in diagnosing fetal gastrointestinal anomalies.
- Accurate prenatal characterization aids in surgical planning and management of meconium pseudocysts.
- This case underscores the utility of advanced MRI techniques in evaluating complex fetal conditions.
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