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Antenatal intra-abdominal cystic lesions are being increasingly diagnosed, especially in the modern era of high-quality scanning equipment. We describe the initial diagnosis, progress and outcome of a fetal splenic cyst. The accompanying images illustrate the progress of the lesion antenatally up to 13 months postnatal age. The case demonstrates the importance of ultrasound surveillance and expectational management in such lesions.
Case Report
A unilocular fetal cyst (figs 1–3) of unknown origin was discovered in a 29-year-old woman during routine antenatal ultrasonography at 23+2 weeks gestational age. The cyst was behind the stomach and above the upper pole of the left kidney, with differential diagnoses being splenic cyst, adrenal cyst/haematoma, duplication cyst of stomach or bowel, mesenteric or ovarian cyst or infradiaphragmatic cystic lung lesions. This cyst was not seen in her earlier scan at 20 weeks. No other fetal or pregnancy related abnormalities were detected.
Similar findings were seen at 29 weeks with no further enlargement of the cyst. The cyst was now noted to be superior and lateral to the adrenal gland, possibly retroperitoneal with no clear blood supply of its own, raising a strong possibility of splenic cyst. In view of the small size and static nature of cystic lesion, no antenatal surgical interventions were planned. The 35-week scan confirmed it to be of splenic origin.
A healthy baby girl weighing 3610 g was delivered by this woman via assisted forceps at 40+4 weeks gestational age. No hyperbilirubinaemia or abdominal mass was noted in the newborn period. The images in the present report (figs 1–7) show the progress of the lesion at varying gestational/postnatal age. A further scan at 13 months of age showed a complete resolution of the cystic mass.
Antenatally diagnosed splenic cysts are rare and usually benign, and prognosis is good. On ultrasound surveillance, they have been reported to spontaneously regress postnatally or occasionally remain unchanged on follow-up.1,2 Nevertheless, the risk of complications postnatally such as rapid enlargement, haemorrhage, infection or rupture are rare, but still exist. Therefore periodical ultrasound examination seems a justified policy of asymptomatic congenital splenic cyst management, as long as the cyst is present in the patient’s spleen. When a splenic cyst is detected, it is necessary to look for cysts in other organs such as kidneys, liver, pancreas and lungs, to rule out the possibility of polycystic disease.
Most splenic cysts resolve spontaneously without any antenatal/postnatal surgical intervention. Knowledge of the differential, aetiology and progression is crucial in the antenatal counselling and management of such cases.
Footnotes
Competing interests: None.
Patient consent: Patient/guardian consent was obtained for publication.