Journal of Ultrasound in Medicine, Vol 16, Issue 2 75-83, Copyright © 1997 by American Institute of Ultrasound in Medicine
Prenatal ultrasound characterization of the suprarenal mass: distinction between neuroblastoma and subdiaphragmatic extralobar pulmonary sequestration
M. R. Curtis, D. P. Mooney, T. J. Vaccaro, J. C. Williams, M. Cendron, N. A. Shorter and S. K. Sargent
Department of Surgery, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756-0001, USA.
With the increased routine use of prenatal ultrasonography,
subdiaphragmatic masses in the fetus are identified more frequently.
Suprarenal masses often are presumed to be neuroblastoma and are removed
surgically postnatally. We sought to better understand the natural history
of subdiaphragmatic extralobar pulmonary sequestration, and to determine if
subdiaphragmatic extralobar pulmonary sequestration can be distinguished
preoperatively from neuroblastoma. The literature was reviewed for cases of
prenatally diagnosed suprarenal masses that proved ultimately to be either
subdiaphragmatic extralobar pulmonary sequestration or neuroblastoma. The
distinguishing features of the two lesions were identified and an algorithm
was created on the basis of these distinctions. Prenatally diagnosed
subdiaphragmatic extralobar pulmonary sequestration is no longer rare, with
one case being reported for every 2.5 cases of neuroblastoma. On prenatal
ultrasonography subdiaphragmatic extralobar pulmonary sequestration usually
is echogenic, is left-sided, and can be identified in the second trimester.
Neuroblastoma is most often cystic, right-sided, and identified in the
third trimester. In summary, subdiaphragmatic extralobar pulmonary
sequestration must be considered in the differential diagnosis of the
suprarenal mass identified on prenatal ultrasonography. Using the algorithm
which we propose, the correct diagnosis can be determined prenatally in 95%
of patients.
