eMedicine Specialties > Radiology > Obstetrics/Gynecology

Cystic Hygroma: Follow-up

Author: Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Coauthor(s): Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Zahida Sabih, MBBS, MSc,
Contributor Information and Disclosures

Updated: Jul 17, 2008

Intervention

Amniocentesis and karyotyping are necessary to diagnose the chromosomal abnormalities that are commonly associated with fetal cystic hygroma.12,6

Once fetal cystic hygroma is diagnosed, all efforts should be aimed at identifying the associated anomalies and following up the patient to assess the development of fetal hydrops. Genetic counseling is necessary to discuss the diagnosis, other diagnostic possibilities, the possible need for karyotyping, and the potential risks to the fetus or child. The patient's family should be appropriately counseled regarding the risks in subsequent pregnancies.

The multidisciplinary procedure known as the ex utero intrapartum treatment (EXIT) is utilized when airway obstruction is anticipated.16 Intubation is attempted while, to avoid hypoxemia, uteroplacental circulation is maintained. EXIT is a valuable procedure in the management a congenital diaphragmatic hernia with intrauterine tracheal obstruction. Developing uses for EXIT include as a tool against cystic hygromas that cause airway obstruction. A combination of US and fetal MRI is increasingly being used in the detection of pathologies that cause fetal airway obstruction.

Related Medscape topic:
Resource Center Genomic Medicine

Medicolegal Pitfalls

  • Apparent resolution of a cystic hygroma does not always guarantee the health of a fetus.
  • A normal karyotype does not exclude all pathologies.
    • Cardiac defects, such as coarctation of the aorta and cardiac septal defects, can be present.
    • Other associated conditions include Noonan syndrome, Joubert syndrome, and polycystic kidney disease.9
  • A loop of umbilical cord near the neck can be mistaken for a cervical cyst. Doppler ultrasonogram findings can be used to easily identify the vascular characteristics of the umbilical cord.
  • In the background of severe oligohydramnios, pockets of amniotic fluid can simulate fetal cystic hygromas.

Special Concerns

There is an increased risk of cystic hygroma associated with maternal exposure to teratogens, such as alcohol, aminopterin, and trimethadione.

 


More on Cystic Hygroma

Overview: Cystic Hygroma
Imaging: Cystic Hygroma
Follow-up: Cystic Hygroma
Multimedia: Cystic Hygroma
References
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References

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  2. Jenderny J, Schmidt W, Hecher K, et al. Increased nuchal translucency, hydrops fetalis or hygroma colli. A new test strategy for early fetal aneuploidy detection. Fetal Diagn Ther. Jul-Aug 2001;16(4):211-4. [Medline].

  3. [Best Evidence] Graesslin O, Derniaux E, Alanio E, et al. Characteristics and outcome of fetal cystic hygroma diagnosed in the first trimester. Acta Obstet Gynecol Scand. 2007;86(12):1442-6. [Medline].

  4. Estroff JA. Nuchal translucency in Turner syndrome. In: Cohen HL, Sivit CJ, eds. Fetal and Pediatric Ultrasound. New York, NY: McGraw-Hill; 2001:36-8.

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  6. Gedikbasi A, Gul A, Sargin A, et al. Cystic hygroma and lymphangioma: associated findings, perinatal outcome and prognostic factors in live-born infants. Arch Gynecol Obstet. Nov 2007;276(5):491-8. [Medline].

  7. Bronshtein M, Bar-Hava I, Blumenfeld I, et al. The difference between septated and nonseptated nuchal cystic hygroma in the early second trimester. Obstet Gynecol. May 1993;81(5 pt 1):683-7. [Medline].

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  15. Cohen HL. Ascites and pleural effusion in hydrops. In: Cohen HL, Sivit CJ, eds. Fetal and Pediatric Ultrasound. New York, NY: McGraw-Hill; 2001:79-82.

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Further Reading

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Keywords

cystic hygroma, cystic lymphangiomas, familial nuchal blebs, FCH, fetal cystic hygromas, cystic hygroma colli, jugular lymphatic obstructive sequences, moist tumors, lymphatic malformations, Turner syndrome, Turner's syndrome, trisomy 21, Down syndrome, Down's syndrome, trisomy 18, Edwards syndrome, Noonan syndrome, Noonan's syndrome

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Contributor Information and Disclosures

Author

Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Zahida Sabih, MBBS, MSc, 
Disclosure: Nothing to disclose.

Medical Editor

Harris L Cohen, MD, FACR, Vice Chairman/Associate Chairman (Research Activities), Director, Division of Body Imaging, Professor of Radiology, Stony Brook School of Medicine; Visiting Professor of Radiology, Johns Hopkins School of Medicine
Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Association of Program Directors in Radiology, Radiological Society of North America, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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