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DOI: 10.1148/rg.253045124
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Intraabdominal Fetal Echogenic Masses: A Practical Guide to Diagnosis and Management1

Ann McNamara, MB, FFR (RCSI) and Deborah Levine, MD

1 From the Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215. Recipient of a Certificate of Merit award and an Excellence in Design award for an education exhibit at the 2002 RSNA Scientific Assembly. Received June 3, 2004; revision requested August 5 and received September 2; accepted September 8. All authors have no financial relationships to disclose.


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  		Figure 1a.  Echogenic bowel. (a) Sagittal sonogram obtained at 20 weeks gestation shows a bright mass in the fetal pelvis (arrows), a finding consistent with echogenic bowel. The bowel is as bright as bone. (b) Axial sonogram of the lower abdomen of another fetus, obtained at 22 weeks gestation, shows the masslike appearance of echogenic bowel.

 


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  		Figure 1b.  Echogenic bowel. (a) Sagittal sonogram obtained at 20 weeks gestation shows a bright mass in the fetal pelvis (arrows), a finding consistent with echogenic bowel. The bowel is as bright as bone. (b) Axial sonogram of the lower abdomen of another fetus, obtained at 22 weeks gestation, shows the masslike appearance of echogenic bowel.

 


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  		Figure 2.  Meconium in the colon. Coronal sonogram of the abdomen, obtained at 34 weeks gestation, shows that the colon has an echogenic appearance. Unlike echogenic bowel in the second trimester, this appearance is almost always a normal finding.

 


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  		Figure 3.  Gastric pseudomass. Sagittal sonogram obtained at 18 weeks gestation shows a clump of debris in the fetal stomach (arrow). During real-time imaging, the debris was seen to move within the stomach. This finding resolved during follow-up.

 


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  		Figure 4a.  Presumed meconium peritonitis. (a) Sagittal sonogram obtained at 19 weeks gestation shows a single calcification with shadowing in the fetal abdomen. (b) Axial sonogram of the abdomen of another fetus, obtained at 20 weeks gestation, shows multiple scattered punctate calcifications without shadowing.

 


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  		Figure 4b.  Presumed meconium peritonitis. (a) Sagittal sonogram obtained at 19 weeks gestation shows a single calcification with shadowing in the fetal abdomen. (b) Axial sonogram of the abdomen of another fetus, obtained at 20 weeks gestation, shows multiple scattered punctate calcifications without shadowing.

 


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  		Figure 5a.  Meconium peritonitis with a meconium pseudocyst in a fetus at 18 weeks gestation. (a) Axial sonogram of the abdomen shows multiple punctate calcifications on the peritoneal surface of the liver. (b) Coronal sonogram obtained lower in the abdomen shows a hypoechoic structure with an irregularly calcified wall (arrow) in the anterior abdomen, an appearance consistent with a meconium pseudocyst.

 


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  		Figure 5b.  Meconium peritonitis with a meconium pseudocyst in a fetus at 18 weeks gestation. (a) Axial sonogram of the abdomen shows multiple punctate calcifications on the peritoneal surface of the liver. (b) Coronal sonogram obtained lower in the abdomen shows a hypoechoic structure with an irregularly calcified wall (arrow) in the anterior abdomen, an appearance consistent with a meconium pseudocyst.

 


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  		Figure 6a.  Intrahepatic calcifications. (a, b) Axial (a) and oblique coronal (b) sonograms obtained at 18 weeks gestation show calcification in the fetal liver. The maternal history was unremarkable, and the outcome was normal. (c, d) Axial sonograms of the liver of another fetus, obtained at 20 weeks gestation, show diffuse punctate calcifications. Results of testing for cytomegalovirus were indeterminate twice, and an infectious cause was thought to be likely. The neonatal outcome was normal.

 


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  		Figure 6b.  Intrahepatic calcifications. (a, b) Axial (a) and oblique coronal (b) sonograms obtained at 18 weeks gestation show calcification in the fetal liver. The maternal history was unremarkable, and the outcome was normal. (c, d) Axial sonograms of the liver of another fetus, obtained at 20 weeks gestation, show diffuse punctate calcifications. Results of testing for cytomegalovirus were indeterminate twice, and an infectious cause was thought to be likely. The neonatal outcome was normal.

 


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  		Figure 6c.  Intrahepatic calcifications. (a, b) Axial (a) and oblique coronal (b) sonograms obtained at 18 weeks gestation show calcification in the fetal liver. The maternal history was unremarkable, and the outcome was normal. (c, d) Axial sonograms of the liver of another fetus, obtained at 20 weeks gestation, show diffuse punctate calcifications. Results of testing for cytomegalovirus were indeterminate twice, and an infectious cause was thought to be likely. The neonatal outcome was normal.

 


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  		Figure 6d.  Intrahepatic calcifications. (a, b) Axial (a) and oblique coronal (b) sonograms obtained at 18 weeks gestation show calcification in the fetal liver. The maternal history was unremarkable, and the outcome was normal. (c, d) Axial sonograms of the liver of another fetus, obtained at 20 weeks gestation, show diffuse punctate calcifications. Results of testing for cytomegalovirus were indeterminate twice, and an infectious cause was thought to be likely. The neonatal outcome was normal.

 


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  		Figure 7a.  Fetal gallstones. (a) Coronal sonogram obtained at 16 weeks gestation shows shadowing stones in the fetal gallbladder. (b) Axial sonogram of the gallbladder of another fetus, obtained at 20 weeks gestation, shows small stones. Neonatal follow-up demonstrated the expected complete resolution of the gallstones in both cases.

 


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  		Figure 7b.  Fetal gallstones. (a) Coronal sonogram obtained at 16 weeks gestation shows shadowing stones in the fetal gallbladder. (b) Axial sonogram of the gallbladder of another fetus, obtained at 20 weeks gestation, shows small stones. Neonatal follow-up demonstrated the expected complete resolution of the gallstones in both cases.

 


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  		Figure 8a.  Liver hemangioma. (a) Axial sonogram of the liver obtained at 16 weeks gestation shows a single 1-cm-diameter, uniformly echogenic, well-circumscribed mass in the anterior aspect of the liver. (b) Axial sonogram of the liver obtained at 18 weeks gestation shows no change in the size or characteristics of the mass (cursors). Results of further examinations up to term were unchanged.

 


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  		Figure 8b.  Liver hemangioma. (a) Axial sonogram of the liver obtained at 16 weeks gestation shows a single 1-cm-diameter, uniformly echogenic, well-circumscribed mass in the anterior aspect of the liver. (b) Axial sonogram of the liver obtained at 18 weeks gestation shows no change in the size or characteristics of the mass (cursors). Results of further examinations up to term were unchanged.

 


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  		Figure 9a.  Echogenic gastric duplication cyst. Axial (a) and oblique coronal (b) sonograms show a well-defined, echogenic, round mass that indents the stomach. The appearance remained constant throughout gestation and into the neonatal period.

 


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  		Figure 9b.  Echogenic gastric duplication cyst. Axial (a) and oblique coronal (b) sonograms show a well-defined, echogenic, round mass that indents the stomach. The appearance remained constant throughout gestation and into the neonatal period.

 


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  		Figure 10a.  Neuroblastoma. (a, b) Axial (a) and coronal (b) sonograms obtained at 18 weeks gestation show a homogeneously echogenic retroperitoneal mass. (c) Coronal magnetic resonance image shows the intermediate-signal-intensity lesion (arrows). s = stomach. A neuroblastoma was confirmed at surgery.

 


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  		Figure 10b.  Neuroblastoma. (a, b) Axial (a) and coronal (b) sonograms obtained at 18 weeks gestation show a homogeneously echogenic retroperitoneal mass. (c) Coronal magnetic resonance image shows the intermediate-signal-intensity lesion (arrows). s = stomach. A neuroblastoma was confirmed at surgery.

 


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  		Figure 10c.  Neuroblastoma. (a, b) Axial (a) and coronal (b) sonograms obtained at 18 weeks gestation show a homogeneously echogenic retroperitoneal mass. (c) Coronal magnetic resonance image shows the intermediate-signal-intensity lesion (arrows). s = stomach. A neuroblastoma was confirmed at surgery.

 


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  		Figure 11a.  Subdiaphragmatic extralobar pulmonary sequestration. Axial sonogram obtained at 18 weeks gestation (a), sagittal sonogram obtained at 20 weeks gestation (b), and axial sonogram obtained at 28 weeks gestation (c) show an echogenic mass in the left retroperitoneum. No feeding vessel was identified. At surgery, the mass was an extralobar pulmonary sequestration.

 


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  		Figure 11b.  Subdiaphragmatic extralobar pulmonary sequestration. Axial sonogram obtained at 18 weeks gestation (a), sagittal sonogram obtained at 20 weeks gestation (b), and axial sonogram obtained at 28 weeks gestation (c) show an echogenic mass in the left retroperitoneum. No feeding vessel was identified. At surgery, the mass was an extralobar pulmonary sequestration.

 


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  		Figure 11c.  Subdiaphragmatic extralobar pulmonary sequestration. Axial sonogram obtained at 18 weeks gestation (a), sagittal sonogram obtained at 20 weeks gestation (b), and axial sonogram obtained at 28 weeks gestation (c) show an echogenic mass in the left retroperitoneum. No feeding vessel was identified. At surgery, the mass was an extralobar pulmonary sequestration.

 


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  		Figure 12a.  Congenital mesoblastic nephroma. (a) Axial sonogram obtained at 36 weeks gestation shows a heterogeneous mass (arrows) in the right retroperitoneum. (b) Coronal sonogram shows that the mass (cursors) originates from the right kidney. (c) Color Doppler image shows blood supply from the ipsilateral renal artery. At surgery, a mesoblastic nephroma was confirmed.

 


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  		Figure 12b.  Congenital mesoblastic nephroma. (a) Axial sonogram obtained at 36 weeks gestation shows a heterogeneous mass (arrows) in the right retroperitoneum. (b) Coronal sonogram shows that the mass (cursors) originates from the right kidney. (c) Color Doppler image shows blood supply from the ipsilateral renal artery. At surgery, a mesoblastic nephroma was confirmed.

 


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  		Figure 12c.  Congenital mesoblastic nephroma. (a) Axial sonogram obtained at 36 weeks gestation shows a heterogeneous mass (arrows) in the right retroperitoneum. (b) Coronal sonogram shows that the mass (cursors) originates from the right kidney. (c) Color Doppler image shows blood supply from the ipsilateral renal artery. At surgery, a mesoblastic nephroma was confirmed.

 




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