1. Medical Imaging CP (2) Cystic Hygroma 0502467
Spring semester ( )
Cystic Hygroma
Name :- Salma Dani
ID:-U
Clinical Instructor:- Wiam Elshami Hassan
Course Instructor :- Wiam Elshami Hassan

2. Content Introduction. Anatomy. Physiology. Radiographic anatomy.
Pathology.
Patient history.
Clinical assessment.
Investigations requested.
Diagnostic imaging examination procedure.
Radiologist’s opinion.
Patient’s prognosis.
Effectiveness of the MDI investigation.
Conclusion.
References

3. Introduction
- On 1st of March , a 33-year-old female patient arrived to Iranian hospital for her second fetal sonography for evaluation of pregnancy site. The first fetal sonography was in 23rd of January and the gestational age was 5 weeks and 5 days. The second fetal sonography showed that the baby has Cystic Hygroma.

4. Anatomy The main parts of the fetus anatomy: Amniotic sac. Cervix.
- Placenta.
- Midbrain.
- Umbilical cord.
- Uterus (also called the womb).
- Vagina.
Figure 1: Fetus Anatomy. Ref 1

5. Physiology
The fetal circulatory system is integrated with the placenta via the umbilical cord so that the fetus receives both oxygen and nutrients from the placenta.
The umbilical cord contains two arteries and one vein. The blood in the arteries contains waste products, such as carbon dioxide, from the baby's metabolism.
Amniotic fluid (AF) and has a number of functions that are essential for normal growth and development:
Protect the fetus.
Cushions the umbilical cord
Serves as a reservoir of fluid and nutrients for the fetus.

6. Radiographic Anatomy
Figure 2: mid-sagittal plane of the face with its sonographic landmarks. Ref 7

7. Radiographic Anatomy
Figure 3: Cerebellar View. Ref 8

8. Radiographic Anatomy
Figure 4: coronal view demonstrates the body of lateral ventricles and the mid-brain. Ref 8

9. Pathology
Cystic hygromas are irregular growths that usually appear on a baby’s neck or head. They are liquid filled sacs brought on by blockages in the lymphatic system. [5].
Cystic hygromas can develop due to genetic disorders or environmental factors [5].
The main symptom of a cystic hygroma is the presence of a soft, spongy lump. This irregularity most generally shows up on the neck [5].
The doctor will arrange an amniocentesis if they notice a cystic hygroma during an ultrasound. [5].
Figure 5: normal and abnormal nuchal translucency. Ref 6

10. Pathology
Treatment:
Cystic hygromas aren’t treated while the baby is in the womb. Instead, the doctor will closely monitor the baby’s health
After birth, cystic hygroma is frequently treatable. The first stage of treatment is surgery. The entire growth must be removed to prevent it from coming back [5].

11. Patient history
On 1st of March , a 33-year-old female patient arrived to Iranian hospital for her second fetal sonography for evaluation of pregnancy site.
The first fetal sonography was in 23rd of January and the gestational age was 5 weeks and 5 days.
The second fetal sonography showed that the baby has Cystic Hygroma.

12. Clinical assessment The Gravida = 2 and Parity = 1
The Gestational age was 11weeks 4 days
The Crown-rump length (CRL) was 48.2 mm.
fetal heart rate is regular, 167 bpm.
The Amniotic fluid is within normal and The placenta is anterior, low lying.

13. Investigations requested
2 Fetal sonography were made, one at 5 weeks and the second at 11 weeks.
No lab tests were requested.

14. Diagnostic imaging examination procedure
The patient arrived in the morning to the radiology department for her second fetal sonography on 1st of March.
The patient was placed in supine position and the sonographer applied the gel on her lower abdomen.
A curvilinear transducer was used
The sonographer noticed something abnormal in nuchal translucency, it was thicker than usual. Measured approximately 8 mm.

15. Diagnostic imaging examination procedure
Figure 6 (a): increased nuchal translucency (8 mm). Ref 9

16. Radiologist’s opinion
1- The first sonography was done in 23rd of January. The sonographer noted:
Intrauterine gestational sac with yolk sac and single fetal pole of approx.5 weeks. GA is seen with presence of heart beat (118 bpm) and normal amniotic fluid.
Figure 7: fetal pole of approx.5 weeks. Ref 9

17. Radiologist’s opinion
2- The second sonography in 1st of March reported that:
Single alive intrauterine fetus of approx.11 weeks of gestational age is seen.
Markedly thickening and cystic appearance of Nuchal Translucency is noted with a size of 8 mm in AP diameter with tiny ill- defined septation indicative of Cystic Hygroma.
Subcutaneous mild edema of scalp and body also noted due to hydrops

18. Radiologist’s opinion
Figure 6 (b). Ref 9
Figure 8. Ref 9

19. Patient’s prognosis
After obtaining the sonography, the patient was referred back to the doctor. Cystic Hygroma and genetic disorders were discussed with her and she referred to perinatologist.
Because abortion is forbidden in UAE, the patient traveled to Iran and has done it there. She returned after a week to Iranian hospital to check for retained tissues.

20. Effectiveness of the MDI investigation
The Ultrasound play a significant role in detecting pregnancy. It helps to check fetus’s development and pick up any abnormalities. Also ultrasound is non-invasive, painless and harmless for both the mother and the fetus.

21. Conclusion
Eventually, a 33-year-old female patient arrived to Iranian hospital for her second fetal sonography for evaluation of pregnancy site. The gestational age was 11weeks 4 days. The fetal sonography showed that the baby has Cystic Hygroma. The nuchal translucency thickness was 8mm. she has done abortion in Iran and came back after 1 week to Iranian hospital to check for retained tissues .

22. References
1- Anatomy: Fetus in Utero - Health Encyclopedia - University of Rochester Medical Center. (n.d.). Retrieved from 2- Fetal Development · Anatomy and Physiology. (n.d.). Retrieved from book/contents/m46316.html 3- Physiology of amniotic fluid volume regulation. (n.d.). Retrieved from 4- Umbilical Cord | FamilyEducation - FamilyEducation. (n.d.). Retrieved from 5- What Is Cystic Hygroma: Causes, Symptoms, and Diagnosis. (n.d.). Retrieved from 6- NT: Imaging. (n.d.). Retrieved from 7- Nasal-bone length in euploid fetuses at weeks' gestation by three-dimensional ultrasound. (n.d.). Retrieved from 24_weeks%27_gestation_by_three-dimensional_ultrasound/figures?lo=1 8- OB Images. (n.d.). Retrieved from anatomy-brain/ 9- Iranian hospital PACS.