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P27.03: Prognostic factors in congenital diaphragmatic defects: ultrasound and MRI

Objectives: Oropharyngeal and neck masses are extremely rarely seen tumors of the fetal life. These tumors have the potential to obstruct the airway which needs emergency neonatal interventions. This study aimed to report prenatal findings of these fetuses and determine the factors influencing on the postnatal outcome and need for the ex utero intrapartum terapy (EXIT). Methods: We present a retrospective review of prenatal presentation, size and location of the mass, diagnostic accuracy of imaging studies, presence of fetal hidrops, associated anomalies such as polyhydramnios, intraoperative management, complications, maternal and neonatal outcomes. Results: Fetal tumors had occured which three of them at oropharynx and four of them at neck. The mean gestational age at diagnosis was 34.2 (min 26 – max 38) weeks. Sonographic features of masses were found to be appopriate in all cases. The mean gestational age at delivery was 36 weeks (min 30 – max 39). It was found polyhydramnios in three cases and all of them delived prematurely and required an intervention for the patency of airway, such as endotracheal entubation or tracheostomy by EXIT procedure. Prenatal sonography was the main diagnostic tool for all patients; however we had the possibility to confirm the diagnosis with magnetic resonance imaging (MRI) in three of them. The pathological examination revealed a pair of hemangioma, teratoma and lymphangioma and one hamartoma. One of the neonatal cases was lost due to bleeding but the others were lost due to prematurity and respiratory problems. One of the cases with diagnosed lymphangioma was treated by surgical method, but the other one was treated by medical treatment. Conclusions: The improved visualization of the relationship of the mass to the entire airway and existence of polyhydramnios may help predict which patients are at the highest risk for airway obstruction, and thus the need for the EXIT strategy.