PRENATAL ULTRASOUND CHARACTERIZATION OF THE SUPRARENAL MASS - DISTINCTION BETWEEN NEUROBLASTOMA AND SUBDIAPHRAGMATIC EXTRALOBAR PULMONARY SEQUESTRATION

With the increased routine use of prenatal ultrasonography, subdiaphra gmatic masses in the fetus are identified more frequently. Suprarenal masses often are presumed to be neuroblastoma and are removed surgical ly postnatally. We sought to better understand the natural history of subdiaphragmatic extralobar pulmonary sequestration, and to determine if subdiaphragmatic extralobar pulmonary sequestration can be distingu ished preoperatively from neuroblastoma. The literature was reviewed f or cases of prenatally diagnosed suprarenal masses that proved ultimat ely to be either subdiaphragmatic extralobar pulmonary sequestration o r neuroblastoma. The distinguishing features of the hive lesions were identified and an algorithm was created on the basis of these distinct ions. Prenatally diagnosed subdiaphragmatic extralobar pulmonary seque stration 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 c onsidered in the differential diagnosis of the suprarenal mass identif ied on prenatal ultrasonography. Using the algorithm which we propose, the correct diagnosis can be determined prenatally in 95% of patients .