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(Circulation. 1999;99:e1-e2.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Prenatal Detection of a Pericardial Teratoma

Curt J. Daniels, MD; Daniel M. Cohen, MD; John R. Phillips, MD; Daniel G. Rowland, MD

From the Divisions of Pediatric Cardiology and Cardiothoracic Surgery, The Ohio State University, Children's Hospital, Columbus, Ohio.

Correspondence to Curt J. Daniels, MD, Columbus Children's Hospital, Division of Cardiology, 700 Children's Dr, Columbus, OH 43205. E-mail cdaniels@chi.osu.edu

A17-year-old gravida II, para I woman was referred for a fetal echocardiographic evaluation at 28 weeks of gestation because of the finding of hydrops fetalis on an obstetrical scan. The study demonstrated a large, complex, anterior mediastinal mass resulting in rotation of the heart leftward and posterior with compression of the right heart chambers (Figure 1). The intracardiac anatomy was normal, with no significant inflow or outflow obstruction identified. Intrauterine removal of the mass was considered but declined by the parents. Preterm labor developed at 32 weeks of gestation and was unresponsive to medical management. The infant was delivered by cesarean section and required immediate endotracheal intubation for respiratory distress. The infant developed hypotension responsive to volume resuscitation and vasopressor medications. The infant's respiratory status stabilized with high-frequency ventilation.

View larger version (89K): [in this window] [in a new window]   Figure 1. Fetal echocardiogram at 28 weeks of gestation demonstrating a large anterior mediastinal mass. Mass was inhomogeneous, with solid and cystic areas consistent with a teratoma (T). Arrows outline extent of tumor. Right ventricle (RV) was mildly compressed. Left ventricle (LV) appeared normal. A indicates anterior; P, posterior; R, right; and L, left.

An MRI was obtained to evaluate the mass and its extent within the thoracic cavity before surgical intervention. The MRI confirmed the diagnosis of a large anterior mediastinal mass consistent with a pericardial teratoma (Figure 2).

View larger version (121K): [in this window] [in a new window]   Figure 2. Thoracic MRI. T1-weighted parasagittal image demonstrating an anteriorly located mass measuring 7 cm in transversex5 cm superior to inferiorx4.5 cm anterior (A) to posterior (P). Mass has . . . [Full Text of this Article]