Prenatal features
In 28 cases (37 %) ultrasound examination detected a feeding systemic
arterial supply and the proposed diagnosis was BPS in 24 patients and
hybrid malformation in 4. Thirteen (46 %) of them showed mediastinal
shift, while ascites developed in 1 case at 22 weeks’ of gestation
(Figure 1 ). Because of the persistence of the ascites, a drain
was placed at 28th week of gestation. In this case,
postnatal diagnosis was BPS.
In 47 cases (63%) no systemic feeding arterial supply was identified
prenatally and the diagnosis of other malformations was proposed: 7 BC,
19 PCM, 15 CLE and 6 without defined prenatal diagnosis. Five (11%) of
them had mediastinal shift. In one case, the hyperechoic image was
associated with a cystic mass since first ultrasound examination at 14
weeks’ of gestation. A compressive BC was suspected with hydropic
changes and a cystic-amniotic shunt was placed at 22 weeks’
(Figure 2 ). The aspect remained stable until birth at 29
weeks’.
Among all 75 patients, mediastinal shift was observed in 18 cases
(24%). Prenatal procedure was required in two cases because of
symptomatic compression, as described above.
The identification of a systemic arterial supply was significantly more
associated with mediastinal shift (46% vs 10%, p = 0.0007).