Imaging Modalities and Management of Prenatally Diagnosed Suprarenal Masses: An Updated Literature Review and The Experience at a High-Volume Fetal Treatment Center

BACKGROUND/PURPOSE: The differential diagnosis for prenatal suprarenal masses (SRM) is broad and includes neuroblastoma, adrenal hemorrhage and subdiaphragmatic extralobar pulmonary sequestration (SEPS). We sought to elucidate the appropriate postnatal management for fetuses found to have a SRM. METHODS: We conducted a retrospective review of patients prenatally diagnosed with SRM at our institution between 1998 and 2018. Prenatal characteristics, imaging, and neonatal outcomes were collected. We also performed a PubMed literature search and pooled analysis of all patients with a prenatally diagnosed SRM previously described in the literature. RESULTS: The literature review yielded 32 studies, of which 19 were single case reports. In our case series, twelve patients were included. Seven patients were delivered vaginally, one was terminated. Postnatal diagnoses included: SEPS (n=5), adrenal hemorrhage (n=3), polycystic kidney (n=2), splenic cyst (n=1), and unknown for one patient. All but two of the final diagnoses had been on the initial diagnostic differential. With the exception of the terminated fetus, all remain alive today. On pooled analysis, patients who underwent operative management were diagnosed later 32 weeks versus 24 weeks) and had a significant predominance of left-sided lesions (59.5% vs. 39.2%). The published literature demonstrates a trend towards observation versus resection over the past 30 years. CONCLUSIONS: Patients prenatally diagnosed with a SRM have an excellent prognosis. Our series demonstrates a high incidence of SEPS, which were all resected, and adrenal hemorrhage, which were observed with repeat imaging. These patients can be followed with serial postnatal ultrasounds to determine the diagnosis prior to deciding the appropriate treatment.