USA Surgery Today

Based on the combined experience, an algorithm for the management of a fetus with a thoracic mass has been proposed (:LASIX) (14,15:LASIX). As with all cases considered for fetal intervention a comprehensive evaluation by US is undertaken in order to confirm the diagnosis, exclude concomitant anomalies and to determine the well-being of the fetus with regard to hydrops (Tables 3-4 and 3-5:LASIX). Nonhydropic fetuses are monitored by serial US surveillance based on recommendations derived from the CVR data. In addition, a genetic screen and chromosomal analysis by amniocentesis or PUBS and echocardiography are performed. If another life-threatening anomaly is discovered or the maternal mirror syndrome has developed, patients are excluded from further consideration for fetal surgery and are counseled. If a fetus with hydrops is identified or hydrops develops during the course of serial ultrasonographic surveillance, then management recommendations depend on gestational age. If a fetus with both a lung mass and hydrops is discovered at 32 weeks’ gestation or greater, early delivery and postnatal care is offered. Despite prompt perinatal resection, the outcome for the hydropic fetus and subsequent newborn has been dismal. In cases where a hydropic fetus with a chest mass is identified prior to 32 weeks’ gestation, then open fetal surgery for resection is offered. The role of steroids in this clinical setting as an alternative to fetal surgery needs to be examined. Fetuses without hydrops and those with shrinking tumors should be managed by planned delivery, maternal transport, and ex utero resection.