PSEUDOCYSTS OF THE
A pseudocyst is a cavity that forms from liquefaction or mucoid degeneration
of Wharton's jelly. It has no epithelial lining and its etiology is unknown. Large
masses of mucus in the umbilical cord are usually associated with hemangiomas
of the umbilical cord, also called angiomyxomas. The large pseudocysts are
probably fluid collections produced by this tumor. The fluid cannot escape
through the thick epithelium of the umbilical cord and appears as a large
cystic mass (1).
Bergman 1962 (2); 2 cases - one stillborn and one alive and normal.
Iaccarino 1986 (3); 7cm cyst compressing the umbilical vessels and IUGR. The
pregnancy was terminated.
UMBILICAL CORD CYSTS AND ANEUPLOIDY
Link to Umbilical Cord
Pseudocysts and Aneuploidy
- Two thirds are at the
placental end / one third are at the fetal end (4).
- May enlarge as the pregnancy
progresses (largest reported cyst = 25 cm)(5)
- Sonographic appearance varies
widely in utero:
- Large cyst-like mass
- Multiple cysts close
to a localized thickening of Wharton's jelly (6). All these cases were
associated with chromosomal aneuploidy in one series (trisomy 18 and 13)
Multiple umbilical cord pseudocysts.
Two vessel cord
- Single or multiple,
large or small. Regardless of their sonographic appearance in utero, they
have a strong association with chromosomal anomalies and structural
Umbilical cord pseudocyst at 13 weeks of gestation
- Angiomatous segment.
- 1-9 cm.
- Echogenic mass
adjacent to large cystic component. Associated vascular changes in the
cord may sometimes be observed with color doppler. One or more of the
umbilical vessels may be narrowed (5,7).
True and pseudocysts of the cord have similar appearances; true cysts are
usually associated with anomalies of the umbilicus and / or bladder such as
omphalocele or patent urachus.
- Detection of a pseudocyst
prior to 24 weeks gestation is an indication for fetal karyotyping.
- After 24 weeks an isolated
pseudocyst is not an indication for karyotyping. Based on current
literature the risk of trisomy 18 in a fetus with no other sonographic
findings after this gestational age is extremely low (8-10). In two large
series (involving 62 cases of trisomy 18), all 24 cases examined after 24
weeks had sonographically detected abnormalities (7,9). Only 27 out of 38
(71%) had sonographically detected abnormalities when scanned prior to 24
weeks (8, 10).
- After 24 weeks a pseudocyst
associated with other anomalies is an indication for karyotyping (11).
- Harp J, Rouse GA, De Lange
M. Sonographic prenatal diagnosis of allantoic cyst. JDMS 1992;8:28-32.
- Bergman P, Lundin P,
Malmstrom T. Mucoid degeneration of Wharton's jelly: An umbilical cord
anomaly threatening fetal life. Acta Obstet Gynecol Scand 1961;40:372.
- Iaccarino M, Baldi F,
Persico O et.al. Ultrasonographic and pathologic study of mucoid
degeneration of the umbilical cord. J Clin Ultrasound 1986;15:127.
- Heifetz SA, Rueda-Pedraza
ME. Hemangiomas of the umbilical cord. Pediatr Pathol 1983;1:385-398.
- Yavner DL, Redline RW.
Angiomyxoma of the umbilical cord with massive cystic degeneration of
Wharton's jelly. Arch Pathol Lab Med 1989;113:935-937.
- Sepulveda W, Gutierrez J,
Sanchez J et.al. Pseudocysts of the umbilical cord: Prenatal sonographic
appearance and clinical significance. Obstetrics and Gynecology
- Jaunianx E, Campbell S, Vyes
S. The use of color doppler imaging for prenatal diagnosis of umbilical
cord anomalies: report of three cases. Am J Obstet Gynecol
- Benacerraf BR, Miller Wa,
Frigoletto FD. Sonographic detection of fetuses with trisomy 13 and 18:
accuracy and limitations. Am J Obstet Gynecol 1988;158:404-409.
- Benacerraf BR. Prenatal
sonography of autosomal trisomies. Ultrasound Obstet Gynecol 1991;1:66-75.
- Nyberg DA, Kramer D, Resta
RG et.al. prenatal sonographic findings of trisomy 18: a review of 47
cases. J Ultrasound Med 1993;12:103-113.
- Sepulveda W, Pryde PG, Greb
AE et.al. Prenatal diagnosis of umbilical cord pseudocyst. Ultrasound
Obstet Gynecol 1994;4:147-150.