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Masses at the Anterior Body Wall

Differential diagnoses of the masses at the anterior body wall include

Fig 1, Fig 2, Fig 3, Fig 4, Fig 5, Fig 6

  • Physiologic omphalocele (8-12 weeks); size of <7 mm, no liver content
  • Omphalocele
  • Gastroschisis
  • Ectopia cordis
  • Limb-body wall defect
  • Bladder exstrophy
  • Cloacal exstrophy
  • Stack of umbilical cord (positive Doppler signal or color flow)
  • Cord edema or localized Wharton’s jelly near the umbilicus
  • Cord cysts (omphalomesenteric cyst or allantoic cyst)
  • Placental mass (chorioangioma) close to the anterior wall
  • Artifacts: pseudo-omphalocele secondary to oblique plane

Fig 1:  Omphalocele  Clubfoot and free floating sac containing liver with covering membrane (arrow)

Fig 2:  Gastroschisis  Free floating echogenic bowel (*) in the amniotic fluid (arrowhead = spine, solid circle = intra-abdominal stomach)

Fig 3:  Bladder extrosphy  Sagittal view of the fetal abdomen: complex extra-abdominal mass (*) below the umbilicus, finally proven to be bladder extrosphy

Fig 4:  Physiologic omphalocele  Sagittal scan of the fetus (10 weeks): bowel contents protruding into the proximal umbilical cord (arrow)

Fig 5:  Pseudo-omphalocele  Oblique cross-sectional scan of the fetus: the liver (*) covered by normal abdominal wall (arrow) protrudes anteriorly, may be mistaken for omphalocele (arrowhead = spine)

Fig 6:  Physiologic omphalocele  Cross-sectional scan of the embryo (8 weeks): bowel contents protruding into the proximal umbilical cord (arrowhead)

Video clips of masses at the anterior body wall

Omphalocele:  Cross-sectional scan: large omphalocele with liver content (solid circle) (arrow = the defect, arrowhead = spine)

Umbilical cord cyst:  Focus on the proximal cord: cord cyst with coarse particles (*) may be due to liquidfaction of the Wharton’s jelly

Gastroschisis:   Free floating bowel mass anterior to abdominal wall

True anterior wall defect

  • Omphalocele
  • Gastroschisis
  • Limb-body wall complex
  • Amniotic band syndrome
  • Bladder exstrophy
  • Cloacal exstrophy
  • Pentralogy of Cantrel

Cystic mass close to the umbilicus

  • Allantoic cyst (urachal cyst)
  • Omphalomesenteric cyst
  • Pseudocyst (liquefaction of Wharton’s jelly)
  • Umbilical vein varix
  • Omphalocele

The approach of the anterior wall defects

  •  Relationship of the cord insertion to the defect: various sites of the defect suggest the nature of pathology as follows:
    • above the umbilicus: pentalogy of Cantrell
    • at the umbilicus: omphalocele
    • paraumbilical area: gastroschisis
    • below the umbilicus: bladder/cloacal exstrophy
    • defects throughout the abdomen: limb-body wall complex
    • severe and asymmetric defect: amniotic band syndrome
  • Characteristics of herniated organs: a herniated organ can suggest the nature of pathology as follows:
    • bowel: either a gastroschisis, omphalocele, or LBWC
    • liver only: highly suggestive of omphalocele (but most omphaloceles also include portions of bowel), very unlikely to be gastroschisis
    • bowel only (in omphalocele): more often related to chromosomal abnormalities
    • solid mass at the lower abdomen: bladder or cloacal exstrophy
  • Presence of covering membranes:
    • presence: omphaloceles (be careful, the covering membrane may not always be seen or may be ruptured), limb-body wall complex (not always)
    • absence: gastroschisis
    • the presence of a herniated liver in a ventral wall defect without a covering membrane is more suggestive of a ruptured omphalocele
  • Associated anomalies:
    • multiple anomalies: omphalocele, LBWC
    • extra-, intra-abdominal bowel obstruction: gastroschisis
    • scoliosis: LBWC
    • non-visualization of bladder: bladder or cloacal exstrophy
    • amputation defects: amniotic band syndrome