Fetal Neck Mass · EXIT Assessment

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Mass nature + airway involvement
   Mass nature + airway involvement assessment (fetal MRI)? (Neck masses: lymphatic malformation (cystic hygroma, most common), cervical teratoma (solid + cystic ± calcification), hemangioma, etc. Fetal MRI is better than ultrasound: assesses extent, airway (tracheal/esophageal compression-deviation), soft-tissue characterization (T1 high = hemorrhage/fat; multiseptated cystic = lymphatic), relation to vessels/spine, differentiates goiter.)
   • Small mass, trachea midline, normal amniotic fluid, no compression → Low risk · follow up + plan delivery
   • Large mass (>5 cm)/anterior/tracheal deviation-compression/polyhydramnios/extension into the mediastinum → Airway involvement → plan EXIT
2. [End] Low risk · follow up + plan delivery
   Small mass, trachea midline, no compression, normal amniotic fluid: low airway obstruction risk; serial MRI/ultrasound follow-up of mass growth and the airway; characterization (lymphatic vs teratoma) guides postnatal management; deliver at a center with neonatal airway capability.
3. [End] Airway involvement → plan EXIT
   Large mass (>5 cm)/anterior/tracheal deviation-compression/polyhydramnios (impaired swallowing)/extension into the mediastinum = high airway-involvement risk: plan EXIT (ex-utero intrapartum treatment) — partial delivery by cesarean, secure the airway while maintaining placental circulation and oxygenation (laryngoscopy/intubation/bronchoscopy/tracheostomy or resection) before clamping the cord; multidisciplinary (OB/ENT-pediatric surgery/anesthesia/neonatology/imaging).

Source guidelines & references

• Fetal neck mass MRI and EXIT indications (airway involvement prediction)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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