> 90% of fetal cases arise in adrenal gland

May be solid, cystic, or mixed

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  Cystic appearance may represent involuting tumor and is excellent prognosis

Calcification may be present but less common than in pediatric age group

Liver most common location for metastases; may form discrete nodules or be diffusely infiltrating

Look for placental metastases especially if maternal symptoms of preeclampsia

Extralobar sequestration may present as suprarenal mass

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  Left-sided mass; separate normal adrenal gland

  
  
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  Dominant feeding vessel from aorta

Adrenal hemorrhage much more common in pediatric population but has been reported in utero

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  No flow on Doppler; will involute over several weeks

Variable fetal course

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  May resolve spontaneously, remain stable, or rarely progress to hydrops and even death

Most fetal neuroblastomas have both favorable stage and biologic markers and have excellent prognosis

Must perform careful, focused, high-frequency exam looking for normal adrenal gland

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  No normal adrenal gland supports neuroblastoma

  
  
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  If present, sequestration is more likely

Assess vascularity with color Doppler

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  Some flow but no dominant feeding vessel

Careful examination of liver for metastases

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  Diffusely infiltrating metastases are difficult to diagnose

  
  
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  Be suspicious when hepatomegaly or hydrops is present

Close follow-up as may either grow or regress

Monitor for hydrops