To the best of our knowledge there are only 13 cases of antena- tally diagnosed congenital splenic cysts reported in the published literature. 1–6 We report a case of congenital splenic cyst that was suspected on ultrasonography examination at 20 weeks of gestation and followed postnatally. We have also reviewed the literature on this condition. CASE REPORT A sonolucent, round cystic lesion with a diameter of 0.6 cm, located in the left upper quadrant of the fetus’ abdomen was detected by sonography in a 30-year-old G 3 P 0 woman when she underwent screening anomaly scan at 20 weeks of gestation. The cyst was homogeneously anechoic with smooth walls and was thought to be located in the spleen, left kidney or left adrenal gland. No other abnormalities were detected in this scan. Three subsequent antenatal follow-up scans at 29, 35 and 38 weeks of gestation did not show any change in the size of the cyst and its exact organ location could not be clearly identi- fied. Incidentally, these follow-up scans showed that the baby’s growth was retarded. At 39 weeks of gestation, the baby boy was born by elective caesarean section because of severe intrauterine growth restric- tion, reversal of blood flow in the umbilical vessels and an abnormal fetal heart rate trace on cardiotochographic moni- toring. There was no requirement for resuscitation at birth; Apgar scores were 8 and 9 at 1 and 5 min, respectively. The birth weight was 2675 g (< 3rd percentile), length 45 cm (< 3rd percentile), and head circumference 32.5 cm (< 3rd percentile). His general physical and neurological examination was normal, but he was admitted to the nursery because of hypoglycaemia (related to SGA status, normal insulin levels) requiring hyper- tonic intravenous dextrose infusion (12% dextrose). He was later established on demand breast feeds at the time of discharge. The nursery course was otherwise uncomplicated. Despite extensive investigations we were unable to identify the cause of the severe growth restriction although it may have been contributed to by cigarette smoking and substance use in the mother (12 cigarettes/day, marijuana 3 cones/day). A postnatal abdominal ultrasound on day 4 of life showed a 0.6-cm sonolucent, rounded cyst with regular margins in the spleen (Fig. 1). Both the kidneys and adrenal glands were normal. A sonagram at 5 months of age showed that the cyst had reduced in size to 0.46 cm (Fig. 2). A further follow-up ultrasound at 10 months of age showed no further reduction in the size of the splenic cyst. We will be following this patient periodically until the cyst completely regresses. DISCUSSION Of the 13 cases of antenatally diagnosed congenital splenic cysts described in the literature, 12 were identified between 28 and 35 weeks of gestation and the remaining one at 17 weeks of gestation. 1–6 The prenatal diagnosis of a splenic cyst on the basis of sonographic findings was first reported in 1988 by Lichman and Miller. 4 Our case was identified at 20 weeks of gestation. The fetal spleen can be identified definitively on J. Paediatr. Child Health (2001) 37, 400–402 Congenital splenic cyst: A case report and review of the literature NS KABRA and JR BOWEN Department of Neonatology, Royal North Shore Hospital, University of Sydney, St Leonards, NSW,Australia Abstract: There are very few cases of antenatally diagnosed congenital splenic cyst described in literature. The present case of congenital splenic cyst was first suspected on ultrasound examination at 20 weeks of gestation and followed sub- sequently. Its exact location in the spleen was found on postnatal ultrasound examination. The aetiology, differential diagnosis, complications and management strategies of this lesion are also discussed . Key words: antenatal diagnosis; congenital splenic cyst. Correspondence: Dr NS Kabra, 3/58 Epping Road, Lane Cove, Sydney, NSW 2066, Australia. Fax: 61 (02) 9926 6155; email: nskabra@acay.com.au Accepted for publication 28 August 2000. Fig. 1 Abdominal ultrasound on day 4 of life showing cystic lesion with a diameter of 0.6 cm in the spleen.