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Introduction

Winter in Cleveland can be beautiful when the air is crisp and the evergreens are cloaked in white. But by mid-March, with its bare trees and gray skies, a longing for something more alive fills the air. Against this backdrop, Lisa Cantwell, a woman in her thirties, saw her doctor for a prenatal ultrasound. Already the mother of two young children, she had been through prenatal testing before. But nothing could have prepared her for the ordeal that she and her husband, Josh, were about to face.

The ultrasound, performed at 18 weeks, showed something in the baby's neck—a dark mass, six centimeters across. In 35 years, Lisa's prenatal specialist had never seen anything like it.

Several follow-up scans that spring and summer revealed that the cyst was growing. Lisa's caregivers were concerned that the cyst would impair the baby's ability to breathe. Her case was transferred from Cleveland Clinic's community hospital to the main campus, which handles the most serious medical cases. Mother and child were admitted to the Fetal Care Center, where a multidisciplinary team of obstetricians, neonatologists, and pediatric subspecialists would provide care. The center is not a place but a virtual team linked by purpose, protocols, and electronic medical records.

When the time came for Lisa to give birth, Dr. Paul Krakowitz, a leading pediatric head and neck surgeon, discovered that the mass was just under the baby's windpipe. The baby might not be able to breathe outside the uterus. Cutting the umbilical cord could prove fatal.

Dr. Krakowitz's team used a rare procedure. Two operating rooms were prepared side by side. Surgeons waited in the second room, ready to operate on the baby if needed. In the first room, Lisa had a normal cesarean, but the baby was lifted only partially out of the uterus. Before full birth, Dr. Krakowitz performed an endoscopy to see whether the baby's windpipe was clear. It was. Baby Dominic was fully delivered and sent to the Neonatal Intensive Care Unit.

To the naked eye, the baby's neck looked perfectly normal, but the cyst was under the skin—and growing. It was a cystic hygroma, a large sac filled with fluid. Once they were home, Lisa carefully monitored Dominic to ensure that the cyst didn't impede his breathing. Almost every day, she checked in by phone with the nurse who ran the Fetal Care Center. But in the second week, Lisa noticed that Dominic was turning blue. The cyst had grown so big that it was strangling her son.

Lisa and Josh rushed Dominic to Cleveland Clinic's Emergency Department. Doctors intubated Dominic to open his airway, and Dr. Krakowitz prepared to operate. The next day, he removed a cyst running from the left lobe of the thyroid into the cervical spine, up through the thyroid cartilage, and into one of the tubes that connect the ...

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