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2002-04-18-12 Answer of the case of the week #70 © Sosa

Answer to case #70 

April 5-18, 2002

Alberto Sosa Olavarría, MD, PhD. Luis Díaz Guerrero, MD, Maria Miraz MD, Aldo Reigosa MD, Emilio Machado MD.

Unidad de Perinatologia, Maternidad Las Acacias ,Valencia, Venezuela

29 years old G2P0 patient had a molar pregnancy 3 years ago.

Her first ultrasound at 14weeks + 4 days demonstrates the following images:



The placenta seems to be molar type and the initial diagnosis was that of a molar pregnancy with fetus.

At the 2nd ultrasound examination at 17 weeks, a genetic amniocentesis was performed that revealed a 46XX normal. Note the change in the appearance of the placenta and the cystic intraabdominal image.



At 20 weeks, the fetus has a normal growth. The molar placenta diagnosis was changed to placental chorioangioma.

At 26 weeks the fetus is at the 10th percentile for growth and a large part of the placenta appears to be a chorioangioma while the rest appears normal. Note the normal appearance of the abdomen on this view.



By 32 weeks, the fetal growth was less then the 10th centile. The following image was obtained in the abdomen on the left side. This round mobile cystic image in the anterior left abdomen and in close relation to the liver. The walls of the mass are echogenic. The bladder is normal.



Also note the evolution of the placenta. 

Other images demonstrated a high velocity flow in the middle cerebral artery, suggestive of fetal anemia. Normal uterine artery flow:

The last examination demonstrated IUGR, oligoamnios, and pathologic Doppler findings including absent diastolic flow in umbilical artery and brain sparing. Interruption of pregnancy was suggested. A newborn below the 10th percentile was delivered. Neonatal evaluation revealed symptoms of abdominal obstruction, the newborn when to surgery. Intestines were normal. The cystic lesion was recognized at pathology to be a hepatic lymphangioma.

Pathology demonstrated a chorioangioma of the placenta.



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