Chorioangioma of placenta with fetal cardiac failure

Clinical History

A 29 year old patient came for a routine antenatal ultrasound at 28 weeks of gestational age. Ultrasound of the gravid uterus was performed followed by colour Doppler study. It showed the presence of a well defined hypoechoic mass in the placenta. Further echocardiography of the foetal heart was performed.

Imaging Findings

The echocardiography showed presence of a well defined hypoechoic mass in the placenta. It measured 12x9.4 cm in size and showed increased vascularity on colour Doppler and power Doppler imaging with low resistance flow in the vessels of the tumour. The umbilical cord vessels appeared dilated, towards the placental end.
Foetal abdomen showed dilated umbilical vein, the foetal heart appeared dilated and associated pericardial effusion was noted. Mild polyhydramnios was seen.

Discussion

Chorioangioma of the placenta is the most common benign vascular tumour arising from the primitive chorionic mesenchym whose aetiology is unknown. Incidence of large chorioangioma (>4cm) varies from 1:500 to 1:16000. They were associated with increased maternal age, diabetes mellitus and hypertension. They are more common in multiple pregnancy and female babies.
Heart enlargement and cardiac failure occurs due to arteriovenous shunting from the tumour or hemolysis leading to anaemia, which causes high output failure.
Most cases of chorioangioma are diagnosed following delivery. However, increased alpha-fetoprotein or β-hCG can arouse suspicion. Ultrasound is the mainstay in diagnosing chorioangioma although there is no specific finding which is diagnostic. Sonographic appearance is a well circumscribed rounded hypoechoic lesion near the chorionic surface, around the cord insertion site. Colour Doppler imaging not only helps differentiate chorioangioma from other lesions like degenerating fibroid, placental teratoma, deceased twin, placental haematoma but also is useful in the prenatal follow-up of these cases.
The main foetal risks include non immune hydrops fetalis, cardiomegaly, congestive cardiac failure, anaemia, thrombocytopenia, consumptive coagulopathy, prematurity and sudden infant death. Maternal risks are mainly polyhydramnios and preterm delivery.

Differential Diagnosis List

Final Diagnosis

Chorioangioma of placenta with fetal cardiac failure

URL:	https://www.eurorad.org/case/6880
DOI:	10.1594/EURORAD/CASE.6880
ISSN:	1563-4086