A case of umbilical cord angiomyxoma with massive arteriovenous shunts diagnosed with HDlive Flow
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IMAGE–OBSTETRICS & GYNECOLOGY
A case of umbilical cord angiomyxoma with massive arteriovenous shunts diagnosed with HDlive Flow Lan Zhang1,2,3,4 · Shuai Huang1,2,3,4 · Junnan Li1,2,3,4 · E. Gong1,2,3,4 · Xinmei Wang5 · Heqiu Li5 · Huan He1,2,3,4 Received: 28 September 2020 / Accepted: 12 October 2020 © The Japan Society of Ultrasonics in Medicine 2020
A 37-year-old woman, gravida 3 para 0, was referred for an umbilical cord mass at 23+2 weeks of gestation. 2D ultrasonography (Voluson E10; GE Healthcare, Austria) demonstrated a mass measuring 8.8 cm × 6.5 cm near the placental insertion of the umbilical cord. There were internal flows with low velocity and resistance demonstrated by pulse wave Doppler. It was characterized by a central hyperechoic area surrounded by a peripheral hypoechoic multicystic area (Fig. 1a). The hyperechoic area was distributed along the cord and surrounded three umbilical vessels (Fig. 1b). HDlive Flow demonstrated that those internal vessels were fed by two umbilical arteries and drained into the umbilical vein, acting as massive arteriovenous shunts (Fig. 1c). The fetus presented normal structures and Doppler velocimetries, but polyhydramnios accompanied by decreased fetal movements was observed. It was thought to be an angiomyxoma with pseudocysts arising from the umbilical cord. An amniocentesis was then performed. Both G-banded chromosome analyses of amniotic fluid cells and chromosomal microarray analysis showed a normal 46, XY karyotype. However, fetal demise occurred at 2 7+1 weeks of gestation. The mass grew to 10.2 cm × 6.5 cm. A 580-g male dead infant without visual abnormality was delivered vaginally after medical * Huan He [email protected] 1
Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, China
2
Fetal Medicine Unit, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
3
International Collaborative Joint Laboratory of Reproduction and Development of Ministry of Education P.R.C, Chongqing Medical University, Chongqing, China
4
State Key Laboratory of Maternal and Fetal Medicine of Chongqing Municipality, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
5
Department of Pathology, Chongqing Medical University, Chongqing, China
induction of labor. Angiomyxoma of the umbilical cord with associated pseudocysts was confirmed through pathology (Fig. 1d-f). Angiomyxoma of the umbilical cord is a rare anomaly [1]. It is associated with increased perinatal morbidity and mortality [2]. HDlive Flow is widely used in diagnosis of some gynecological diseases, such as congenital heart disease [3]. Akiba et al. have reported the sonographic features of umbilical cord hemangioma using HDlive Flow, in which only one umbilical artery was involved [4]. To the best of our knowlwdge, no cases with involvement of three umbilical vessels have been reported. In our case, the heterogeneous mass with internal flows strongly supported a sus
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