Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications

Figures & data

Figure 1. A: (case 17) cervical cutaneous hemangioma at 27 weeks gestation. A1, a mixed mass mainly in the front neck, with a size of about 56 × 33 × 56 mm and internal tubular anechoic signals (arrow). A2 shows abundant blood flow signals within the mass by the color Doppler (arrow). B: (case 5) B1, a mixed echogenic mass was seen in the left shoulder, left axillary area, and left chest wall, with a size of about 58 × 41 × 40 mm, with internal honeycomb echoes (arrow). B2, the rich blood flow signal can be detected internally, with burr-like blood flow spectrum. B3, unenhanced MRI SSFSE sequence shows multiple tortuous vessels with low signal intensities (arrow). C: (case 1) C1, at 23 weeks of gestation, a solid uniform echogenic mass, with a size of 22 × 17 × 19 mm and clear borders, was detected in the dorsal side of right lower leg (arrow). C2, three-dimensional reconstruction (arrow). C3, after birth. C4, surgical resected specimens (arrow). D: (case 12) D1, a hyperechoic well-circumscribed mass in the precordial area of the left chest wall, about 27 × 18 × 33 mm and regular shape (arrow). D2, three-dimensional reconstruction (arrow). E: (case 14) at 35 weeks of gestation, hemangioma from the right buccal extending to the frontal chest wall. E1, internal blood supply is shown in Doppler images (arrow). E2, three-dimensional reconstruction (arrow). E3, unenhanced MRI FIESTA sequence shows a mass (triangle arrow) compressing the esophagus (large arrow) and traches (small arrow). F: (case 2) At 30 weeks of gestation. F1, a cutaneous hemangioma was observed on the top of the head (arrow). F2, the internal structure of the mass was clearly shown by a high frequency line array probe (arrow).

Table 1. Size and growth rate of fetal cutaneous hemangioma diagnosed at different gestational weeks in 15 cases who chose to continue pregnancy.

Case number	Ultrasound	First time	Second time	Third time	Fourth time	Growth rate, cm^3/wk*
1 (Figure 1(C))	Gestational week Dimensions, mm Volume, cm^3	23 22 × 17 × 19 3.7	30 40 × 28 × 36 21.1	37^+5 65 × 35 × 55 65.4		4.20
2 (Figure 1(F))	Gestational week Dimensions, mm Volume, cm^3	29 32 × 30 × 3 1.5	31 36 × 29 × 3 1.6			0.05
3	Gestational week Dimensions, mm Volume, cm^3	31 65 × 45 × 46 70.4	33 62 × 61 × 38 75.2	36 70 × 64 × 42 98.4		5.60
4	Gestational week Dimensions, mm Volume, cm^3	31 35 × 18 × 31 10.2	37^+2 60 × 30 × 50 47.1			5.95
5 (Figure 1(B))	Gestational week Dimensions, mm Volume, cm^3	29 58 × 41 × 40 49.7	32 58 × 41 × 55 68.4	34 65 × 45 × 60 91.8	36 66 × 57 × 47 92.5	6.11
6	Gestational week Dimensions, mm Volume, cm^3	25 29 × 15 × 23 5.2	27 35 × 14 × 25 6.4			0.60
7	Gestational week Dimensions, mm Volume, cm^3	27 39 × 28 × 13 7.4	30^+3 61 × 29 × 32 29.6			6.52
8	Gestational week Dimensions, mm Volume, cm^3	30^+4 57 × 19 × 45 25.5	37^+1 79 × 76 × 50 157.0			20.55
9	Gestational week Dimensions, mm Volume, cm^3	31^+3 98 × 75 × 43 165.3	36 112 × 109 × 51 325.6			32.06
10	Gestational week Dimensions, mm Volume, cm^3	25^+2 29 × 23 × 13 4.5	32 34 × 26 × 15 6.5			0.28
11	Gestational week Dimensions, mm Volume, cm^3	26 31 × 31 × 16 8.0	32 50 × 26 × 44 29.9			3.65
12 (Figure 1(D))	Gestational week Dimensions, mm Volume, cm^3	25 27 × 18 × 33 8.4	30 37 × 29 × 40 22.4			2.80
13	Gestational week Dimensions, mm Volume, cm^3	23 57 × 46 × 24 32.9	28 66 × 56 × 45 87.0	32 68 × 52 × 50 92.5	40 87 × 62 × 53 149.5	8.35
14 (Figure 1(E))	Gestational week Dimensions, mm Volume, cm^3	35^+1 78 × 31 × 66 83.5	36 90 × 30 × 89 125.7			42.20
15	Gestational week Dimensions, mm Volume, cm^3	33^+4 63 × 23 × 38 28.8	36^+4 69 × 26 × 41 38.5			3.23

*Average.

Table 2. Prenatal ultrasound findings and pregnancy outcomes in 8 fetuses with complications.

Case number	Dimension, mm	Volume, cm^3	Complications	Delivery	Postpartum findings	Treatments
3	65 × 45 × 46	70.4	At 31 weeks: cardiac enlargement (cardiothoracic area ratio 0.44) and tricuspid regurgitation (regurgitation area 1.57 cm^2); at 32 weeks: cardiac enlargement (cardiothoracic area ratio 0.50) and tricuspid regurgitation (regurgitation area 1.90 cm^2) reverse blood flow signals were seen in the diastole of aortic arch and ascending aorta	At 38^+6 weeks: C-section	Severe tricuspid regurgitation (regurgitation area 2.10 cm^2), severe pulmonary hypertension, heart failure	Propranolol treatment was ineffective; supply artery was ligated
5 (Figure B)	58 × 41 × 40	49.7	At 29 weeks: hemangioma complicated with arteriovenous fistula, cardiac enlargement (cardiothoracic area ratio 0.4), tricuspid regurgitation (regurgitation area 0.4 cm^2), compensatory widening of left subclavian artery, left innominate vein and superior vena cava	At 37^+2 weeks: C-section	Moderate-severe tricuspid regurgitation (regurgitation area 1.79 cm^2), severe pulmonary hypertension	Propranolol treatment was ineffective; supply artery was ligated
9	98 × 75 × 43	165.3	At 31 weeks: the heart enlarged (cardiothoracic area ratio 0.37), pericardial effusion, the inner diameter of the inferior vena cava widened, the PSV value of the middle cerebral artery increased (80.75 cm/s (>1.5 MoM)), and the left lower extremity skin edema and thickened.	At 36^+5 weeks: C-section	Fetal secondary and tricuspid regurgitation (regurgitation area 0.34 cm^2), mitral regurgitation (regurgitation area 0.67 cm^2)	Propranolol treatment
14 (Figure E)	78 × 31 × 66	8305	At 35 weeks: fetal hydrops (skin edema, pleural effusion), moderate polyhydramnios; at 36^+1 weeks: intrauterine week fetal distress	At 36^+1 weeks: C-section	KMP, DIC, pulmonary hemorrhage, respiratory distress syndrome	Death on day 3 after birth
16	91 × 47 × 70	156.5	At 31 weeks: the intra-abdominal segment of umbilical vein widened.	Termination of pregnancy
17 (Figure A)	56 × 33 × 56	54.1	At 27 weeks: heart enlargement (cardiothoracic area ratio 0.66), tricuspid regurgitation (regurgitation area 1.68 cm^2), mitral regurgitation (regurgitation area 0.40 cm^2)	Termination of pregnancy
18	69 × 27 × 56	54.6	At 24 weeks: cardiothoracic enlargement (cardiothoracic area ratio 0.42), superior vena cava dilation	Termination of pregnancy
13	57 × 46 × 34	46.6	At 27 weeks: enlarged heart (cardiothoracic area ratio 0.41)	Termination of pregnancy

KMP: Kasabach-Merritt phenomenon; DIC: disseminated intravascular coagulation.