Early prenatal ultrasonographic
diagnosis and follow up treatment of a giant abdominal hemangioma: a
rare case report
Dinu-Florin Albu 1,
Cristina-Crenguta Albu 2, Andrei Oncescu 3, Stefan-Dimitrie Albu 4
1Dr. Dinu-Florin Albu, Ass. Professor, Obstetrics Gynecology
and Medical Genetics, Expert in Maternal Fetal Ultrasound and
Maternal-Fetal Medicine, 2Dr. Cristina-Crenguta Albu, Ass. Professor,
Ophthalmology and Medical Genetics, 3Dr. Andrei Oncescu, MD Obstetrics
Gynecology, 4Stefan-Dimitrie Albu, Medical Student.
All are affiliated with University of Medicine and Pharmacy
Carol Davila“, Bucharest, Romania
Address for
Correspondence: Dr. Cristina-Crenguta Albu, Address- 27A,
Catedrei Street, 1st District, Bucharest, Romania. E-mail:
stevealbu@yahoo.com
Abstact
We report the rare case of a fetus diagnosed in utero as early as 16
weeks with a growing lateral abdominal wall hemangioma. Ultrasonography
confirms space occupying lesion and Colour Doppler ultrasound
examination proves the vascularity of lesion. Fetal MRI was performed
at 27 weeks and confirmed the localization, neither of the internal
organs being affected and no other hemangiomas being detected. The baby
was delivered at 36 weeks after premature rupture of membranes and
transferred to the pediatric department. Angiography was
performed and after further analysis the baby was referred for surgical
treatment. Surgery was a success and the baby came for the
routine 6 months check up.
Key words:
Hemangioma, Abdominal wall, Prenatal, Ultrasonographic, Diagnosis
Manuscript received:
30th September 2016,
Reviewed: 12th October 2016
Author Corrected:
20th October 2016,
Accepted for Publication: 31st October 2016
Introduction
Vascular anomalies are encompassed in two major categories: vascular
tumors, which are proliferative endothelial lesions, such as
hemangiomas, and vascular malformations, which are developmental
aberrations of hematic or lymphatic vessels [1, 2].
Haemangioma are common benign vascular soft tissue tumour. The most
frequent sites of haemangiomas are extremities, head and neck. Exact
cause of haemangioma is unknown. Vascular tumors of the abdominal wall,
benign congenital malformations that may cause pain or cosmetic
disfigurement are very rarely [3, 4]. The abdominal wall is a quiet
rare location of haemangionas [4].
Abdomen hemangiomas may occur in such atypical locations and can have
such unusual features that they cause significant diagnostic dilemma
[5, 7].
Hemangiomas of the abdominal wall can be isolated congenital vascular
tumors or associated with other vascular malformations [4]. Very
rarely, hemangiomas can occur in the inguinal canal along the spermatic
cord [5, 6].
Case
Report
We report a case of a 36 year old Caucasian woman, who was referred at
16 weeks’ gestation for routine prenatal scan. There was no
family history of congenital anomalies and chromosomal defects. The
couple was not consanguineous and had normal general health.
Methods
Routine ultrasonography at 16 weeks of pregnancy, double and triple
marker test (AFP, uE3 and hCG), selective ultrasonography for detection
of fetal abnormalities, Colour Doppler ultrasound examination, 3D and
4D live scan with Voluson Echograph E8, amniocentesis, QF-PCR, fetal
karyotype and fetal MRI, were performed.
Results
Double test was found normal at that time. The biometry of the fetus
was normal for his gestational age. Triple test was not sensitive to
the presence of a possible trisomy. Ultrasound examination at 16 weeks
of gestation revealed a single fetus with: lateral abdominal wall soft
tissue mass. (Figure 1, Figure 2). The visualization of pulsating
Doppler signals and the smooth and sonoluscent aspect of the tumor was
highly suggestive for the diagnosis: giant lateral abdominal wall
hemangioma. (Figure 3, Figure 4).
Figure-1 and 2:
Initial ultrasound examination of the fetal abdomen revealed a
lateral abdominal wall soft tissue mass.
Figure-3 and 4:
3D Power Doppler HD ultrasound examination of the fetal abdomen
revealed a
giant lateral abdominal wall hemangioma.
Figure -5:
3D reconstruction of
hemangioma.
Figure- 6: Female
normal karyotype: 46, XX.
Amniocentesis was performed in order to exclude chromosomal
abnormalities and was found normal: female normal karyotype: 46, XX
(Figure 6).
Fetal MRI was performed at 28 weeks of gestation and confirmed the
localization, neither of the internal organs being affected and no
other hemangiomas being detected.
Follow up scans showed the increase of the tumor size as the pregnancy
advanced and the apparition of polyhidramnios.
The fetus was delivered at 37 weeks through cesarean section after
premature rupture of membranes. After, the baby was transferred to the
Department of Neonatology. After further
investigations the baby was referred for surgical specific treatment.
Surgery was a success and the baby came for the routine 6 months check
up.
Discussion
and Conclusions
The muscles and fascial layers of the abdominal wall protect
intraperitoneal contents and abdominal structures are extended to the
retroperitoneal space [8].
The cause of hemangiomas is not yet understood, but it is known that
they are not related to drugs or medications that may have been taken
during pregnancy, nor are they related to any known environmental
exposures that may have occurred during that time. Rarely, in some
families multiple family members over several generations have been
affected, and this is related to a gene abnormality.
Abdominal wall lesions can be nontumorous or tumorous. Nontumorous
lesions include congenital lesion, abdominal wall hernia, inflammation
and infection, vascular lesions or miscellanous conditions [8].
Congenital hemangiomas can be classified into two subtypes:
rapidly involuting congenital hemangioma and non-involuting congenital
hemangioma. On ultrasonography these lesions are usually seen as
well-defined hypoechoic masses and appear diffusely vascular [9].
In the present case, the initial diagnosis of a wall abdominal
hemangioma was made on ultrasound examination. 3D Power Doppler HD
ultrasound examination was an appropriate initial diagnostic modality.
On subsequent examinations the size of the hemangioma remained stable
during pregnancy.
This case suggests that the early prenatal ultrasound diagnosis was
very useful in the management, treatment and prognosis of a giant
abdominal wall hemangioma.
Treatment is dependent upon both the stage of growth of the lesion, the
presence of complications, and emotional needs and considerations.
Observation, laser therapy, drug therapy, and surgical removal are the
four most common management options. In some patients, a combination of
several of these treatments may be used over a period of time [10].
In this case, after specific investigations in the neonatal care unit
the baby was referred for surgical treatment. Surgery was a success and
the baby came for the routine 6 months check up.
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
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How to cite this article?
Dinu-Florin Albu, Cristina-Crenguta Albu, Andrei Oncescu,
Stefan-Dimitrie Albu. Early prenatal ultrasonographic diagnosis and
follow up treatment of a giant abdominal hemangioma: a rare case
report. Int J Med Res Rev 2016;4(10):1764-1767.doi:10.17511/ijmrr.
2016.i10.09.