Prenatal embolisation of a large chorioangioma using enbucrilate

Tze Kin Lau, Simon C.H. Yu, Tak Yeung Leung, Ka Fai To, Tak Yuen Fung, Tse Ngong Leung

Case report 

The patient was a 31-year-old nulliparous woman. She had a normal routine morphology scan at 19 weeks. The placenta was posterior, not low lying and without any local lesions. She presented at 24 weeks of gestation with an antepartum haemorrhage. According to the patient’s dates, the uterus was large with a fundal height of 30 cm. Ultrasound examination revealed a hydropic fetus with marked generalized skin oedema, bilateral pleural effusion, pericardial effusion, placentomegaly and cardiomegaly. The amniotic fluid index was 21 cm and the umbilical venous blood flow was pulsatile. There was an 8 × 9 cm well-circumscribed highly vascular solid tumour with low echogenicity arising from the lower part of the placenta protruding into the amniotic cavity (Fig. 1a). The umbilical cord inserted approximately 5 cm from the tumour, sending an artery to supply the tumour. The diagnosis was compatible with severe fetal hydrops secondary to high-output cardiac failure due to a large placental chorioangioma. Cordocentesis showed a fetal haemoglobin concentration of 12.3 g/dL and a normal fetal karyotype of 46XX.

Due to extreme prematurity and grave prognosis, embolisation of the chorioangioma was discussed and accepted. The procedure was performed at 24 weeks and 2 days of gestation under local anaesthesia.Under ultrasound guidance, a 20-gauge spinal needle was inserted into the lumen of the distal end of the feeding vessel within the tumour. The needle was flushed with 7 mL of 5% dextrose solution, followed by 1.5 mL of enbucrilate (Histoacryl, Braun, Melsungen, Germany), dilutedwith lipiodol (LipiodolUltra-Fluid, Guerbet, Aulnay-sous-Bois, France) at a ratio of 1:5. There was immediate and complete blockage of the vascular tree starting from the distal end and cessation of blood flow (Fig. 1b), observable by grey-scale ultrasonography and confirmed by colour and gated Doppler. The whole procedure took 10 minutes.

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