A Case of Massive Subchorionic Thrombohematoma Diagnosed by Ultrasonography and Magnetic Resonance Imaging

Abstract

Massive subchorionic thrombohematoma is uncommon but associated with a poor perinatal prognosis. Placental enlargement was detected in a 25-year-old Japanese primipara woman with fetal growth retardation and oligohydramnios at 23 weeks’ gestation. Ultrasonography (USG) showed an abnormal sonolucency within the placenta at 28 weeks’ gestation, but could not give an unequivocal differentiation from placental abnormalities such as hematomas, cysts and other tumors. Magnetic resonance imaging (MRI) pointed to a large hematoma in the subchorionic region. Simultaneously, the amniotic fluid was brownish colored. From these findings, it was possible to have prenatal diagnosis of massive subchorionic thrombohematoma. At 32 weeks’ gestation, the fetus died in utero and was stillborn 3 days later. Pathological findings for the placenta revealed a large hematoma diffused between the villous chorion and the chorionic plate, with wide necrosis of placental tissue, likely due to formation of multiple thrombi. The clinical and pathological findings were compatible with massive subchorionic thrombohematoma. MRI might be useful for the detection of massive subchorionic thrombohematoma and help its clinical management in combination with USG and pulse Doppler imaging.

Massive Subchorionic Hematoma: Peculiar Prenatal Images and Review of the Literature

“…On the other hand, in the remaining 7 cases, they were described as 'heterogeneous'. Massive subchorionic hematoma was also reported recently to be diagnosed prenatally by MRI [7,8; and the present case). In case 8 [7], pelvic MRI showed an iso-intense lesion, although the ultrasonographic findings were described as heterogeneous.…”

“…Massive subchorionic hematoma was also reported recently to be diagnosed prenatally by MRI [7,8; and the present case). In case 8 [7], pelvic MRI showed an iso-intense lesion, although the ultrasonographic findings were described as heterogeneous. In case 9 [8], the MRI was heterogeneous but the ultrasound was homogeneous.…”

“…In cases 4, 5, 7, 8, and 11, Doppler examination of the uterus demonstrated abnormal waveforms, suggesting severe fetal distress [4,6,7; and the present case]. Stillbirth and neonatal death (survival for 20 min to 5 days after birth) were reported in 6 of the 11 reported cases (fetal survival rate = 45.5%).…”

“…The appearance of this abnormality on both imaging modalities might be explained by its recent development just before imaging studies. Kojima et al [7] emphasized the difficulty of determining the timing of pregnancy termination in their severely immature case with a massive subchorionic hematoma. We also experienced a similar case of IUFD with massive subchorionic hematoma, and agree with such a conclusion.…”

Extensive Subamniotic Haematoma

“…As Kojima et al (2001) stated that ultrasound alone may not be sufficient to definitely exclude the differential diagnoses of placental haematoma, we decided to perform magnetic resonance imaging in an attempt to better characterize the tumefaction.…”