The natural history of an umbilical cord hemangioma

Abstract

Umbilical cord hemangiomas are rare, and the natural history is poorly understood. We present a case where the clinical course was complicated by distal umbilical cord edema, episodes of proximal obstruction of umbilical artery blood flow, transient fetal pleural and pericardial effusions, and position-dependent abnormal fetal heart rate monitoring with periods of sustained fetal tachycardia. Delivery was performed for fetal growth restriction with abnormal fetal surveillance. This case highlights possible mechanisms for fetal decompensation as well as the importance of a multifaceted approach to the management of an umbilical cord mass using multiple tools for fetal assessment. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:455-458, 2016.

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

“…244 This condition carries a high morbidity and mortality rate of approximately 35%, often related to coexisting factors including rupture with resulting hemorrhage, nonimmune hydrops, polyhydraminios, fetal disseminated intravascular coagulopathy (DIC), fetal growth restriction, additional hemangiomas, other fetal anomalies, and stillbirth. [244][245][246][247][248][249] Stillbirth may result secondary to mechanical obstruction of umbilical vessels by the tumor as suggested by Kamitomo et al who noted stenosis of the umbilical vein and an umbilical artery in association with this lesion. 245 Interestingly, a number of reports have noted the presence of amnionic inclusion cysts and pseudocysts in association with hemangiomas.…”

“…245,[252][253][254] Prenatal sonographic diagnosis has been reported infrequently. 194,245,248,[253][254][255][256] Location and sonographic appearance of a hemangioma in close proximity to the abdominal wall have led to prenatal and neonatal misdiagnosis of an omphalocele. 253 Prenatal sonographic findings include notation of a hyperechoic lesion or a multicystic mass within the umbilical cord.…”

“…245,246,248 Color Doppler imaging will confirm the vascular nature of the lesion with depiction of multiple branching arterial vessels with low resistance at Doppler assessment. 248 Interestingly, prenatal sonographic detection of an umbilical cord hemangioma was recently reported as an early sign of diffuse neonatal hemangiomatosis (DNH) with the newborn later diagnosed with multiple hemangiomas in the liver, intestines, skin and brain. 257 Although hemangiomas may occur at any point throughout the entire length of the umbilical cord, the fetal and placental insertion sites (both fixed and often sonographically depicted) should be scanned in detail.…”

Prenatally detected umbilical cord tumor as a sign of diffuse neonatal hemangiomatosis

“…8 The association of an umbilical cord hemangioma and obstruction of the umbilical artery blood flow, transient fetal pleural and pericardial effusions and positiondependent abnormal fetal heart rate monitoring with periods of sustained fetal tachycardia has also been reported. 9 As umbilical and fetal hemangiomas share these characteristics, we suggest prenatal monitoring of the peak systolic velocity in the fetal middle cerebral artery.…”

Umbilical cord and visceral hemangiomas diagnosed in the neonatal period

“…The use of multiple treatments can be explained by our limited knowledge of the biology of hemangiomas. [19] The traditional drugs of choice were corticosteroids and drugs such as thalidomide and somatostatin but propranolol is now the first-line treatment for problematic proliferating hemangiomas. [20] In our patient, we initiated propranolol treatment because of the extent of the lesion and the potential risk of serious complications, and the response was favorable.…”