Ultrasonographic diagnosis of ectasia of the umbilical vein

Abstract

Anomalies of the umbilical cord are associated with high rates of stillbirth, possibly because of fetal hypoxia during pregnancy.' In the past, this pathology was usually detected after delivery, thus preventing any therapeutic measures from being taken to save the infant's life.Progress towards a prenatal diagnosis of umbilical cord defects has been made recently with the introduction of high-resolution ultrasound examination; in this way it was possible to diagnose correctly cases of umbilical cord hematoma,' angiomy~oma,~ and allantoicHere we describe a case of ectasia of the umbilical vein with fetal distress, which we were able to recognize by ultrasonic imaging and successfully treat by elective cesarean section. CASE REPORTA 38-year-old woman, gravida 4 para 3, received a routine ultrasound examination at 34 weeks. Although the placenta, the fetus, and the amount of amniotic fluid were normal, anomalies were found in the umbilical cord. In fact, the portion of the cord close to the abdominal wall of the fetus was normal but was followed by an enlarged segment, initially with a thickening of the wall and later with a dilatation of the umbilical vein (diameter was 9.2 cm) surrounded by a thin wall. In a more distal section, a second smaller dilatation was detected (Fig. 1). Evidence of a turbulent flow in both cavities was seen.The mother was submitted to a number of laboratory investigations, which gave evidence of a severe hypochromic anemia, but clotting function and the values of E3 and HPL were within the normal range. Serologic tests for rubella, toxoFrom the *Clinica Ostetrica e Ginecologica, tIstituto di Puericultura e Medicina Neonatale, and ZIstituto di Anatomia e Istologia Patologica dell'universita di Ferrara, Ferrara, Italy.For reprints contact F. Vesce, MD, Clinica Ostetrica e Ginecologica dell'universita di Ferrara, Ferrara, Italy. plasmosis, syphilis, viral hepatitis, and cytomegalovirus infection were negative.Two weeks later, despite the absence of changes in the echographic picture, a decrease in fetal heart rate variability, with variable decelerations associated with weak uterine contractions, was observed. Clear amniotic fluid was collected by amniocentesis: since the lecithidsphingomyelin ratio was 2.3, a cesarean section was performed with the delivery of a 2,420-g female newborn.The placenta was normal. The umbilical cord, centrally inserted, measured 40 cm in length. At 10 cm from its abdominal end, an enlargement of myxomatous tissue containing normal vessels was present. In the immediate subsequent portion of the cord, the umbilical vein showed a sac, 5 cm in diameter, filled with partially clotted blood, followed by a collapsed thin-walled dilatation (Fig. 2).Microscopic examination revealed that the intima was torn with blood dissecting between the muscle and adventitia toward Wharton's jelly (Fig. 3). There was no evidence of angiitis. The pathologic pattern was consistent with an intramural dissecting hematoma.Birth weight, head circumference, and length of the infant were a...

Umbilical cord pseudocyst in trisomy 18

“…Umbilical cord tumours are located at the placental margin and appear at ultrasound evaluation as dense multicystic masses, histologically composed of thin-walled interanastomosing vessels (Seifer et al, 1985). Ectasia of the umbilical vein appears echographically as a large filled mass showing evident turbulent blood flow (Vesce et al, 1987).…”

“…Umbilical cord masses that can be detected prenatally are rare and include cystic remnants of embryonic development (Sachs et al, 1982;Hill et al, 1987), haematoma (Ruvinsky et al, 1983), angiomyxoma or haemangioma (Seifer et al, 1985), mucoid degeneration (Iaccarino et al, 1986), and ectasia of the umbilical vein (Vesce et al, 1987).…”

Severe fetal anemia as a consequence of extra‐abdominal umbilical vein varix: A case report and review of the literature

“…12 Table 1. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] Including our case, 11 cases (79%) have been diagnosed antenatally. The average of diameter of the EAUVV was 3.4 cm (range: 1-5 cm).…”

HDlive for Assessment of Placenta and Umbilical Cord

“…14,[39][40][41][42] Conventional 2D sonography shows a large banana-like umbilical cord enlargement including umbilical vein varix with massive thrombosis (Fig. 24).…”