Massive subchorionic thrombohematoma: a case report demonstrating serial sonographic changes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20220582Keywords:
Placental pathology, Antepartum haemorrhage, Subchorionic hematoma, Premature labourAbstract
Massive subchorionic thrombohematoma (MST) is the presence of a large hematoma or thrombus confined to the subchorionic space. Sonographic findings vary and include placenta descriptions such as heterogeneous, homogeneous, hypoechogenic, or jelly-like mass, which can be differentiated from the normal placenta. Our case report highlights the serial sonographic features observed in a singleton pregnancy from 13 to 29 weeks of gestation. Ultrasound findings of the placenta changed from a 65 ml subchorionic hematoma at 16 weeks to a well-defined placental mass with cystic areas at 20 weeks to an amorphous gelatinous mass at 23 weeks which became primarily replaced by an anechoic lesion with internal septations at 27 weeks. She delivered a live female at 29 weeks. MST usually has a dramatic initial presentation, but these findings may be compatible with a favourable outcome. Serial ultrasound assessment of the placenta is helpful to define the perinatal prognosis and may demonstrate gradual changes and eventual resolution.
References
Fung TY, To KF, Sahota DS, Chan LW, Leung TY, Lau TK. Massive subchorionic thrombohematoma: A series of 10 cases. Acta Obstet Gynecol Scand. 2010;89(10):1357-61.
Windrim C, Athaide G, Gerster T, Kingdom JCP. Sonographic Findings and Clinical Outcomes in Women With Massive Subchorionic Hematoma Detected in the Second Trimester. J Obstet Gynaecol Canada. 2011;33(5):475-9.
Chhabra A, Butcher CD, Batra K, Mohsen NA, Hallowell MJ, Kuhlman KA, et al. Subchorionic Hemorrhage Imaging: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging Medscape. 2017. Available at: https://emedicine.medscape.com/article/404971-overview#a4. Accessed on 20 June 2021.
Fox H SN. Pathology ofthe placenta. Philadelphia: Wiley-Blackwell. 2007;116-30.
Yanagisawa F, Aoki S, Odagami M, Miyagi E. Massive subchorionic hematoma (Breus’ mole) presents a variety of ultrasonic appearances: A case report and literature review. Clin Case Reports. 2019;7(4):744-8.
Wang L, Zhou Q, Li L, Zeng S. Unique fluid-fluid level ultrasonic appearance in subacute placenta abruption with massive subchorionic hematoma. Int J Gynecol Obstet. 2018;141(3):391-2.
Linthwaite RF. Subchorial Hematoma Mole ( Breus ’ Mole ). J Am Med Assoc. 1963;186(9):107-9.
Shanklin DR, Scott JS. Massive subchorial thrombohaematoma (Breus’ mole). Obstet Gynecol Surv. 1976;31(1):12-6.
Szlachetka K, Faske E, Laniewski S, Glantz JC. A Rare Case of Two Consecutive Breus’ Molar Pregnancies. J Ultrasound Med. 2017;36(6):1279-82.
Usta IM, Abdallah M, El-Hajj M, Nassar AH. Massive subchorionic hematomas following thrombolytic therapy in pregnancy. Obstet Gynecol. 2004;103(5 Pt 2):1079-82.
Fang J, Wan YL, Chen CK, Tsui PH. Discrimination between newly formed and aged thrombi using empirical mode decomposition of ultrasound b-scan image. Biomed Res Int. 2015;2015.
Sur TK, Biswas TK, Ali L, Mukherjee B. Anti-inflammatory and anti-platelet aggregation activity of human placental extract. Acta Pharmacol Sin. 2003;24(2):187-92.
Reiners N, Sai V, Ragavendra N, Sridhar A, Chen A. Obstetrics and Gynaecology Cases-Reviews Breus Mole: A Placental Anomaly in a Patient Undergoing a Dilation and Evacuation. 2016. Available at: https://clinmedjournals.org/articles/ogcr/obstetrics-and-gynaecology-cases-reviews-ogcr-3-093.pdf. Accessed on 20 June 2021.
Nishijima K, Shukunami KI, Tsuyoshi H, Orisaka M, Tajima K, Kurokawa T, et al. Massive subchorionic hematoma: Peculiar prenatal images and review of the literature. Fetal Diagn Ther. 2005;20(1):23-6.
Alanjari A, Wright E, Keating S, Ryan G, Kingdom J. Prenatal diagnosis, clinical outcomes, and associated pathology in pregnancies complicated by massive subchorionic thrombohematoma (Breus’ mole). Prenat Diagn. 2013;33(10):973-8.
