Kobayashi Yukari, Hasegawa Akihiro, Samura Osamu, Okamoto Aikou
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Minato Ku, Tokyo, Japan.
Radiol Case Rep. 2023 Oct 11;18(12):4474-4478. doi: 10.1016/j.radcr.2023.09.055. eCollection 2023 Dec.
A Breus' mole is a massive subchorionic thrombohematoma that arises below the chorionic plate on the fetal side of the placenta. It requires careful perinatal management because of the associated high incidence of severe fetal growth restriction and intrauterine fetal demise. However, the mechanism of its development remains unclear, and there are no reports examining the continuous changes in the hematomas. Herein, we report a case of a Breus' mole in which ultrasonographic massive subchorionic thrombohematoma changes were observed during pregnancy. A 40-year-old pregnant patient presented with fetal growth restriction, a hematoma with a highly echoic lesion, and an extremely thickened placenta. The clinical picture of massive subchorionic thrombohematoma gradually changed from a high-echoic phase with a 7-cm thick placenta to a high- and low-echoic mixed phase to a completely low-echoic phase with a prominent atrophic placenta (placental thickness = 3.5 cm) in almost 8 weeks. At 34 weeks of gestation, a male infant was delivered via cesarean section due to its nonreassuring fetal status with extremely low birth weight (1230 g). Postpartum histological findings revealed the presence of a Breus' mole. In conclusion, we observed the ultrasonographic changes of the massive subchorionic thrombohematoma that were detected as a placental hemorrhagic infarction by magnetic resonance imaging, from a high- to low-echoic area. The clinical course from massive subchorionic thrombohematoma to Breus' mole may be a prominent atrophic change in the placental tissue during pregnancy. These sequential ultrasonographic findings could be a key factor in understanding the pathophysiology of Breus' moles.
布雷斯氏痣是一种巨大的绒毛膜下血栓血肿，出现在胎盘胎儿侧的绒毛板下方。由于其伴有严重胎儿生长受限和宫内胎儿死亡的高发生率，需要进行仔细的围产期管理。然而，其发生机制仍不清楚，也没有关于血肿持续变化的报道。在此，我们报告一例布雷斯氏痣病例，在孕期观察到超声检查显示的巨大绒毛膜下血栓血肿变化。一名40岁的孕妇出现胎儿生长受限、伴有高回声病变的血肿以及极度增厚的胎盘。巨大绒毛膜下血栓血肿的临床表现从胎盘厚度为7厘米的高回声期逐渐转变为高回声与低回声混合期，再到胎盘显著萎缩（胎盘厚度 = 3.5厘米）的完全低回声期，历时近8周。妊娠34周时，因胎儿状况不佳、出生体重极低（1230克），通过剖宫产分娩出一名男婴。产后组织学检查结果显示存在布雷斯氏痣。总之，我们观察到巨大绒毛膜下血栓血肿的超声变化，磁共振成像将其检测为胎盘出血性梗死，从高回声区转变为低回声区。从巨大绒毛膜下血栓血肿到布雷斯氏痣的临床过程可能是孕期胎盘组织的显著萎缩性变化。这些连续的超声检查结果可能是理解布雷斯氏痣病理生理学的关键因素。
