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多发性巨大胎盘绒毛膜血管瘤:一例报告。

Multiple giant placental chorioangioma: A case report.

作者信息

Hashemi Atefe, Moradi Alamdarloo Shaghayegh, Vafaei Homeira, Barzegar Hamide, Jafari Firouzeh, Haseli Sara, Abbaspour Elahe

机构信息

Maternal-Fetal Medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine Shiraz University of Medical Sciences Shiraz Iran.

Neonatal Research Center Shiraz University of Medical Sciences Shiraz Iran.

出版信息

Clin Case Rep. 2024 Jul 25;12(8):e9219. doi: 10.1002/ccr3.9219. eCollection 2024 Aug.

Abstract

KEY CLINICAL MESSAGE

Giant chorioangiomas, despite being rare, pose significant fetal and maternal risks. Timely and individualized treatment plans are crucial to reduce morbidity and mortality when fetal compromise occurs. Additionally, successful conservative management relies on consistent ultrasound monitoring, Doppler flowmetry assessments, and amniotic fluid level measurements.

ABSTRACT

Chorioangiomas are benign placental tumors that manifest in approximately 1% of pregnancies. Giant chorioangiomas, characterized by tumors exceeding 4 cm, are exceptionally rare and pose substantial risks to maternal and fetal health. This case report details a patient with multiple giant chorioangiomas, emphasizing the rarity and consequential complications associated with these tumors. A 23-year-old woman, G3P2, at 28 weeks gestational age, was diagnosed with multiple large, well-defined placental masses with increased vascularity, indicative of giant placental chorioangiomas. Subsequent ultrasound revealed various fetal anomalies such as cleft palate and lip, as well as lung and heart abnormalities. At 34 weeks of gestation, an emergency cesarean section was performed due to preeclampsia. Subsequently, a female neonate was born with hydrops fetalis. Unfortunately, she passed away within the first hour of her life. Complications associated with chorioangiomas primarily arise from arteriovenous shunts, which potentially lead to compromised fetal perfusion and cardiac failure. Although small-sized chorioangiomas are often discovered incidentally, Doppler ultrasound and magnetic resonance imaging can reliably distinguish these tumors from other placental lesions. Additionally, management strategies tailored to gestational age and maternal-fetal symptoms typically necessitate a multidisciplinary approach. However, additional research is essential to understand the mechanisms of chorioangiomas and to develop comprehensive management guidelines.

摘要

关键临床信息

巨大绒毛膜血管瘤尽管罕见,但对胎儿和母亲有重大风险。当胎儿出现危及情况时,及时且个性化的治疗方案对于降低发病率和死亡率至关重要。此外,成功的保守治疗依赖于持续的超声监测、多普勒血流测量评估和羊水水平测量。

摘要

绒毛膜血管瘤是良性胎盘肿瘤,约1%的妊娠中会出现。以肿瘤直径超过4厘米为特征的巨大绒毛膜血管瘤极为罕见,对母婴健康构成重大风险。本病例报告详细介绍了一名患有多发性巨大绒毛膜血管瘤的患者,强调了这些肿瘤的罕见性及相关并发症。一名23岁、孕3产2的妇女,孕28周时被诊断出有多个边界清晰、血管增多的巨大胎盘肿块,提示为巨大胎盘绒毛膜血管瘤。随后的超声检查发现了各种胎儿异常,如唇腭裂以及肺部和心脏异常。孕34周时,因先兆子痫进行了急诊剖宫产。随后,一名女新生儿出生时患有胎儿水肿。不幸的是,她在出生后第一小时内死亡。与绒毛膜血管瘤相关的并发症主要源于动静脉分流,这可能导致胎儿灌注受损和心力衰竭。虽然小尺寸的绒毛膜血管瘤常为偶然发现,但多普勒超声和磁共振成像能够可靠地将这些肿瘤与其他胎盘病变区分开来。此外,根据孕周和母婴症状制定的管理策略通常需要多学科方法。然而,有必要进行更多研究以了解绒毛膜血管瘤发病机制并制定全面的管理指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/391a/11272946/a0b4c62b01a6/CCR3-12-e9219-g002.jpg

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