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Fantasia I, Polsinelli V, Ambrosii S, Tabacco S, Stanislao V, Ludovisi M, Dotta A, Conforti A, D'Alfonso A, Di Fabio S, Guido M. Late third trimester diagnosis of congenital giant hemangioma complicated by the Kasabach-Merritt phenomen: a case report and literature review. J Matern Fetal Neonatal Med 2023; 36:2274803. [PMID: 37908053 DOI: 10.1080/14767058.2023.2274803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023]
Abstract
Objective. To describe the case of a large cervical mass diagnosed in the late third trimester with development of Kasabach-Merritt phenomenon (KMP) in the immediate postnatal period, along with a literature review.Methods. Description of case-report and literature search through Medline/Pubmed, performed from inception to December 2022 for articles relating to the pre and postnatal diagnosis of KMP.Results. A 36-year-old multiparous woman was admitted to hospital for contractions at 40 weeks of gestation, in an otherwise uneventful pregnancy. Admission's ultrasound showed the presence of a voluminous mass of 14x15 cm of the posterior side of the neck, highly vascularized, and no signs of hemodynamic imbalance. Postnatally, blood tests showed the presence of severe anemia and thrombocytopenia requiring several transfusions of blood, plasma, platelets and clotting factors. Due to the association of congenital hemangioma and thrombocytopenia a diagnosis of KMP was made. After attempts of conservative treatment, surgical removal was needed to stop the hematological cascade with regression of symptoms. The review of the literature identified 14 articles including 9 cases of prenatally suspected KMP and 6 diagnosed in the immediate postnatal period and without signs of fetal hydrops. Adverse perinatal outcome, in terms of postnatal death/termination of pregnancy, was observed in 67% of cases (6/9) in the prenatally suspected group and 33% of cases in those with a postnatal diagnosis of KMP. Fetal hydrops was present in 83% of cases with adverse perinatal outcome.Conclusions. The Kasabach-Merrit syndrome is a rare condition, which can have a dangerous evolution when it develops in utero or in the immediate postnatal period carrying a risk of perinatal mortality of approximately 50%. Even if the fetus shows no signs of anemia or heart failure, the risk of developing it in the immediate postnatal period is high and should be mentioned to the couple.
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Affiliation(s)
- I Fantasia
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
| | - V Polsinelli
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Ambrosii
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Tabacco
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
| | - V Stanislao
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Ludovisi
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - A Conforti
- Department of Neonatal Medicine and Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A D'Alfonso
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Di Fabio
- Neonatology Unit, San Salvatore Hospital, L'Aquila, Italy
| | - M Guido
- University Department of Obstetrics & Gynaecology, San Salvatore Hospital, L'Aquila, Italy
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Gică N, Dumitru A, Panaitescu AM, Gică C, Peltecu G, Ciobanu AM, Bălănescu L. Prenatal Ultrasound Diagnosis of Klippel-Trenaunay Syndrome. Diagnostics (Basel) 2023; 13:3400. [PMID: 37998536 PMCID: PMC10670238 DOI: 10.3390/diagnostics13223400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Klippel-Trenaunay syndrome (KTS) is a very rare vascular malformation syndrome also referred to as a capillary-lymphatic-venous malformation with unknown aetiology. The aim of our paper is to highlight interesting images, regarding a rare case of foetal Klippel-Trenaunay syndrome diagnosed prenatally in our department and confirmed postnatally with a favourable evolution during the gestation and neonatal periods. This case was diagnosed at 26 weeks gestation and characterised through ultrasound by the presence of superficial multiple cystic structures of different sizes spreading over the left leg with hemihypertrophy and reduced mobility. The cystic lesions were spreading to the left buttock and the pelvic area. The right leg and upper limbs had normal appearance with good mobility. There were no signs of hyperdynamic circulation or foetal anaemia, but mild polyhydramnios was associated. The ultrasound findings were confirmed postnatally, the left leg presented multiple cystic lesions and port wine stains, and there was hypertrophy and fixed position, with favourable evolution at 6 months of life, when the size of the lesions began to decrease and the mobility of the leg improved.
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Affiliation(s)
- Nicolae Gică
- Obstetrics and Gynecology Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (C.G.); (G.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Andreea Dumitru
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Anca Maria Panaitescu
- Obstetrics and Gynecology Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (C.G.); (G.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Corina Gică
- Obstetrics and Gynecology Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (C.G.); (G.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Gheorghe Peltecu
- Obstetrics and Gynecology Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (C.G.); (G.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Anca Marina Ciobanu
- Obstetrics and Gynecology Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (N.G.); (C.G.); (G.P.); (A.M.C.)
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital Bucharest, 020021 Bucharest, Romania;
| | - Laura Bălănescu
- Department of Pediatric Surgery and Anaesthesia and Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
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Walter A, Calite E, Müller A, Kalff JC, Meyer C, Geipel A, Gembruch U, Schreiner C. Prenatal diagnosis and management of a giant intrahepatic arteriovenous malformation—Sonographic findings, clinical implications, and treatment. Clin Case Rep 2022; 10:e6175. [PMID: 35937027 PMCID: PMC9347331 DOI: 10.1002/ccr3.6175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
| | - Jörg C. Kalff
- Department of Surgery Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Carsten Meyer
- Department of Diagnostic and Interventional Radiology Bonn University Hospital, University Hospital Bonn Bonn Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine University Hospital Bonn Bonn Germany
| | - Christine Schreiner
- Department of Neonatology and Pediatric Intensive Care Medicine University Hospital Bonn Bonn Germany
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Yu D, Sun L, Chen T. Prenatal ultrasound diagnosis of Klippel-Trenaunay-Weber syndrome associated with umbilical cord hemangioma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:254-256. [PMID: 33210306 DOI: 10.1002/jcu.22896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/28/2020] [Indexed: 06/11/2023]
Abstract
We describe a case of prenatal diagnosed Klippel-Trenaunay-Weber syndrome, which mainly manifested as hypertrophy of the left thigh, and was associated with umbilical cord hemangioma and loss of heterozygosity (LOH) for 1q21.2 q44. This case report describes the second reported case associated with umbilical cord hemangioma and the first reported case with LOH for 1q21.2 q44.
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Affiliation(s)
- Dongmei Yu
- Department of Special Examinations, Qingdao Women and Chlidren's Hospital, Qingdao, China
| | - Lingyu Sun
- Department of Special Examinations, Qingdao Women and Chlidren's Hospital, Qingdao, China
| | - Taotao Chen
- Department of Special Examinations, Qingdao Women and Chlidren's Hospital, Qingdao, China
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Shiyun PMM, Pan YMM, Jinzhou WMM, Siyu YMB, Ling WMB, Xiyue ZMB, Fan YMD. Prenatal Ultrasound Diagnosis of Klippel-trenaunay Syndrome Associated with the Thickened Thigh and Dilated Inferior Vena Cava: A Case Report and Literature Review. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.210012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Ivanitskaya O, Andreeva E, Odegova N. Prenatal diagnosis of Klippel-Trenaunay syndrome: Series of four cases and review of the literature. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2020; 28:91-102. [PMID: 32528545 DOI: 10.1177/1742271x19880327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/08/2019] [Indexed: 01/19/2023]
Abstract
Klippel-Trenaunay syndrome is a rare disease with a classic triad of port wine stains, varicose veins, and bony and soft tissue hypertrophy of an extremity. The quality of life in these patients is significantly affected, making the prenatal diagnosis of Klippel-Trenaunay syndrome important. We present four prenatally diagnosed cases of this anomaly with a unique case of ectrodactyly of the hand in foetus with Klippel-Trenaunay syndrome. Such a combination has not been previously reported prenatally. A review of the literature for similar cases is also presented.
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Affiliation(s)
- Olga Ivanitskaya
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Elena Andreeva
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
| | - Natalia Odegova
- Medical Genetic Department, Moscow Regional Research Institute of Obstetrics and Gynecology, Moscow, Russian Federation
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7
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Someya M, Sasahara J, Yamamoto S, Sawada A, Nishikawa M, Ishii K. Prenatally diagnosed congenital hemangioma with elevated middle cerebral artery peak systolic velocity mimicking the Kasabach-Merritt phenomenon: A case report. J Obstet Gynaecol Res 2019; 45:2456-2460. [PMID: 31502338 DOI: 10.1111/jog.14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/25/2019] [Indexed: 12/13/2022]
Abstract
Congenital hemangioma is a rare vascular tumor that develops prenatally, and a large congenital hemangioma may be accompanied by the Kasabach-Merritt phenomenon. We present a case of prenatally diagnosed fetal congenital hemangioma through ultrasound and maternal anti-Jr(a) antibody alloimmunization with elevated middle cerebral artery peak systolic velocity. To investigate fetal anemia and hemostatic condition, we performed percutaneous umbilical blood sampling, which revealed no symptom of either Kasabach-Merritt phenomenon or sensitization to anti-Jr(a) antibody. Consequently, pregnancy could be continued without further intervention. After birth, congenital hemangioma was found on the infant's left thigh, and Kasabach-Merritt phenomenon was not shown. Percutaneous umbilical blood sampling could provide precise information prenatally in case of congenital hemangioma with maternal alloimmunization.
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Affiliation(s)
- Masayuki Someya
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Jun Sasahara
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Satoshi Yamamoto
- Department of Neonatology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Akihisa Sawada
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Masanori Nishikawa
- Department of Radiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Keisuke Ishii
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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Mardy AH, Chetty SP, Norton ME, Sparks TN. A system-based approach to the genetic etiologies of non-immune hydrops fetalis. Prenat Diagn 2019; 39:732-750. [PMID: 31087399 DOI: 10.1002/pd.5479] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Abstract
A wide spectrum of genetic causes may lead to nonimmune hydrops fetalis (NIHF), and a thorough phenotypic and genetic evaluation are essential to determine the underlying etiology, optimally manage these pregnancies, and inform discussions about anticipated prognosis. In this review, we outline the known genetic etiologies of NIHF by fetal organ system affected, and provide a systematic approach to the evaluation of NIHF. Some of the underlying genetic disorders are associated with characteristic phenotypic features that may be seen on prenatal ultrasound, such as hepatomegaly with lysosomal storage disorders, hyperechoic kidneys with congenital nephrosis, or pulmonary valve stenosis with RASopathies. However, this is not always the case, and the approach to evaluation must include prenatal ultrasound findings as well as genetic testing and many other factors. Genetic testing that has been utilized for NIHF ranges from standard chromosomal microarray or karyotype to gene panels and broad approaches such as whole exome sequencing. Family and obstetric history, as well as pathology examination, can yield additional clues that are helpful in establishing a diagnosis. A systematic approach to evaluation can guide a more targeted approach to genetic evaluation, diagnosis, and management of NIHF.
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Affiliation(s)
- Anne H Mardy
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Shilpa P Chetty
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Mary E Norton
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
| | - Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, US
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9
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Radiological Aspect of Klippel-Trénaunay Syndrome: A Case Series With Review of Literature. Curr Med Sci 2018; 38:925-931. [PMID: 30341531 DOI: 10.1007/s11596-018-1964-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/26/2018] [Indexed: 01/19/2023]
Abstract
Klippel-Trénaunay syndrome (KTS) is a rare angio-osteo-hypertrophic syndrome characterized by vascular malformations, soft tissue and/or bone hypertrophy, and varicose veins. For the purpose of describing the imaging findings and elucidating the role of medical imaging in the diagnosis and assessment of patient with KTS, we have reviewed the imaging data of 14 KTS patients. The imaging features on different imaging modalities were analyzed. Unilateral lower limb involvement was evident in 71% of cases (n=10) and bilateral but asymmetric lower limb involvement in the remaining 29% of cases (n=4). The most commonly depicted imaging features were varicosities in 93% (n=13), muscle hypertrophy in 79% (n=11) and venous anomalies in 64% (n=9). Other less common imaging findings included lymphedema in 29% (n=4), arterial malformations 29% (n=4), soft tissue hemangiomas 21% (n=3), pelvic and thigh phleboliths 21% (n=3), venous aneurysms 21% (n=3), bone abnormalities 14% (n=2) and lymphadenopathy 14% (n=2). A severe unilateral lower limb deformity resulting in contractures and muscle atrophy of the whole limb was depicted in 1 case. The pathognomonic marginal vein of Servelle was identified in 2 cases. AV shunt was highly suspected in 4 cases and was confirmed by DSA in 1 case, making Klippel-Trénaunay-Weber syndrome a more apt diagnosis. Associated ipsilateral duplicated renal artery was found in 1 case. We have concluded that medical imaging is the cornerstone in the diagnosis and assessment of severity and complications, follow-up and differentiation of KTS from other similar conditions. Different imaging modalities play complementary roles in the evaluation of KTS patients.
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AboEllail MAM, Hanaoka U, Numoto A, Hata T. HDlive Imaging of a Giant Fetal Hemangioma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:2315-2318. [PMID: 26507697 DOI: 10.7863/ultra.15.01070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Mohamed Ahmed Mostafa AboEllail
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan (M.A.M.A., U.H., T.H.), Department of Obstetrics and Gynecology, Numoto Ladies Clinic, Kagawa, Japan (A.N.)
| | - Uiko Hanaoka
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan (M.A.M.A., U.H., T.H.), Department of Obstetrics and Gynecology, Numoto Ladies Clinic, Kagawa, Japan (A.N.)
| | - Atsuo Numoto
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan (M.A.M.A., U.H., T.H.), Department of Obstetrics and Gynecology, Numoto Ladies Clinic, Kagawa, Japan (A.N.)
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan (M.A.M.A., U.H., T.H.), Department of Obstetrics and Gynecology, Numoto Ladies Clinic, Kagawa, Japan (A.N.)
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