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Ungureanu A, Nagy RD, Constantin C, Gheonea IA, Iliescu DG. Prenatal Diagnosis and Prognosis of Abdominal Arteriovenous Fistulae: A Comprehensive Case Series and Systematic Review. Diagnostics (Basel) 2024; 14:826. [PMID: 38667471 PMCID: PMC11048791 DOI: 10.3390/diagnostics14080826] [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: 03/20/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
This study had two main objectives. Firstly, we conducted a thorough literature review on the prenatal diagnosis of abdominal congenital arteriovenous fistulas (CAVFs) involving the abdominal aorta and hepatic arteries. Secondly, we aimed to provide detailed descriptions of eight additional cases diagnosed at our medical center and assess the outcome of this anomaly for informed counseling. We conducted a systematic search of online databases using specific keywords like "outcome", "ultrasound", "intrahepatic fistulae", and "fetal venous anomalies", focusing on studies published between 1998 and 2023. We selected 10 relevant articles and analyzed 13 cases. Additionally, we conducted a five-year prospective study in two referral centers, identifying eight CAVF cases with an incidence rate of 0.16%. Among the 21 cases evaluated, 11 resulted in live births, all of which received treatment. However, four cases (36.3%) had poor postnatal outcomes and neonatal demise due to heart failure. Prenatal signs of poor fetal hemodynamics, including cardiomegaly or hydrops, were observed in 52.3% of cases, regardless of outcome. Our findings highlight the rarity of this vascular malformation and emphasize the importance of effective treatment to avoid unfavorable outcomes. The long-term effectiveness of prenatal treatment or postnatal embolization remains uncertain, with liver transplantation being considered the most reliable treatment option.
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Affiliation(s)
- Anda Ungureanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Department of Cardiology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
| | - Rodica Daniela Nagy
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
| | - Cristian Constantin
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Dominic Gabriel Iliescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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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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Mathews B, Namdeo S, Krishnan V. Prenatal Diagnosis of Aorta-Portal Vein-Umbilical Vein Anastomosis. J Med Ultrasound 2019; 27:215-216. [PMID: 31867200 PMCID: PMC6905248 DOI: 10.4103/jmu.jmu_8_19] [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: 10/30/2018] [Accepted: 02/11/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Basil Mathews
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Sushmita Namdeo
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Vivek Krishnan
- Department of Fetal Medicine and Perinatology, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
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Beissel A, Riou S, Fischer Fumeaux CJ, Cassart M, Blanc S, Claris O, Guibaud L. Kasabach-Merritt phenomenon and prenatal counseling: a case series. Clin Case Rep 2016; 4:692-5. [PMID: 27386131 PMCID: PMC4929808 DOI: 10.1002/ccr3.580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 02/19/2016] [Accepted: 03/20/2016] [Indexed: 11/12/2022] Open
Abstract
Kasabach–Merritt phenomenon can be encountered in the perinatal period. No consensus exists regarding prenatal management. We report one prenatal case leading to therapeutic abortion and one neonatal case, successfully treated by a multimodal therapy. Prenatal counseling should include the possibility of neonatal multimodal treatment that can lead to favorable outcomes.
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Affiliation(s)
- Anne Beissel
- Department of Neonatal Intensive Care Unit Hospices Civils de Lyon Femme Mère Enfant Hospital 97 bd Pinel Bron Lyon 69500 France
| | - Stéphanie Riou
- Department of Neonatal Intensive Care Unit Hospices Civils de Lyon Femme Mère Enfant Hospital 97 bd Pinel Bron Lyon 69500 France
| | | | - Marie Cassart
- Perinatal Imaging - Radiology department Etterbeek-Ixelles Hospital Brussels Belgium; Fetal imaging department CHU St Pierre Brussels Belgium
| | - Sébastien Blanc
- Department of Neonatal Intensive Care Unit Hospices Civils de Lyon Femme Mère Enfant Hospital 97 bd Pinel Bron Lyon 69500 France
| | - Olivier Claris
- Department of Neonatal Intensive Care Unit Hospices Civils de Lyon Femme Mère Enfant Hospital 97 bd Pinel Bron Lyon 69500 France
| | - Laurent Guibaud
- Multidisciplinary consultation of Angioma Department of Fetal and Pediatric Imaging Hospices Civils de Lyon Femme Mère Enfant Hospital 97 bd Pinel Bron Lyon 69500 France
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Botha T, Rasmussen O, Carlan SJ, Greenbaum L. Congenital Hepatic Arteriovenous Malformation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479304263512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatic arteriovenous malformation (AVM) is a rare developmental vascular disorder characterized by direct arterial connection to a fistulous venous drainage system within the liver. The condition results in a high-flow, low-resistance shunt that can cause high-output cardiac failure and hydrops. Prenatal diagnosis is possible when sonography detects multiple engorged vascular channels in the fetal liver. Current treatment options include postnatal obliteration of the arterial feeder vessels by surgical ligation or percutaneous transcatheter embolization with detachable coils. The authors present a case of a prenatally diagnosed hepatic AVM complicated by fetal distress, high-output cardiac failure, and consumptive coagulopathy that had recanalization of feeder vessels noted two weeks after initial successful coil placement.
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Affiliation(s)
- Tracey Botha
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
| | - Olga Rasmussen
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
| | - S. J. Carlan
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida,
| | - Lennard Greenbaum
- Department of Obstetrics and Gynecology, Fetal Diagnostic Center, Arnold Palmer Hospital for Children and Women, Orlando, Florida
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Imai H, Hidaka N, Murakami T, Kido S, Yumoto Y, Fukushima K, Kato K. In Utero Sonographic Findings of Giant Hepatic Hemangioma and Associated Perinatal Complications: A Report of Two Cases. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2014.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Prenatal diagnosis of Klippel–Trenaunay–Weber syndrome with Kasabach–Merritt syndrome in utero. J Med Ultrason (2001) 2014; 42:109-12. [DOI: 10.1007/s10396-014-0557-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/04/2014] [Indexed: 12/20/2022]
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Zhang EG, Regan F, Layton M, Paramasivam G, Wyatt-Ashmead J, Roberts I, Kumar S. Managing the difficult case of fetal anemia. J Matern Fetal Neonatal Med 2011; 24:1498-503. [PMID: 21714692 DOI: 10.3109/14767058.2010.551149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To describe a series of complex fetal anemia cases, detail the appropriate investigations and management, and review the literature. METHODS Four cases of non-red cell alloimmunization or infective cases of fetal anemia are presented. RESULTS Of the four cases presented, one was a neonatal death, one pregnancy was terminated, one case was diagnosed with Diamond Blackfan anemia, and one case was due to recurrent feto-maternal hemorrhages despite negative Kleihauer tests. CONCLUSIONS Non-alloimmune causes of fetal anemia can be difficult to manage. Some cases require repeated and frequent intrauterine transfusions. The perinatal mortality and preterm delivery rates are increased, and some cases require considerable long-term treatment including regular transfusions. We present our experience of a series of non-immune fetal anemia managed in a tertiary unit, review the literature, and suggest appropriate management.
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Affiliation(s)
- Eko G Zhang
- Centre for Fetal and Maternal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College London , London, UK
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Tsukimori K, Hojo S, Kawarabayashi Y, Nakanami N, Masumoto K, Kohashi K, Tsuneyoshi M, Taguchi T, Wake N. Fetal neck capillary hemangioma associated with Kasabach-Merritt syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:397-401. [PMID: 17324993 DOI: 10.7863/jum.2007.26.3.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Kiyomi Tsukimori
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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Kamil D, Geipel A, Heep A, Breuer J, Knöpfle G, Gembruch U, Berg C. Prenatal diagnosis and therapy of upper extremity vascular malformation causing high cardiac output and Kasabach-Merritt sequence: a report of two cases. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2006; 27:217-9. [PMID: 16435320 DOI: 10.1002/uog.2681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We present two cases of upper extremity vascular malformation causing a high output state in the prenatal period. One fetus responded well to transplacental digitalis treatment. Both newborns had a Kasabach-Meritt sequence including anemia and thrombocytopenia. Postpartum treatment included successful interventional occlusion of the main feeding arteries and subsequent surgical removal of the tumor.
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Affiliation(s)
- D Kamil
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
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Respondek-Liberska M, Janiak K, Jakubek A, Marosyñka I, Lipka B, Dembowska B, Milewska-Bobula B, Perek D, Wilcyñski J. Prenatal diagnosis of fetal face hemangioma in a case of Kasabach-Merritt syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:627-629. [PMID: 12047548 DOI: 10.1046/j.1469-0705.2002.00731_3.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Gembruch U, Baschat AA, Gloeckner-Hoffmann K, Gortner L, Germer U. Prenatal diagnosis and management of fetuses with liver hemangiomata. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:454-460. [PMID: 11982977 DOI: 10.1046/j.1469-0705.2002.00689.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To study the relationship between prenatal appearance and perinatal outcome of fetuses with hepatic hemangiomata with special emphasis on criteria that may help to improve perinatal management. METHODS In a tertiary referral center six fetuses with hepatic hemangiomata were evaluated by gray-scale, color, and pulsed wave Doppler ultrasound between 1994 and 2000. Fetal blood sampling was performed in four cases. All data (computerized files and video tapes) were analyzed retrospectively. RESULTS Two fetuses showed very similar sonographic findings. They had an isolated large ('giant') round hepatic hemangioma (diameter 43 and 68 mm, respectively) supplied by one hepatic artery and drained by one hepatic vein, both of them showing high velocity and low pulsatility blood flow. Fetal blood count and coagulation parameters were normal in one case, whereas the other fetus showed a Kasabach-Merritt sequence with severe thrombocytopenia (10 platelets/nL) and mild disseminated intravascular coagulation. Intrauterine platelet transfusion was performed immediately prior to planned Cesarean delivery. Rapid platelet consumption continued postnatally, requiring several thrombocyte transfusions. Platelet counts stabilized only after tumor resection on the second day of life. One fetus with diffuse neonatal hemangiomatosis developed high-output cardiac failure with hydrops in addition to Kasabach-Merritt sequence (15 platelets/nL), and died following premature delivery. Three fetuses, however, showing an isolated small hyperechogenic hepatic hemangioma (5, 5, and 6 mm in diameter, respectively) did not develop any perinatal complications. CONCLUSION Large fetal liver hemangiomata and diffuse hemangiomatosis may cause severe perinatal complications, particularly high-output cardiac failure and/or Kasabach-Merritt sequence with severe consumption of platelets and clotting factors and hemolytic anemia. Fetal blood sampling enables the prenatal detection of these potential complications, allowing critical modification of perinatal management such as intrauterine platelet transfusion, especially directly before delivery. In contrast, isolated small hyperreflexic hepatic hemangiomata do not appear to be associated with any of these fetal and postnatal sequelae.
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Affiliation(s)
- U Gembruch
- Department of Obstetrics and Gynecology, Medical University, Lübeck, Germany.
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Raman S, Ramanujam T, Lim CT. Prenatal diagnosis of an extensive haemangioma of the fetal leg: a case report. J Obstet Gynaecol Res 1996; 22:375-8. [PMID: 8870422 DOI: 10.1111/j.1447-0756.1996.tb00992.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Extensive haemangioma with platelet consumption (Kasabach-Merritt syndrome) is rare. The lesion is usually a single cutaneous cavernous haemangioma similar to that found in our patient. Multiple superficial strawberry naevi were also seen all over the rest of the body. This condition was diagnosed antenatally in this patient with the use of colour Doppler. There is one recent report where the thrombocytopaenia was diagnosed by cordocentesis. Unfortunately the baby developed heart failure with intractable coagulopathy and died 2 days later.
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Affiliation(s)
- S Raman
- Department of Obstetrics and Gynaecology, University Hospital, Kuala Lumpur, Malaysia
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Abstract
Hematologic disorders are implicated in approximately 10% to 27% of cases of nonimmune hydrops fetalis. In almost all of these disorders, anemia leading to heart failure, edema, ascites, and anasarca is the final common denominator. The etiology of the anemia in these cases can be conveniently divided into two categories: (1) excessive erythrocyte loss by hemolysis or hemorrhage, and (2) erythrocyte underproduction. The former include intrinsic erythrocyte abnormalities such as alpha-thalassemia and glucose-6-phosphate dehydrogenase deficiency, and conditions with excessive fetal blood loss such as fetomaternal hemorrhage and twin-twin transfusion. The latter include bone marrow replacement syndromes and conditions associated with failure of erythrocyte production. The presentation, diagnosis, and management of hematologic disorders associated with nonimmune hydrops fetalis are reviewed.
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Affiliation(s)
- M O Arcasoy
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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