Discussion Author: jamal saad
Chorioangioma is a primary benign tumour with predominantly vascular involvement. It is found in 1% of all placentas undergoing careful and systematic histopathological examination. The preferred localisation is on the fetal side of the placental disk and it may protrude into the amniochorial cavity; the volume is variable (but rarely exceeds a maximum diameter of 4-5 cm).
A rarer form is the clinically relevant large chorioangioma which is likely to be associated with complications like polyhydramnios, pre-term birth, IUGR, anemia, fetal congested heart decompensation, non-immune fetal hydrops, perinatal mortality.
Hydrops fetalis due to a large chorioangioma is a rare complication. Our Patient s pregnancy had only pericardial effusion without prominent signs of fetal hydrops .
There are only few reports of color Doppler assessment of placental chorioangioma. While Grundy et al  and Hirata et al  found only arterial blood flow in the chorioangioma, Kung et al  did not find any vascularity in one patient and only peripheral venous flow in the second. Our study showed both central and peripheral flow with only arterial characteristics. In patients with fetal and/or maternal complications, color Doppler may play a role in demonstrating the blood flow inside the mass. As for those without complications and with little or no blood flow, it is of limited use.
With the increasing use of ultrasound, prenatal diagnosis of these tumors is becoming more common(4). Management includes umblical blood sampling and intravascular transfusion for fetal anemia which temporarily corects the hydrops and significantly prolongs the pregnancy(5). Ablation of the blood supply of plancental chorioangioma via operative fetoscopy is another management alternative in patients with large chorioangioma(5).
Color Doppler imaging helps differentiate placental chorioangioma from other placental lesions and may be useful in the prenatal follow-up of chorioangioma.
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