A 29-year-old Japanese primipara with fetal sacrococcygeal teratoma and hydronephrosis was referred to our department at 22 weeks of gestation. The preload index of the inferior vena cava (PLI) was 0.75 and fetal cardiac failure was suspected at 28 weeks of gestation. The sodium and chloride concentrations and osmolarity of the fetal urine were 96 mEq/L, 81 mEq/L and 204 mOsm/L, respectively, and we predicted a good renal function. Then, a vesico-amniotic shunting operation was performed at 28 weeks of gestation to keep the renal function and PLI decreased 0.41 after this operation. At 30 weeks of gestation, the fetus was delivered by a cesarean section owing to preterm PROM and a huge growing sacrococcygeal teratoma. The baby was female, weighing 2,020 g, and the 1 minute Apgar score was 1. She died almost 7 hours after birth due to respiratory insufficiency. An autopsy confirmed bilateral hydronephrosis, urethral stenosis, sacrococcygeal immature teratoma, and pulmonary hypoplasia. The size of this tumor revealed 80 x 70 x 45 mm in intrapelvic cavity and 130 x 90 x 50 mm out of body, and this tumor was classified as Type II according to the American Academy of Pediatrics Surgery Section classification.
A 36-year-old pregnant woman with a rapidly growing hemangioma in the vagina was treated by transcatheter arterial embolization after delivery. Blood flow characteristics within the tumor were evaluated using transvaginal color Doppler ultrasound both before and after the embolization. The vascular resistance in the tumor vessels within the vaginal hemangioma was observed to be significantly decreased; the tumor reduced in volume following this non-surgical treatment.
Ten patients with ovarian bleeding, who were surgically treated, had been preoperatively evaluated using transvaginal color Doppler ultrasound. The blood-flow velocity waveforms of the bleeding also were analyzed. The bleeding artery of the ovary was clearly detected in 9 of 10 (90%) patients by transvaginal color Doppler ultrasound and was later confirmed by either a laparotomy or laparoscopic surgery. Either a corpus luteum cyst or a ruptured corpus luteum was associated with the bleeding in the 9 of the 10 patients. The resistance-index value in each bleeding artery examined in the 9 cases was relatively low, ranging from 0.46 to 0.59 (mean: 0.51). Based on our findings, transvaginal color Doppler ultrasound is useful for preoperatively detecting bleeding arteries in clinically severe cases of ovarian bleeding.
The detection of color vascularity by TV-CDU in patients with an ectopic pregnancy is helpful for diagnosis, especially for patients with either a questionable adnexal mass in B-mode images or lower serum β-hCG concentrations.
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