Massive subchorionic hematoma (Breus’ mole) presents a variety of ultrasonic appearances: A case report and literature review

Abstract

Key Clinical Message Massive subchorionic hematoma (MSH) presents a variety of ultrasonic appearances. Placentomegaly with fetal growth restriction should be included as one of the differential diagnoses for intraplacental MSH. Care management of MSH requires to be tailored to each individual's responses while taking the NICU's capabilities and the patient's wishes into consideration.

Massive subchorionic thrombohematoma: a case report demonstrating serial sonographic changes

“…13 MST located close to the umbilical cord insertion compresses the umbilical vessels and provides a poorer prognosis. 5 In eleven cases reported by Nishijima et al 55% resulted in stillbirth or neonatal death, and all the survivors were delivered at an average gestational age of 32 weeks. 14 In ten cases reported by Fung et al only 60% resulted in a live birth, out of which 66% were preterm.…”

“…On some occasions, it may simply appear as placentomegaly. 5 One suggested criteria for the diagnosis of MST include involvement of much of the placental surface area with a blood clot measuring at least 1 cm in thickness. 4 This lack of a distinct diagnostic criteria may account for the limited number of cases documented.…”

“…Descriptions for MST in the literature range from heterogenous, homogenous, or hypoechogenic mass, differentiated from the normal placenta. 1,5 Other descriptions in the literature include bulbous (jelly-like) placenta and a fluid-fluid level appearance within the placental tissue. 6 The one feature common to all is that the placental mass/thrombus should be >1 cm.…”

Fetal survival in pregnancy complicated by massive subchorionic thrombohaematoma

“…Massive subchorionic thrombohaematoma (MST), formerly described as Breus’ mole, is a maternal thrombus greater than 1 cm in thickness that develops between the chorionic plate and villous chorion of the placenta. The thrombus bulges above the chorionic plate often resulting in the compression of umbilical vasculature 1–5. According to the Atlas of Placental Pathology , the thrombus involves at least 25% of the chorionic plate 6.…”

“…According to the Atlas of Placental Pathology , the thrombus involves at least 25% of the chorionic plate 6. MSTs are uncommon, occurring in approximately 1 in 3000 pregnancies 3 7 8. While the underlying aetiology of MST is unclear, several maternal comorbidities have been associated with an increased risk of MSTs including thrombophilia, cardiovascular disease, hypertension, diabetes mellitus and pre-eclampsia 1 2 4 5.…”