Placental Mass-Like Lesions
Roya Sohaey, MD
DIFFERENTIAL DIAGNOSIS
Common
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Acute Placental Abruption
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Placental Implantation on Myoma
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Focal Myometrial Contraction (FMC)
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Chorioangioma
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Complete Hydatidiform Mole
Less Common
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Placental Teratoma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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Routinely evaluate the whole placenta
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Sagittal views
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Midsagittal (with lower uterine segment)
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Right and left parasagittal
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Axial views
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Upper, mid, lower
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Identify location of mass
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In the placenta
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Chorioangioma
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Extension of abruption
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Teratoma (rare)
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Behind the placenta
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Abruption
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Myoma
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FMC
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Replaces the placenta
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Complete hydatidiform mole
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Interrogate mass with Doppler
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Masses with flow
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Chorioangioma
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Complete hydatidiform mole
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Masses with little or no flow
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Abruption
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FMC
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Characterize pattern of flow
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Peripheral flow with myoma
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Linear contiguous flow with FMC
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Helpful Clues for Common Diagnoses
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Acute Placental Abruption
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Identify abruption location
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Marginal (most common)
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Retroplacental
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Preplacental (most rare)
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Retroplacental abruption can mimic mass
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Thick placenta may be only finding
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Acute blood isoechoic to placenta
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Blood becomes hypoechoic with time
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Doppler shows no flow in hematoma
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Look for signs of fetal distress
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Assess fetal heart rate
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Fetal tone and movement
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Cord Doppler evaluation
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Assess amount of placenta detached
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< 30% associated with good prognosis
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> 50% associated with > 50% fetal death
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Placental Implantation on Myoma
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Myoma appearance
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Hypoechoic to uterus and placenta
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Calcifications are common
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Degenerating myomas
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Central cystic change
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Decreased blood flow
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Retroplacental myomas are associated with abruption
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Use Doppler to differentiate blood from myoma
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Rarely associated with intrauterine growth restriction
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Large amount of placenta implanted on myomatous uterus
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Focal Myometrial Contraction (FMC)
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Normal finding throughout pregnancy
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Uterine wall contraction
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Inner contour affected most
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Inner uterine bulge
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Outer contour relatively preserved
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FMC tends to be isoechoic to uterine wall
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Will resolve or change with time
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May take more than 30 minutes
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May need to reassess on follow-up exams
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Chorioangioma
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Benign, vascular placental tumor
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Most < 5 cm
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Common location is on fetal side of placenta, near cord insertion site
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Ultrasound features
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Well-defined mass
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Generally hypoechoic
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Heterogeneous if hemorrhage, infarction or degenerating
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Variable amount of blood flow
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Complete Hydatidiform Mole
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Most common type of gestational trophoblastic neoplasia
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100% paternal genetic makeup
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Variable ultrasound appearance
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Doppler findings
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↑ Flow between cysts
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High-velocity, low-impedance flow
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Associated theca lutein cysts
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Bilateral, multiseptated ovarian cysts
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Seen in 50% of cases
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Helpful Clues for Less Common Diagnoses
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Placental Teratoma
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Extremely rare
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Benign mature teratoma
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Calcifications suggest diagnosis
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Differentiate from demised twin next to placenta
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Histogenesis theories
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Twin incorporated in placenta
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Primitive gut tissue grows in placenta
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Other Essential Information
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Placental masses may be either incidental at time of exam or symptomatic
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Symptoms associated with abruption
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Retroplacental abruption
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Preterm labor
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Pain
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Fetal distress
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Marginal abruption
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Bleeding with or without contractions
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Preplacental
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Asymptomatic
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Fetal distress
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Large abruptions can be multifocal
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Can bleed directly into placenta
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Evaluate placenta first and quickly if fetal distress
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