Umbilical vein aneurysm: A clinical case and a review of literature
Background. The rate of umbilical vein aneurysm ranges from 0.4% to 1.1% per 1,000 placentas, accounting for about 4% of all umbilical vein malformations. The data obtained by both Russian and foreign authors on the characteristics of pregnancy and delivery in this abnormality are extremely limited.Tumanova U.N., Lyapin V.M., Kozlova A.V., Baev O.R., Bychenko V.G., Shchegolev A.I.
Case report. The paper describes a clinical case of placental umbilical vein branch aneurysm as a solid structural mass along the placental edge, which is suspected in a 29-year-old patient at 32 weeks’ gestation. Color Doppler mapping detected mosaic blood flow within the mass; hereupon the diagnosis was differentiated between vascular anomaly of the umbilical cord and placental hemangioma. Cesarean delivery was carried out at 35 weeks’ gestation due to progressive polyhydramnios and fetal health problems. Contrast-enhanced computed tomography indicated a placental umbilical vein branch aneurysm volume of 176 cm3 in the bearing placenta; the volume of the placenta was 503 cm3. The morphological examination of the placenta showed that at the umbilical cord attachment site, there was an 8х7х3-cm space-occupying lesion spreading under the amnion as a vein varix having a length of 13 cm and a diameter of 1.2-2 cm. Signs of fine-cystic degeneration of the muscle layer were microscopically found in the aneurysm wall.
Conclusion. The diagnosis of an umbilical vein aneurysm is valid when detecting local umbilical vein varix, the diameter of which is more than 9 mm or if the diameter in the region of dilation is more than 50% higher than that in the unaffected areas. On the basis of the literature data and the given case, the authors suggest that the most important points in the detection of umbilical vein aneurysm are to determine management tactics for a pregnant woman and to choose the optimal delivery method, depending mainly on the development of aneurysm complications, concomitant fetal lesions, and gestational age.
Keywords
aneurysm
umbilical vein
umbilical cord
fetus
computed tomography
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Received 07.02.2018
Accepted 02.03.2018
About the Authors
Ulyana N. Tumanova, Ph.D., scientific researcher of Department of Morbid Anatomy, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74955314444. E-mail: u.n.tumanova@gmail.comVyacheslav M. Lyapin, pathologist of Department of Morbid Anatomy, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74955314444. E-mail: v_lyapin@oparina4.ru
Alina V. Kozlova, Radiologist of the Department of Radiation Diagnostics, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Oparina str. 4. Tel.: +74954387647. E-mail: av_kozlova@oparina4.ru
Oleg R. Baev, MD, Head of maternity department, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74954381188. E-mail: o_baev@oparina4.ru
Vladimir G. Bychenko, Head of the department of radiation diagnostics, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Oparina str. 4. Tel.: +74954387647. E-mail: v_bychenko@oparina4.ru
Aleksandr I. Shchegolev, MD, professor, Head of Morbid Anatomy, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named
after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74955314444. E-mail: ashegolev@oparina4.ru
For citations: Tumanova U.N., Lyapin V.M., Kozlova A.V., Baev O.R., Bychenko V.G., Shchegolev A.I. Umbilical vein aneurysm: A clinical case and a review of literature. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (6): 119-25. (in Russian)
https://dx.doi.org/10.18565/aig.2018.6.119-125
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