SEARCH

SEARCH BY CITATION

We present a case of a placental surface cyst whose contents were less echogenic than the surrounding amniotic fluid (Figure 1). This finding was discovered when a 31-year-old Caucasian woman presented during her first pregnancy for a second-trimester ultrasound examination that showed a singleton intrauterine pregnancy with a normal and active fetus with measurements consistent with 26 weeks' gestation. A cyst of about 4 cm in diameter was noted within the amniotic fluid close to the umbilical cord insertion into the placenta. The umbilical cord was morphologically normal with normal blood velocity waveforms. Color flow Doppler ruled out any vascular involvement with the cyst. During our counseling session we mentioned to the patient that (1) the clinical significance of placental surface cysts depends on the association of fetal growth restriction and (2) that most placental surface simple cysts are associated with normal pregnancy outcomes1. The patient voiced her understanding of this information and agreed to a follow-up ultrasound evaluation and a postpartum examination of the placenta and infant. Ultrasound evaluation at 33 weeks' gestation demonstrated a fetus with appropriate interval growth. The remaining ultrasonographic findings were similar to those noted at 26 weeks' gestation. Spontaneous vaginal delivery of a normal female newborn weighing 3660 g with Apgar scores of 9 and 10 at 1 and 5 min, respectively, occurred at term. Pathological evaluation demonstrated a 619-g disc-shaped placenta measuring 18.7 × 16.6 × 4.7 cm. The cord was trivascular, inserted 6.5 cm from the nearest margin of the placenta and measured 51.7 cm in length and up to 1.5 cm in diameter. No knots or tears were noted. The villi were of normal maturation state and there were no clinically significant areas of infarct or severe ischemic change. On the fetal surface of the placenta a fluid-filled cyst was found located adjacent to, but independent from, the cord insertion. This cyst measured 4.6 × 3.8 × 3.2 cm and had a centrally located laminated thrombus filled with fibrin (Figure 2).

thumbnail image

Figure 1. Ultrasonic image showing an anechogenic cystic structure within the amniotic fluid at 26 weeks' gestation.

Download figure to PowerPoint

thumbnail image

Figure 2. Gross examination of the placenta revealed a surface cyst with a subchorionic fibrin clot. The umbilical cord was normal.

Download figure to PowerPoint

In summary, we have presented evidence of a unique ultrasonographic feature, namely that of a placental surface cyst with contents less echogenic than the surrounding amniotic fluid.

References

  1. Top of page
  • 1
    Brown DL, DiSalvo DN, Frates MC, Davidson KM, Genest DR. Placental surface cysts detected on sonography: histologic and clinical correlation. J Ultrasound Med 2002; 21: 641646; quiz 647–648.

J. De Leon-Luis*, R. H. Oneson†, J. Santolaya-Forgas*, * Division of Reproductive Genetics, Fetal Medicine and Ultrasound, Department of Obstetrics and Gynecology, Texas Tech University and Health Science Center, 1400 Coulter, Amarillo, TX 79106, † Heartland Pathology Consultants, Edmon, OK, USA