ABOELLAIL Mohamed¹, 石村 球², SURAPHAN Sajapala¹, 山本 健太¹, 田中 圭紀¹, 新田 絵美子¹, 金西 賢治¹, 秦 利之¹

Mohamed ABOELLAIL¹, Mari ISHIMURA², Sajapala SURAPHAN¹, Kenta YAMAMOTO¹, Tamaki TANAKA¹, Emiko NITTA¹, Kenji KANENISHI¹, Toshiyuki HATA¹

¹Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, ²GE Yokogawa Medical Systems

キーワード :

【Objective】
We present our experience of using HDliveFlow with the HDlive silhouette mode for diagnosing complete molar pregnancy in the first trimester, and differentiating it from missed abortion with hydropic degeneration.
【Case reports】
Case 1
A 44-year-old pregnant Japanese woman, primigravida, was referred to our ultrasound clinic at 7 weeks and 3 days of gestation for antenatal care, as she was known to have type 1 diabetes mellitus. Transvaginal two-dimensional（2D）sonography revealed the absence of a gestational sac in the uterine cavity. One week later, follow-up 2D color Doppler showed that the uterus also had no gestational sac but was filled with an echogenic mass, containing numerous variously sized vesicles without any blood flow. HDliveFlow with the HDlive silhouette mode demonstrated these vesicles forming a mass with the clear demarcation of its edges, and revealed no blood flow inside the mass. The serum HCG level was 82,906 mIU/mL. A diagnosis of molar pregnancy was suspected, and evacuation was performed. Histopathology revealed a complete hydatidiform mole.
Case 2
A 36-year-old pregnant Japanese woman, gravida 2, para 1, was referred to our clinic at 11 weeks and 3 days of gestation because of suspected molar-like changes on 2D sonography. Transvaginal HD-flow revealed these vesicles within the endometrium with dense vascularity around these vesicles. HDliveFlow with the HDlive silhouette mode showed the uterus filled with abundant blood vessels with some vesicles inside the endometrium. The serum HCG level was 13,454 mIU/mL. Because of fear of marked bleeding due to the heavy vasculature, preoperative prophylactic uterine artery embolization was performed followed by evacuation of the uterine contents. Histopathology revealed missed abortion with hydropic degeneration.
【Conclusion】
The spatial relationship between the vesicles and surrounding vascularity of the uterus could be demonstrated using HDliveFlow with the HDlive silhouette mode in both cases.
This technique might add additional information confirming the diagnosis and in differentiating a complete mole from other missed abortions or trophoblastic diseases when the 2D sonography alone is not conclusive.