Percutaneous Embolisation of a Giant Placental Chorioangioma with n-Butyl-2-Cyanoacrylate: a Case Report and Review of the Literature

Giantplacental chorioangiomas (CA) are benign tumors usually associated with unfavorable fetal outcome. The management of symptomatic tumors depends mainly on gestational age and fetal symptoms. Intervention aims to block the vascular supply to the tumor. Various methods have been described such as fetoscopic or interstitial laser coagulation, intratumoral alcohol injection, endoscopic ligation, and embolisation. We present a case of a large CA treated by tissue glue (n-Butyl-2-Cyanoacrylate) injection into the feeding vessel. In a 31yearold woman at 22 weeks of gestation, routine ultrasound examination showed a solid, giant hypoechogenic tumor arising from the right side of an anterior placenta, and protruding into the amniotic cavity. The tumor was highly vascularized, and supplied by a large feeding artery and vein with pulsatile blood flow on Doppler investigation. There was polyhydramnion with a deep vertical pocket of 10.4 cm. No signs of fetal anemia or hydrops were observed. The embolisation was performed under ultrasound guidance. A 20-gauge needle was inserted into the arterial feeding vessel, flushed with 5% glucose solution, followed by the injection of a mixture of n-Butyl-2-Cyanoacrylate diluted with lipiodol. Immediate interruption of the vascular supply was observed. Subsequently, the patient was discharged without any complications and delivered spontaneously a healthy newborn at 37 2/7 weeks of gestation. Our case emphasizes the potential of percutaneous embolisation of CA as a minimal invasive procedure compared to laser coagulation and a further option in cases of CA with large feeding vessels.