PMC6699333_01
Ultrasonogram at 23 weeks of gestation shows abnormal bean-like dilation of the umbilical vein.
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At 23 weeks of gestation, fetal screening ultrasonography showed two normal umbilical arteries and abnormal bean-like dilation of the umbilical vein (Figure 1), which was diagnosed as extra-abdominal UVV.
Ultrasonogram at 28 weeks of gestation shows enlargement of the thrombus or hematoma (measured 29 x 24 mm) beside the umbilical vein varix (UVV).
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At 28 weeks of gestation, the hematoma beside the UVV enlarged up to 29 x 24 mm (Figure 2) and blood flow in one of the umbilical arteries was not detected, while peak systolic velocity (PSV) in another umbilical artery near the UVV increased up to about 100 cm/s.
Ultrasonographic echocardiogram at 32 weeks of gestation shows edematous enlargement of the umbilical vein varix and an increase of the peak systolic velocity of the umbilical artery (UmA-PSV) up to 149 cm/s.
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At 32 weeks of gestation, edematous enlargement of the UVV and an increase of PSV of the UVV up to 149 cm/s were detected by ultrasonographic echocardiogram (Figure 3), and fetal heart rate tracing showed variable deceleration.
Pathological findings. In the middle of the umbilical cord, there is an area of vascular engorgement (125 mm in length) with central UVV. Cross-section of the cord shows occlusion of one of the umbilical arteries by a fibrin thrombus (a) with central calcification (b). Umbilical vein on both sides of the UVV is markedly dilated (c, e). The UVV, measured 25 x 11 mm, contains a large fresh thrombus (d).
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The pathological examination showed UVV with fresh thrombi, venous dilatation on both sides of the UVV, and occlusion of one of the umbilical arteries by fibrin thrombi with focal calcification (Figure 4).