PMC4857324_01
Prenatal ultrasound at 34.5 weeks of gestation age shows a large right hydrothorax, reaching 77mm x 49mm x 29mm with the right lung being compressed (open arrow), and the hyperechogenic mass (closed arrow) is recognized in the retrospection of the images.
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And follow-up ultrasound at 34.5 weeks revealed massive right-sided pleural effusion displacing the fetal heart to the left (Figure 1).
PMC4857324_02
(a) Aortography shows a well-vascularized mass fed by the enlarged right internal thoracic (white arrow) and inferior diaphragmatic arteries (black arrow). (b) Inferior vena cavogram shows significant IVC compression at the diaphragm level (arrow), leading to the dependant patency of azygos vein. (c, d) The selective angiography of the right internal thoracic and inferior diaphragmatic arteries clearly shows a highly vascularized lesion without early filling venous branches. (e) After initial embolization, repeat angiography reveals that the right 8th, 9th, and 10th intercostal arteries have an increased width and contributed slightly to the vascularity of the lesion.
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Inferior vena cavogram showed significant compression at the diaphragm level, leading to the dependent patency of azygos vein draining part of blood to superior vena cava (Figure 2).
PMC4857324_03
MRI shows the right diaphragmatic hemangioma. (a) The right diaphragmatic hemangioma shows a pattern of intense hyperintensity on T2-weighted image (arrow). (b) The follow-up MRI examination at 18 months confirms the tremendous regression of the hemangioma (arrow) and the disappearance of pleural effusion.
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The ultrasound at 12 months confirmed the tremendous reduction in the size of the hemangioma, and the MRI at 18 months demonstrated nearly complete regression of the mass (Figure 3).