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CME Credit Offered
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Poster Session 4

(989) Sonographic indicators of intralesional haemorrhage in fetal lymphatic malformation: a retrospective cohort study

Friday, January 31, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Charles Litwin, MDCM, MSc

    Fellow
    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, ON, Canada

    • Coauthor(s)

  • YK

    Yada Kunpalin, MD, PhD

    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

  • Lennart Van der Veeken, MD, PhD (he/him/his)

    Fellow
    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

  • PC

    Paolo Campisi, MD, MSc

    Department of Otolaryngology – Head & Neck Surgery, Hospital for Sick Children and University of Toronto
    Toronto, Ontario, Canada

  • MC

    Manuel Carcao, MD, MSc

    Department of Haematology/Oncology, Hospital for Sick Children and University of Toronto
    Toronto, Ontario, Canada

  • JK

    Johannes Keunen, MD, PhD

    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

  • NA

    Nimrah Abbasi, MDCM, MSc

    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

  • Greg Ryan, MD

    Head, Fetal Medicine program & Ontario Fetal Centre
    University of Toronto
    Toronto, Ontario, Canada

  • TV

    Tim Van Mieghem, MD, PhD

    Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

  • SS

    Shiri Shinar, MD

    Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto
    Toronto, Ontario, Canada

Objective: To review the rate of intralesional hemorrhage (IH), sonographic indicators of IH and outcomes in a cohort of fetuses with lymphatic malformations (LMs).

Study Design: We performed a single-center retrospective cohort study of fetal LMs over a 13-year period. IH was defined as ultrasound findings demonstrating reticular echogenicity, fluid-fluid levels or clot without flow on Doppler. Fetal transfusion was considered if the middle cerebral artery peak systolic velocity (MCA-PSV) was elevated >1.5 MoM. Lymphangioma volume ratio (LVR) was calculated using the formula: 0.532 x (tumour width x length x height in cm)/head circumference (cm). Predictive strength of LVR on IH was determined by ROC analysis.

Results: Twenty-six isolated LMs were identified antenatally. Three pregnancies were terminated and 5 were lost to follow-up. Of the remaining, 10 involved the head and neck (H&N) and 8 involved the axilla. H&N LMs were diagnosed at 26.1 weeks gestation (IQR 21.6-28.8 weeks) with an LVR at presentation of 2.24 (IQR 0.68-17.29). Axillary LMs were diagnosed at 28.1 weeks gestation (IQR 23.6-32.3 weeks) with an LVR at presentation of 4.17 (IQR 1.26-7.02). Lesion growth was observed over the course of pregnancy (Fig 1). Five cases of IH were detected at 28.7 weeks gestation (IQR 24.4-35.2) and were found to have significantly larger tumour volume compared to those without bleeding (LVR: 11.09±5.25 vs 5.33±4.11, p=0.04, table 1). LVR greater than 6.86 had a detection rate of 80% (95%CI 37.6-99.0%) for IH with a specificity of 66.7% (95% CI 39.1-86.2%). Polyhydramnios was present in all cases of IH but only in 2 out of 13 without IH. Of the 5 cases of IH, 2 died in utero, 2 required fetal transfusions and all 3 survivors were treated with sclerotherapy and rapamycin postnatally.

Conclusion: Intralesional hemorrhage is a recognized complication of fetal LMs with polyhydramnios. LVR may serve as a good predictor for IH prompting serial follow-up with MCA-PSV. Surviving fetuses typically require further treatment postnatally.