Differential diagnosis, investigations and treatment
The subsequent fetal ultrasound revealed multiple well-defined hypoechoic lesions within the placenta with increased vascularity, indicating placental chorioangioma. (Figure 1) Additionally, various fetal anomalies were identified, including features indicative of large for gestational age, cleft lip and palate, hypoplastic lung, and a hyperechoic lung mass adjacent to the left atrium with systemic circulation. Notably, no signs of hydrops fetalis were observed. Moreover, fetal Doppler assessment revealed an increased peak systolic velocity of the middle cerebral artery (MCA-PSV) measuring 92, with 2.14 multiples of the median (MoM) for the gestational age, and an umbilical artery pulsatility index (PI) of 1.01. These findings were indicative of fetal anemia, accompanied by pulsatile turbulent flow.