Placenta

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of placental pathology:

Contents of this page:

1) Subchorionic cyst of the placenta

2) Velamentous insertion of umbilical cord into placenta

3) Vesicular mole (also called Molar pregnancy orHydatidiform_mole)

4) Placental calcification

5) Placental mass (mass in placenta- Chorioangioma of placenta or Placental Chorioangioma)

6) Succenturiate placenta

7) Placental venous lake

8) Placenta previa

    Incomplete/ partial placenta previa

    Complete placenta previa

9) Retained products of conception (RPOC)/ retained_placenta

Subchorionic cyst of the placenta:

The two sonographic images above show a cystic lesion of the placenta, just below the placental surface. Few mobile echoes were seen within the lesion. No other abnormalities were seen in the placenta and the fetus. This finding is generally considered to be clinically of little significance. However some reports suggest an association with fetal IUGR (Intrauterine growth retardation). Diagnosis: subchorionic cyst of the placenta. Also known as membranous cyst, chorionic cyst. It is believed to be due to deposition of fibrin in the subchorionic region of the placenta. Images courtesy of Dr. Gunjan Puri, Surat, India.

Reference: 1) http://www.jultrasoundmed.org/cgi/content/full/21/6/641 (free article)-- rated excellent by us.

Velamentous insertion of umbilical cord into placenta:

These ultrasound and color doppler images show the umbilical cord inserting into the placental membranes before reaching the placental tissue proper. This is the typical appearance on sonography, of velamentous insertion of the umbilical cord. Ultrasound images courtesy of Dr. Latha Natrajan, Bangalore, India.

Reference: http://www.jultrasoundmed.org/cgi/content/full/25/8/963 (free article and images).. excellent

Vesicular mole (also called Molar pregnancy or Hydatidiform mole) in 1st trimester:

Sonography of the uterus was done in this 1st trimester pregnancy. Ultrasound and Power Doppler images reveal:

a) Hyperechoic mass in the uterine cavity with multiple cystic spaces within it. b) Uterus is enlarged (bulky) c) The myometrium is hypoechoic compared to the contents of the uterine cavity. These appearances can be likened to a "snowstorm" or "moth eaten" look. d) Power Doppler images show increased flow within the enlarged uterus. These ultrasound images suggest a sonographic diagnosis of Vesicular Mole. Ultrasound images were taken using a Nemio- XG machine by Joe Antony, MD, India.

Reference: http://www.ajronline.org/cgi/reprint/160/1/137.pdf

Placental calcification:

Calcific areas in placenta:

This 3rd trimester pregnancy shows extensive calcification of the basal plate (uterine or maternal surface) of the placenta. There is also calcification along the placental septa and chorionic plate. The calcific deposits in the placenta are seen as hyperechoic foci with acoustic shadowing. Such calcium deposits in the placenta suggest macroscopic calcification as opposed to micro-calcification seen in the 2nd and early 3rd trimester. Clinically and pathologically, calcific changes of placenta have no significance. More ultrasound images and short ultrasound video clips of placental calcification can be seen at:

http://cochinblogs.blogspot.com/2009/08/placental-calcification.html 

Placental mass (mass in placenta - Chorioangioma of placenta or Placental Chorioangioma):

Sonography of the placenta in this 16 week pregnancy shows a large, solid mass, that is non calcific and shows mild vascularity on Power Doppler imaging. The mass is inhomogenous and shows many cystic spaces within it. This tumor of the placenta lies close to the cord insertion site. Flow seen on Power Doppler image suggests that this placental tumor is vascular and excludes placental hematoma. Ultrasound images of this type of placental mass are highly suggestive of placental chorioangioma. The other diagnostic possibility can be a hamartoma of the placenta. Chorioangioma of placenta is the commonest tumor of the placenta and is benign in nature. This mass measures 12 x 8 cms., an unusually large size for a chorioangioma, and can signify poor prognosis for this pregnancy. Images courtesy of Jaydeep Gandhi, MD, India. These ultrasound images were taken with a Toshiba Nemio-30 Ultrasound system.

Reference: http://radiographics.rsna.org/content/27/4/1187.full   

Succenturiate placenta:

Synonyms: bilobed or bilobate placenta:

This was a 3rd trimester pregnancy showing part of the placenta along the anterior wall of the uterus (SUCCENT PL), and the main part of the placenta along the posterior wall (PL). The sucenturiate lobe of placenta is connected to the main placenta by a string of blood vessels (see Color Doppler image on right). Both images taken on a GE, Logiq-3 ultrasound system. 

Reference: http://www.sonoworld.com/Fetus/page.aspx?id=181

Placental venous lake:

This placenta, in a 28 week pregnancy shows a large hypoechoic (almost anechoic), measuring 5 x 3.5 cms. in size. Some particulate matter was seen flowing through this area, which was closer to the fetal surface of the placenta. These ultrasound images suggest a typical appearance of a large venous lake in the placenta. Color Doppler image showed no major flow pattern within this placental lake. The fine, echogenic strands within the lesion appear to be nothing more than artefacts produced by slow flowing blood within the lesion. Ultrasound images are courtesy of Dr. Ravi Kadasne, MD, UAE.

Reference: http://www.obgyn.net/ultrasound/ultrasound.asp?page=/us/present/0206/moroder_placental_lakes

Placenta previa:

This is a condition, wherein the placenta covers the internal os. Depending on the degree of coverage of the internal os, there are 3 grades of placenta previa:

Marginal placenta (marginal placenta previa): here is the tip of the placenta reaches the margin of the internal os.

Partial or incomplete placenta previa: here the internal os is partially covered by the lower part of the placenta.

Complete placenta previa: here the placenta completely covers the internal os.

Another condition is low lying placenta, wherein the placenta reaches into the lower uterine segment, but clearly away from the internal os.

Incomplete/ partial placenta previa:

The above ultrasound and color Doppler images show the lower margin of the placenta partially covering the internal os, suggesting partial placenta previa. One point to be noted is that placenta previa is diagnosed in the 2nd and 3rd trimester of pregnancy, and that normal uterine contractions can cause the placenta to be "pushed" lower down its normal position, creating an appearance of placenta previa (a false positive diagnosis of placenta previa). Hence it is advisable to repeat the ultrasound scan after 30 minutes to exclude a false diagnosis of this condition.

Complete placenta previa:

This ultrasound image shows the placenta completely covering the internal os (INT OS), thus diagnostic of complete placenta previa. Follow up ultrasonography is advisable in all cases of placenta previa, to look for ascent of the placenta to a higher position due to the growth of the uterus. Such cases of placenta previa (both partial and complete) are in danger of hemorrhage (antepartum) and are advised rest to prevent this. Ultrasound image of complete placenta previa is courtesy of Dr. Vikas Shukla, MD, India.

Reference: http://emedicine.medscape.com/article/796182-overview

Retained products of conception/ retained placenta:

The above ultrasound images show a post partum uterus on transabdominal sonography. There is a hyperechoic mass within the endometrial cavity measuring 8 x 5 cms. The color Doppler ultrasound image shows poor vascularity of the mass and the endometrium. Transverse section ultrasound image of the post partum uterus shows that the mass is located more towards right half of the uterine cavity; also note that the endometrial mass is eccentric within the cavity- the anterior myometrium is thicker whilst the posterior wall of the uterus is thinner. The placenta was not expelled at the time of delivery. Thus this eccentric, markedly thick, inhomogenous mass is the retained placenta with a certain degree of placenta accreta being present. Absence of vascularity or poor flow does not rule out retained products of conception/ retained placenta. The single most important sign of retained products of conception is the large endometrial mass. Other signs of retained placenta or products include complex fluid or thickened endometrium (more than 10 mm.).

References: http://www.jultrasoundmed.org/content/24/9/1181.full.pdf+html (RPOC-free article and images).

                   http://radiographics.rsna.org/content/29/5/1371.full.pdf+html  (imaging of placenta - free article)

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  This page was last edited on: Monday July 04, 2011 04:02 PM  

Copyright ©   2007- All rights reserved- www.ultrasound-images.com Dr. Joe Antony, MD, Cochin- 20, India.

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