case_images: PMC10913809_01
case_images: Ultrasonography was performed at 23 weeks of gestation. (a) The placenta was found to be attached to the left lateral and posterior wall of the uterus, exhibiting localized thickening. Within this area of thickening, there were observed inhomogeneous hypoechoic regions. (b) Superb Micro-vascular Imaging (SMI) revealed an abnormal echogenic region within the thickened placental tissue that exhibited a lack of microvascular blood flow signals, but demonstrated surrounding vascularity. Visually, this elliptical-shaped echogenic region was observed to be enveloped by microvascular blood flow. (c and d) Branched micro-vascular blood flow was observed in the normal placental tissue next to the lesion.
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case_images: The placenta was found to be attached to the left lateral and posterior wall of the uterus, exhibiting localized thickening (Figure 1a). Visually, this elliptical-shaped echogenic region was observed to be enveloped by microvascular blood flow (Figure 1b, Video S2). Branching micro-vascular blood flow was observed in the normal placental tissue adjacent to the lesion (Figure 1c and d, Video S3).
case_images: Follow-up ultrasound images. The lesion gradually transformed into (a) a local hypoechoic area of the placenta accompanied by (b) focal heterogeneous strong echo and decreased in size. It was (c) measured approximately 7.0x3.4x5.0 cm at 29 weeks and approximately (d) 3.9x3.9x4.2 cm at 36+6 weeks of gestation.
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case_images: Visually, this elliptical-shaped echogenic region was observed to be enveloped by microvascular blood flow (Figure 1b, Video S2). Subsequent ultrasound images revealed a gradual transformation of the lesion into a localized hypoechoic area within the placenta (Figure 2a), accompanied by focal heterogeneous strong echoes (Figure 2b), which gradually diminished in size. The dimensions were approximately 7.0x3.4x5.0 cm at 29 weeks (Figure 2c) and approximately 3.9x3.9x4.2 cm at 36+6 weeks (Figure 2d).
case_images: Fetal growth curve (NICHD Asian standard). From the 29th week of gestation, the ultrasound had suggested that the fetus was small for gestational age.
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case_images: Branching micro-vascular blood flow was observed in the normal placental tissue adjacent to the lesion (Figure 1c and d, Video S3). From the 29th week of gestation, the ultrasound suggested that the fetus was small for gestational age according to NICHD Asian standards (Figure 3).
case_images: Image of the placenta. The placenta was approximately 20x18 cm in size and 450 g in weight, with large grayish-yellow infarcts.
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case_images: The placenta measured approximately 20x18 cm and weighed 450 g, with large grayish-yellow infarct (Figure 4).