HDlive Flow with HDlive silhouette mode in diagnosis of fetal hepatic hemangioma

Tumors affecting the liver are rare in fetal and infant life, with hemangioma being the most common1. Fetal hepatic hemangiomas on two-dimensional (2D) ultrasound are well-defined, mixed solid and cystic tumors with punctate calcifications in 50% of the mass. Hypoechoic areas represent vascular structures with low resistance on color Doppler imaging2. Here we describe our experience of HDlive Flow with HDlive silhouette mode in diagnosing fetal hepatic hemangioma in the third trimester of pregnancy. A 28-year-old Japanese woman, gravida 3 para 1, was referred to our clinic at 29 + 3 weeks of gestation because of a suspected fetal intra-abdominal tumor. Ultrasound examination (Voluson E10, GE Healthcare Japan, Tokyo, Japan) revealed on 2D imaging an intra-abdominal, well-defined, mixed solid tumor (45 × 40 × 23 mm) with cystic lesions and punctate calcification, located on the left side of the fetal stomach (Figure 1a). Imaging with HD-Flow demonstrated moderate blood flow within the mass (Figure 1b). HDlive Flow with HDlive silhouette mode at 30 + 2 weeks demonstrated a vascular pattern within the mass characterized by multiple, closely packed blood vessels with differing directions of blood flow, giving a pomegranate-like appearance (Figure 2 and Videoclip S1). The feeder artery was identified clearly originating from the celiac artery. Magnetic resonance imaging (MRI) showed a well-defined, hypervascularized tumor on the left side of the liver (Figure S1). A diagnosis of fetal hepatic hemangioma was suggested. At 37 + 2 weeks, elective Cesarean section was performed to avoid possible intrapartum rupture of the