ダイナミックCTによる診断の後，母体救命を目的とした人工妊娠中絶術前に子宮動脈塞栓術（UAE）を施行した巨大絨毛膜下血腫（Breus’ mole）の1例

Dynamic computed tomography for diagnosis and subsequent uterine artery embolization（UAE）before pregnancy termination for maternal life-saving in massive subchorionic thrombohematoma（Breus’ mole）：a case report

巨大絨毛膜下血腫（massive subchorionic thrombohematoma：MSH，通称：Breus’ mole）は，妊娠早期に生じたと考えられる絨毛膜下血腫が増大し，母体貧血および胎児発育不全を引き起こす稀ながら予後の悪い周産期疾患である。その原因や発症機序に関して確立された見解はなく，画像所見を伴う症例報告は散見されるもののその数は多くない。また，文献検索の範囲内では本疾患に対するダイナミックCTおよびIVRを施行した報告はない。

Massive subchorionic thrombohematoma（MSH）is a rare and critical condition with a poor fetal prognosis. We report the case of a primigravida in her 40s who was diagnosed with MSH at 20 weeks’ gestation and subsequently developed progressive maternal anemia and fetal growth restriction. Magnetic resonance imaging（MRI）revealed a large hematoma in the placenta. Dynamic CT revealed active extravascular contrast leakage originating from the placental attachment site. Due to worsening maternal anemia, UAE was performed before emergent termination of the pregnancy to save the mother’s life. Pathological examination confirmed the diagnosis of MSH. This case suggests that dynamic CT is useful for assessing active bleeding in MSH, and that preoperative UAE may reduce intraoperative hemorrhage in such critical cases.