chorioangiomas are the most common benign tumors of the placenta originating from primitive angioblastic tissues . the newborn are rare and usually associated with tumors greater than 5 cm in diameter and consist of polyhydramnios , fetal anemia , massive edema with pleural effusion , ascites and intrauterine growth retardation . we present a case with large chorioangioma as the cause of non - immunologic hydrops fetalis with a successful outcome . the patient was a female newborn with history of polyhydramnios , symptoms of congestive heart failure and associated anemia , thrombocytopenia and coagulopathy . chorioangioma of the placenta has potentially serious perinatal risks and so the pregnancy needs to have regular surveillance . the term non - immunologic hydrops fetalis ( nihf ) defins an edematous fetus with fluid collections in some or all serous cavities that does not have erythroblastosis fetalis from isoimmunization . in 1943 dr edith potter published the first description of nihf ; now over 80 conditions are known to be associated with hydrops with very high perinatal mortality ranging from structural heart disease , fetal arrhythmias , chromosomal anomalies , intrauterine infections and larger chorioangiomas of the placenta[25 ] . in most countries with low rhesus - negative rates in the population , nonimmune causes are more prevalent ; the incidence depends on the region and also varies seasonally in relation to parvovirus b19 epidemics . we describe a newborn in whom cardiac enlargement and congestive heart failure were caused by a vascular shunt through a large placental chorioangioma , emphasizing the importance of the anatomical study of the placenta for the correct diagnosis , managing the neonatal care and evolution of the newborn . a 2.120 g preterm female newborn , product of a non consanguineous marriage was born from a primigravida by emergency cesarean section at 32 weeks of gestation because ultrasound examination revealed cardiomegaly with abnormal umbilical flow and signs of vascular fetal insufficiency . physical examination at birth revealed 1 minute apgar score 8 , anasarca , poor respiratory effort with bilateral wet rales , hepatosplenomegaly with ascites and no reflexes . the initial chest radiograph obtained 2 hours after birth showed soft tissue edema , cardiomegaly and pleural effusion compatible with congestive heart failure . laboratory data included hypoproteinemia and hypoalbuminemia , anemia ( hematocrit 31% ; hemoglobin 10.3mg / dl ) and hyponatremia ( na 125 meq / l ) , thrombocytopenia ( platelets 4110/l ) and deranged coagulation profile ( prothrombin time 19 seconds , activated partial thromboplastin time 120 seconds ) . the infant 's cardiorespiratory status gradually improved with water restriction , conventional respiratory assistance and inotropic drugs which resulted in 29 percent decrease in weight compared to her birth weight . pathology of the placenta showed edema without signs of placental infarction and a big tumoral mass measuring 1043 cm ( fig . microscopic examination revealed large fusiform vessels in a fibrotic stroma with focal edema and clusters of myxoid cells ( fig . 2 and 3 ) . placental chorioangioma : tumoral mass measuring 1043 cm placental chorioangioma : large fusiform vessels in a fibrotic stroma with focal edema and clusters of myxoid cells placental chorioangioma is a benign vascular tumor detected in 1 percent of placentas after systematic examination . most of these tumors are small and discovered only by microscopic examination and have no adverse impact on the fetus . larger tumors are rare and when above 5 cm in diameter , they are associated with serious complications . these tumors are found accidentally by ultrasound examination . in our case , the placental tumor measured more than 10 cm and led to cardiomegaly with abnormalities in the umbilical flow and signs of vascular fetal insufficiency . where the tumor is avascular , no specific complications should be expected . when the tumor is vascularized , and in particular if it contains numerous large vessels , serial ultrasound and doppler examinations are warranted to detect early features of fetal congestive heart failure . two hypotheses are proposed for formation of congestive heart failure in this condition : the left to right shunt as a result of intra tumoral arteriovenous shunting and chronic fetal hypoxia secondary to insufficient placental function or anemia and thrombocytopenia[8 , 9 ] . the detection of ultrasound findings of heart failure or suggestive signs of anemia as cardiomegaly , enlargement of the liver and abnormal umbilical vein . large placental chorioangiomas are rare and the prognosis is bad when a big tumor causes fetal hemodynamic changes with nihf , but treatment of heart failure may be promising in these newborns and complete recovery is achieved in some cases . chorioangioma of the placenta has potentially serious perinatal risks and so the pregnancy needs to have regular surveillance .