Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 555
A
B
C
D
E
F
G
H
FIG. 15.27 Retained Products of Conception (RPOC). (A) and (B) Sagittal TAS scans in a patient 6 days after vaginal delivery. (A) There is
a hyperechoic mass (calipers) in superior region of the uterus. (B) Color Doppler image shows a few areas of low in the periphery of the mass.
(A and B courtesy of Shannon Sheedy, MD.) (C)-(E) Retained products of conception 1 month after a miscarriage. (C) There is a hyperechoic
mass (calipers) in the endometrial cavity. (D) Color Doppler shows substantial low from the myometrium extending into the RPOC. (E) Anglecorrected
spectral Doppler shows peak systolic velocity of 298 cm/sec. See also Video 15.12. (F) and (G) Sagittal TVS from two different patients,
each a few months after delivery with calciied RPOC. (H) Sagittal sonogram shows a large area of RPOC after a cesarean section. The thin
myometrium suggests placental invasion, in this case due to placenta accreta.
for uterine rupture. At times the myometrium and endometrium
are heavily vascularized by RPOC (Fig. 15.27C–D, Video 15.12).
In these cases, one study suggested that if there is higher-velocity
low (which they deined as >60 cm/sec), surgical removal of
the residual tissue may be performed using sonographic guidance.
192 However, these were not angle-corrected velocity measurements,
limiting the usefulness of relying on a speciic velocity
threshold.
Placental site trophoblastic tumor (PSTT) is an uncommon
cause of postpartum bleeding but should be considered when
there are persistently low serum levels of human chorionic
gonadotropin (hCG) and/or elevated levels of human placental
lactogen. 193 he hCG levels tend to be low, sometimes only
minimally elevated, compared with the more common forms of
gestational trophoblastic neoplasia. he sonographic appearance
of PSTT is most commonly a heterogeneous predominately solid
mass involving the endometrium and/or myometrium; occasionally
it can be predominately cystic with marked vascularity
simulating an arteriovenous malformation. 194 his is discussed
in more depth in Chapter 30.
Endometritis
Endometritis should be considered as a potential diagnosis in
the postpartum period when patients have fever and/or pain.