PMC4775801_01
B mode TVS reveals large pyometra distending endometrial cavity with defect in anterior wall near fundus and collection in pouch of Douglas.
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TVS was performed to look for a cause of endometrial collection, which revealed a collection with thick echoes within the uterine cavity suggestive of pyometra and a defect of size 2.0 x 2.0 cm in the anterior wall near fundus (Figure 1).
(a) Axial contrast enhanced CT in venous phase reveals pyometra communicating with peritoneal collection through defect in anterior wall of the uterus near fundus. Free nondependant air with smooth peritoneal enhancement suggesting pyopneumoperitoneum. (b) Sagittal contrast enhanced CT in venous phase reveals pyometra communicating with peritoneal collection through defect in anterior wall of the uterus near fundus. (c) Coronal contrast enhanced CT abdomen in venous phase reveals pyometra communicating with peritoneal collection through defect in the uterus near fundus.
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Emergency CECT abdomen and pelvis was performed which confirmed the pyometra, defect of 2.0 x 2.0 cm in the anterior wall of the uterus, and moderate peritoneal collection with multiple air pockets and smooth peritoneal enhancement suggesting pyeopneumoperitoneum with peritonitis (Figures 2(a), 2(b), and 2(c)).
Postoperative surgical specimen showing 2 x 2 cm defect in the anterior wall near fundus of the uterus.
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At laparotomy a defect of 2 x 2 cm was found in the anterior wall of the uterus and hence abdominal hysterectomy was performed (Figure 3).