PMC9428636_01
Transvaginal grayscale ultrasound image of the uterus in sagittal plane demonstrates gestational sac (arrow) implanted in the niche of previous caesarean scar site, crossing serosal line (red line), while uterine cavity line (green line) remains intact
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fig01
Endometrium measured 12 mm, both the uterine cavity and cervical canal were empty, without direct contact to the sac (Fig. 1).
(A) Transvaginal grayscale ultrasound demonstrates heterogeneous mass inside the uterine cavity protruding anteriorly through the scar tissue (arrow). Both the serosal line (red line) and uterine cavity line (green line) are crossed. (B) Colour Doppler imaging reveals intense vascularity in the vesicouterine space (arrow), involving posterior wall of urinary bladder
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Using colour Doppler imaging it was noticed, that the peritrophoblastic perfusion remained intense, and new hypervascular area in the vesicouterine space was found (Fig. 2).
(A) Sagittal T2-weighted magnetic resonance image demonstrates gestational sac as heterogeneous mass in the anterior part of lower uterine wall within the prior caesarean scar site, extending into the uterine cavity (white arrow). The scar margins are separated (red line) following infiltration by ectopic tissue. The "tenting sign'' (yellow arrow) suggests trophoblast invasion into the wall of urinary bladder. (B) Coronal T2-weighted sequence demonstrates the disruption of thin myometrium secondary to pathological infiltration (white arrows). (C, D) Sagittal and coronal T1-weighted delayed post-contrast magnetic resonance images with full urinary bladder show no "tenting sign'' (yellow arrows) evident in A image, therefore transmural trophoblast growth into the urinary bladder can be excluded
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fig03
The magnetic resonance imaging was performed (Fig. 3), however this diagnostic modality did not provide any additional information.
Transvaginal grayscale ultrasound image of the uterus in sagittal plane one month after the surgery demonstrates completely restored caesarean scar site (arrow)
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At one month follow-up visit human chorionic gonadotropin concentration decreased to normal level and transvaginal ultrasonography showed completely restored myometrium of 10 mm in thickness at caesarean scar site (Fig. 4).