PMC5884325_01
Findings of gray-scale ultrasound (a, e), Color Doppler (b), left panels of (c) and (f), Pulse Wave Doppler (right panels of (c) and (f)), and multiphase computed tomography (d). Images were taken on the first day of hospitalization (day 36 after vaginal termination) for (a)-(d) and day 55 for (e) and (f). (a) A low-echoic mass (arrow: size of 24 x 10 mm and indicative of an intrasac free lumen) is observed in the uterus, which is surrounded by a high-echoic mass (encircled by arrowheads: indicative of hematoma/thrombus). (b) Swirling blood flow (arrow) in the uterine cavity. (c) Swirling blood flow with arterial waveforms on Pulse Wave Doppler. At this stage, diastolic flow is evident. (d) An enhanced mass, measuring 24 mm in diameter, suggestive of a uterine artery pseudoaneurysm (arrow). (e) A high-echoic mass (arrowheads) is present but without an evident low-echoic mass. (f) Diastolic flow is absent on Pulse Wave Doppler, referred to as "absent diastolic flow" of the sac. This pattern was also confirmed by setting the "low-cut filter" lower. This "absent diastolic flow" was observed repeatedly and was also reproducible when the various scanning angles were changed.
CRIOG2018-2158248.001.jpg
PMC5884325_01_CRIOG2018-2158248.001.jpg
fig1
Ultrasound revealed an intrauterine low-echoic mass/area (Figure 1(a)), in which Color Doppler revealed swirling blood flow (Figure 1(b)) and Pulse Wave Doppler revealed an arterial waveform (Figure 1(c)). Multiphase computed tomography confirmed an intrauterine sac-like structure with enhancement without extravasation from it (Figure 1(d)). On day 55, an intrauterine low-echoic area disappeared, replaced by the high-echoic mass/area (Figure 1(e)), but was still showing a Color Doppler flow. Pulse Wave Doppler revealed that systolic blood flow remained, whereas diastolic flow was absent (Figure 1(f)).