Presentation
Secondary amenorrhea of 12 weeks, four days, referral for pregnancy confirmation, and suspicious finding of the uterus.
Patient Data
Longitudinal 2-dimensional sonogram of the uterus shows homogeneous, hyperechoic internal echoes, filling the gestational sac, avascular, with fluid-fluid level.
Pseudoflow in grayscale.
Pseudoflow in color Doppler.
Case Discussion
Acute hemorrhage typically will be hyperechoic on ultrasound, as it contains many fresh red blood cells and clotting factors, unlike subacute or chronic hemorrhage (isoechoic to hypoechoic).
The texture is generally more homogenous due to the fresh nature of the blood; in subacute and chronic cases, it will be more heterogeneous. The margins are typically well defined, as it has recently occurred, and this is filling up the gestational sac.
Acute hemorrhages are echogenic and may contain mixed elements; by utilizing color or power Doppler, one should not mistake it for an actual flow of blood within the blood vessel.
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