Bilobed placenta accreta
Referred for MRI assessment of the placenta for an abnormal appearance on ultrasonography.
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Gravid uterus with duplicate/bilobed placenta with one lobe implanted fundal notably left fundo-anterior, while the second is implanted posterior wall involving the circumference of the upper uterine segments apart from its anterior wall with its lower edge still away from the closed internal os by 11 cm (>2 cm) excluding possibility of low-lying placenta/previa type.
This is associated with bifurcated/bifid umbilical cord with one common insertion at the fetal end, while the placental ends show eccentric insertion along the right aspect of the fundal placental lobe and the inferior aspect the posterior lobe both by velamentous insertion, still both attain their normal 3-vessel configuration.
The placental tissue itself shows heterogeneous signal still mainly hyperintense with multiple variable-sized lacunae (grade II maturation).
The placental myometrial interface shows:
- multiple areas of myometrial thinning with myometrial thickness <5 mm and loss of its trilaminate layering notably postero-fundal wall of the upper lobe and left postero-lateral wall of the lower lobe
- focally interrupted myometrial border along the same sites
- this is associated with focal uterine bulging (“pear-shaped” uterus, with the fundus and the body wider than the caudal segments)
- T2-weighted intra-placental dark thick bands, with longest dimension of 4.5 cm (>2 cm) along the left posterolateral aspect of the posterior wall placental lobe with suspected intra-placental abnormal vascularity manifested as tortuous and enlarged flow voids at the same location deep within the placenta and measuring 8.5 mm in maximum dimension (>6 mm)
- no visualization of direct invasion of the nearest tissues