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Cesarean scar niche with blood collection

Case contributed by Mohamed Saber
Diagnosis certain

Presentation

Multiple cesarean sections, continuous vaginal spotting, and pelvic pain.

Patient Data

Age: 30 years
Gender: Female

Thinning out of the myometrium at the lower uterine segment at the site of the previous cesarean section scar (arrow) with a hypoechoic area is seen within, likely due to tethering of the endometrium, suggestive of a cesarean scar niche.

Follow up after 5 months

ultrasound

A turbid collection is seen centered on the cesarean scar niche, measuring 3.5 x 3 cm. No internal vascularity on the color duplex study.

This collection elicits a high signal on T1 with no suppression on T1 fat sat or detectable enhancement on the post-contrast T1. It elicits intermediate signal on T2 with internal signal void and hyperintense foci. Thinning out of the overlying myometrium and uterine retroversion are also noted.

Case Discussion

Blood accumulation in a cesarean scar niche may serve as a source of dysfunctional uterine bleeding, accounting for vaginal spotting after the routine menstrual cycle as in this case.

Ultrasound contribution by Dr.Shaimaa Hussien

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