Presentation
Patient presenting with per vaginal bleeding with severe anemia, hb-4.9g/dL.
Patient Data
Extensive hyper-reflective gaseous foci levels with posterior dirty shadows interspersed with multiple distal reverberation artifacts, occupy the proximal and the medial endometrial cavity with resultant obscurity of the endometrial parenchymal outline. The anteverted uterus is bulky (528.4 cc) and shows an hetero-dense, mixed echo content (~96 cc) distending the cervical canal and the vaginal vault. Color Doppler mapping of the cervical material reveals augmented vascularity.
A solitary enlarged, heterogenous solid nodule (nodal disease) is noted at the proximal para-aorta. The right kidney demonstrates a focal area of increased echogenicity at the upper pole cortex ipsilaterally. Rest of the abdominal -pelvic viscera grossly looks normal.
Case Discussion
A case of neglected miscarriage subsequently transformed into gestational trophoblastic neoplasia (GTN), clinically confirmed; resulting into marked uterine luminal gaseous foci (pneumatometra a.k.a pneumouterus) tracking from the cervical canal towards the fundal endometrial cavity. There is attendant nodal disease involvement at the proximal para-aorta which partially extrinsically compresses the inferior vena cava plus accompanying features of a likely unilateral right sided focal parenchymal renal infection.
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