Presentation
26 weeks pregnant. Moderate speed trauma. Tender lower abdomen.
Patient Data
No free intraperitoneal fluid or gas. Uterus is intact. Single intrauterine foetus. No foetal bone fracture. Normal volume, low density liquor. Posterior placenta with a normal pattern of enhancement. Retroplacental venous lakes are demonstrated, particularly in the left lower aspect. At the right lateral margin of the mid to upper placental margin there is a planar area of enhancement which is also likely due to venous lakes, however a small focal abruption in this region is difficult to exclude.
Striated areas of low attenuation in the left kidney with no perinephric stranding or hematoma, favored nonacute. This may reflect areas of chronic scarring or less likely a degree of pyelonephritis. A tiny inferior pole renal calculus is noted on the left. The liver, spleen, pancreas, adrenals and gallbladder are normal. No focal bowel abnormality. Lung bases are clear. No fracture of the thoracolumbar spine or pelvis. Chronic bilateral L5 pars defects.
IMPRESSION
- No definite acute injury.
- Ultrasound follow-up of the right lateral margin of the placenta and right maternal kidney advised.
Case Discussion
Clinically there was a low suspicion of placental injury and the patient was monitored with serial CTG which was reassuring. A follow-up US (images not available) demonstrated normal morphology of the maternal kidneys and placenta. The patient was lost to follow up.
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