Presentation
Patient with a history of endometrial carcinoma recently diagnosed histopathologically through a sample obtained by curettage. She consulted for intractable vaginal bleeding.
Patient Data
The T2FS-weighted images in the axial and sagittal plane shows anteriorly, the open cervix, and, emerging towards the vaginal cavity, the body and uterine fundus. The vagina, which is located posteriorly, presents in its interior, part of the pathological endometrium, blood products, and gel.
The axial T2 weighted images located in the uterus also show a complex lesion in the right adnexa, possibly partly hydrosalpinx. Two fibroids are visualized, due to their size, they would not be the cause of the inversion of the uterus.
The T1FS-weighted images enhanced in the axial plane shows the little improvement with the contrast of the pathological endometrium of the compromise of the endometrial junction. The walls of the vagina are thin.
The sagittal-enhanced T1FS-weighted images shows from ventral to dorsal, the bladder, the inverted uterus (note the hypointense serosa in central view), and the distended vaginal cavity.
Case Discussion
Uterine inversion an unusual condition in which the uterine fundus folds over into the uterine cavity to a varying degree.
It generally occurs after a vaginal delivery but there are other conditions that may cause it.
The literature mentions the presence of submucosal leiomyomas as a non-puerperal cause of uterine inversion, which was not the case in this patient.
In this case, probably, the uterine atony the presence of pathological tissue and instrumental maneuvers that ended up achieving adhesions to the fundus of the vagina.
During the hospitalization, our patient presented hypovolemic shock, from which, after her recovery, an hysterectomy and salpingectomy was performed, prior to having detached the adhesions and reversing the uterus vaginally. The diagnosis was confirmed by direct visualization.
I am grateful to Dante Lopez, our in Bioimages's Graduate.