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.