Case Of the Week (COW) 29 November 2015

Placenta accreta
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Findings
USG- Placenta occupying lower uterine segment , covering the cervical os. Loss of subplacental clear space. Loss of placenta-myometrial interface. Multiple placental lacunae ,on colour doppler which shows abnormal increased vascularity. MRI -Heterointense placenta Thinning of normal myometrium Increased intramural vessels. T2 hypointense band seen extending from myometrium to placenta.

Discussion
 Abnormal penetration of placental tissue beyond endometrial lining of uterus Defect of the decidua basalis allows the invasion of chorionic villi into the myometrium. classified on the basis of the depth of myometrial invasion. The normal placenta attached to decidua. At delivery, the placenta separates at the decidual plane Uncomplicated placenta previa Intact subplacental hypoechoic zone Placental sonolucencies Subplacental hypoechoic zone intact Intact bladder/uterine interface Gestational trophoblastic disease Diffusely cystic placenta Abnormal fetus with severe intra-uterine growth restriction.

Contributed By: 
Prof. N Kailasanathan, Dr S Mubarak Sazira
Barnard Institute of Radiology