Answer for BIR CoW 09 Apr 2023
Uterine Isthmocele
Findings
A well defined triangular defect with internal T2 hyperintensity seen involving the lower uterine segment above the internal at the LSCS scar site with focal myometrial thinning Lesion shows T1 hyperintensity with patchy areas of gradient blooming and diffusion restriction
Discussion
Aka C-section scar - niche, pouch, diverticulum
ACUTE puerperium or postpartum (6-8 wks) Edema with small hematoma at incision site Small bladder flap hematoma (<2cm) Minimal free fluid in pelvis
CHRONIC – remote hysterotomy for C section Focal thinning of myometrium in LUS above internal os Fluid withing triangular defect resulting from myometrial thinning
DIFFERENTIAL DIAGNOSIS Myomectomy scar – no triangular defect Marked uterine anteflexion – true long axis of uterus aids in diagnosis Myometrial cyst – no associated myometrial thinning
CLINICAL FEATURES Asymptomatic May have AUB
TREATMENT May need Surgery for intractable bleeding
REFERENCES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590568 https://radiopaedia.org/articles/cesarean-section-scar-diverticulum-1 https://www.eurorad.org/case/16410 https://www.ajronline.org/doi/pdfplus/10.2214/AJR.07.2916 Diagnostic radiology and Imaging - Gynaecology
Findings
A well defined triangular defect with internal T2 hyperintensity seen involving the lower uterine segment above the internal at the LSCS scar site with focal myometrial thinning Lesion shows T1 hyperintensity with patchy areas of gradient blooming and diffusion restriction
Discussion
Aka C-section scar - niche, pouch, diverticulum
ACUTE puerperium or postpartum (6-8 wks) Edema with small hematoma at incision site Small bladder flap hematoma (<2cm) Minimal free fluid in pelvis
CHRONIC – remote hysterotomy for C section Focal thinning of myometrium in LUS above internal os Fluid withing triangular defect resulting from myometrial thinning
DIFFERENTIAL DIAGNOSIS Myomectomy scar – no triangular defect Marked uterine anteflexion – true long axis of uterus aids in diagnosis Myometrial cyst – no associated myometrial thinning
CLINICAL FEATURES Asymptomatic May have AUB
TREATMENT May need Surgery for intractable bleeding
REFERENCES https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8590568 https://radiopaedia.org/articles/cesarean-section-scar-diverticulum-1 https://www.eurorad.org/case/16410 https://www.ajronline.org/doi/pdfplus/10.2214/AJR.07.2916 Diagnostic radiology and Imaging - Gynaecology
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!