* Department of Obstetrics and Gynecology, Hôpital FÊlix Guyon **Departement of Radiology, Hôpital FÊlix Guyon, Reunion Island, France.
This is a 30-year-old patient, that underwent an interruption of pregnancy at 6 weeks. In her obstetrical history, she had three cesareans for disproportion, the last one, exactly one year ago. At 7 weeks, the patient was referred to our service due to a vaginal bleeding. A vaginal scan revealed a small mass (8 mm) near the cervix. A medication for a spontaneous expulsion was prescribed.
The patient came for a repeat scan at 10 weeks with chronic bleeding and mild pain. The scan revealed a hyperechogenic and hypervascular mass on the cervical-isthmic area. The patient was hospitalized. The HCG level was 9875 UI/ml. After multidisciplinary discussion, a bilateral intra-uterine embolization was proposed. The control after the embolization showed a decreased peripheric pregnancy vascularization. We then performed a curettage and suction.
The anatomo-pathologist examination confirmed the presence of trophoblast material. Nevertheless one day later, the scan confirmed the presence of the left cervical sac, which was smaller and with less vascularization. At day 1, the HCG level was 3300 UI/ml. One week later, we could observe the decrease in the size of the sac. At day 8, the HCG level was 320 UI/ml. Two weeks later, the HCG level was negative.
Endovaginal scan at 10 weeks. Note that the uterus is empty and there is a mass close to the cervix