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Placenta Percreta

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This is an MRI of the abdomen and pelvis

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in a patient who was referred from

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Maternal-Fetal Medicine Clinic for an

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abnormal obstetric ultrasound at 28 weeks.

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Again, we've placed our steady-state

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free precession images on the left and

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our turbo spin echo images on the right.

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As we scroll down, the gravid

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uterus comes into view.

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We can nicely visualize the T2

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heterogeneous myometrium on all

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sides near the fundus of the uterus.

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As we scroll inferiorly, particularly on the

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turbo spin echo sequences, we can see that this

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patient's placenta is particularly low-lying.

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It's really occupying the majority

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of the lower uterine segment and

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paracervical region for this patient.

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Again, we see features of placenta accreta

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spectrum with T2 dark placental bands,

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placental heterogeneity, and a relatively

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lobular appearance of the placenta.

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I'd like to point out that for this

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patient as well, that as we scroll

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inferiorly, it becomes more and more

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difficult to discern any myometrium.

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Particularly posteriorly for this patient,

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we can see that there is placental tissue

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that is bulging in the region of the

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cervix and upper one third of the vagina.

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And we see numerous engorged vessels in

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the left hemipelvis for this patient.

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These are coronal T2-weighted images of the

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abdomen and pelvis for the same patient.

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Again, we see a low-lying,

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heterogeneous placenta with thinning

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of the overlying myometrium.

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There is, in some places, there are in some

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places, areas where it seems that the placenta

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is directly abutting the dome of the bladder.

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And again, this placenta is heterogeneous.

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It's not as lumpy-bumpy as some of the

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other placentas that we've seen, but

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there are certainly features of placenta

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accreta spectrum present with placental

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bands and heterogeneity, as well as

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the abnormal position of the placenta.

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Lastly, these are sagittal T2-weighted

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images of the pelvis in this patient.

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We can see that this patient

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has a complete placenta previa.

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This is the anterior lip and

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posterior lip of the cervix, with

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the placenta sitting directly on top.

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As we scroll through, again we see those classic

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features of placenta accreta spectrum, multiple

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large placental bands, tissue heterogeneity,

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and a lobular contour of the placenta.

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There are also several regions in which

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it becomes difficult to distinguish the

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placenta from the dome of the urinary bladder,

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which is a concerning finding,

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particularly in this patient with

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minimal to no overlying myometrium.

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And so concern was raised for placenta

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percreta in this patient, which was proven

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at pathology following cesarean hysterectomy.

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Another salient feature of this case that I'd

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like to highlight is that when we evaluate the

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area of the amniotic sac surrounding the fetus,

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there is little to no amniotic fluid present.

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In the other cases of pregnancy that we've

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evaluated thus far, we've seen amniotic fluid

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as T2 hyperintense and surrounding the fetus.

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And on these images, there's really

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almost no amniotic fluid present.

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We can see a small amount of fluid in the

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cervical canal, but it was ultimately determined

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that this patient had premature rupture of

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membranes, which necessitated a more urgent

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operative intervention for the patient.

Report

Faculty

Erin Gomez, MD

Assistant Professor of Radiology

Johns Hopkins Hospital

Tags

Women's Health

Uterus

MRI

Gynecologic (Gyn)

Gynecologic (GYN)

Genitourinary (GU)

Body

Bladder

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