What Does The Following Ultrasound Report Suggest?

Posted on Fri, 11 Sep 2015

Question: married Nov.2014 / Last period. May 7th 2015, after 10th week no heart beat. So D&C done on July 28th 2015. Now the transvaginal sonagram report says diffusly cystic and in homogeneous uterine appearance with a thickened endomterium with hypervascularity throughout. thickness 26.6mm
Left overy simple cyst 3.3mm, right overy clc. Whether the sak is still in the uterus, and when the wall thickness become normlacy.

Answered by Dr. Sameer Kumar (44 minutes later)

Brief Answer:
possible retained products of conception

Detailed Answer:
hello,
Thanks for the query to hcm,
I could find the previous ultrasound reports attached where i could see that there was a gestational sac and an ovarian cyst as on 28/july/2015. If you have undergone D& C on 28th july itself then endometrium couldn't be this thick. This indicates that either D&C was done improperly and products of conception still remain.
I would like you to upload the latest scan report for review please for better opinion.
regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (32 hours later)

Respected Dr. Your reply is received for my question and very thankful and The trans vaginal sonogram done 28/07/2015 is attached here with for your perusal. The Dr. give me the Pills for miscarriage on 23/07/2015 but slight bleeding only came then The Dr. done D&C on 28/7/2015 and the Dr. says there is no tissue in the uterus, if further scraping your uterus wall may be punctured. so advised to attend the next scan and blood test (HCG) on 20/08/2015 If I am wait for 20thaugust 2015 or do the another D&C immediately ? Whether my uterus caninfected ? Or go to second opinion ? There is no pain or bleeding or fever.
Please explain the wall thickness and hypervascularity througout. Now i am in
USA, nobody help me. So Please Dr. kindly give me the correct diagnosis to
correct my problem. Thanking you

Answered by Dr. Sameer Kumar (36 minutes later)

Brief Answer:
answered

Detailed Answer:
Hello,
The report does mention a thickened endometrium but there is no sign of products of conception. If D& C has already been done once after attempt on medical abortion then a repeat D& C is not recommended at all as it may, yes increase chances of infection / even rupture of uterus. If there is no bleeding or fever at present then the wisest thing would be to wait for at least 2 weeks and get a repeat ultrasound pelvis done to check for endometrial thickness again and also a serum beta hcg test to check for levels of hcg which shall indicate competition of abortion.
You need not worry right now, just wait for the next ultrasound scheduled.
The hypervascularity can be explained due to recent abortion and but the thickened endometrium post D&C in less than a week cannot be explained unless there was an ultrasound guided D&C and only products of conception were removed, which is unlikely.
Nevertheless, you should wait for next 2 weeks and if your menses return then you should watch for heavy bleeding. In either case there is no real need to worry,
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (5 days later)

Respected Dr. Thank your for valuable answers for my diagnosis. My hcg level is on 07/08/2015 is 17324 and now the level is 30000 on 13/08/2015.why the level
is increasing. whether it is a molar pregnancy. Dr. suspicious is a molar
pregnancy. After a D&C done ,How diagnosis it is molar pregnancy. what is the treatment if molar pregnancy, or another D&C may done to cure the wall thickness. or wait till the normal mensuration. No bleeding or fever or vomiting,

Answered by Dr. Sameer Kumar (3 hours later)

Brief Answer:
answered

Detailed Answer:
Hello,
This hcg levels shouldn't be high if D&C was successful. Level of 30000 indicate a probable continuing pregnancy which has been missed during D&C . In molar pregnancy the levels are actually more than 100000IU. You need to get a repeat ultrasound and from a reliable diagnostic centre and if required D&C ma be required again.
regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sameer Kumar (5 days later)

Respected Dr. Please refer my earlier questions. Now the hcg level is decreased
25000 on 21/08/2015 . now trans vaginal ultrasounds are taken and uploaded.
The Dr. refused to done second D&C. The Dr. suspicious this is gestational
trophoplastic diesease ? and to consult the oncologist. Whether I can go
second opinion for another gynecologist for D&C. or oncologist. Whether the
remaining tissue is there in my uterus? necessary advise may please be given.

Answered by Dr. Sameer Kumar (10 hours later)

Brief Answer:
answered

Detailed Answer:
Hello,
I have gone through your scan pictures and it is evident that the uterus is filled filled contents and it looks snow storm appearance on ultrasound. The decreasing , yet still high hcg , indicates a possible partial mole. The doppler effect showing flow at the possible placental site may also indicate toward PSTT ( PLACENTAL SITE TROPHOBLASTIC TUMOUR).
This has to be investigated and you should be taking a gyne- oncologist's opinion now for sure.
THIS IS A GESTATIONAL TROPHOBLASTIC DISEASE. Next step for confirmation would be an MRI and then a PET SCAN. Please meet the oncologist soon and discuss the differentials i mentioned above.
Regards

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar