Retained Products of Conception Versus Differentials-MRI

A 30 yr old lady with history of dilatation and curettage few weeks earlier for early pregnancy, has presented with persistent vaginal bleeding. Sonography reveals a complex mixed echogenic intracavitary lesion in cervical region with   relatively normal  uterine cavity except for small leiomyoma . Endo-myometrial junction is normal . MRI has been done to delineate the lesion better as beta-HCG is mildly elevated. Case submitted by – DR MGK Murthy.

Teaching points

·         Retained products of conception are  easily picked up on MR imaging particularly in sagittal and on fat suppression with higher magnetic strength

·        In this case relatively normal uterine cavity with no tell tale sign of embryo having been harbored previously there, raises the possibility of   either  the pregnancy and evacuation is of  relatively longer history , OR       to start with it was  cervical  OR we are dealing with primary problem at cervix

·        Relatively raised beta-HCG again contributes to confusion as it should get back to normal in about 2 weeks after evacuation or go skyrocketing in trophoblastic neoplasm up to 1000mIU/ml

·          Contrast would add information without conclusion,    as b-HCG (slightly raised ) suggests , some  viable trophoblastic tissue in retained products and that would enhance

·        So what do we do?

·        We apply the famous law of TWO ( followed with great success !)

·        Just simply let them do conservative management/ reevacuation- leave  it to them and ask for review  sonography and MR after 2- 3 weeks  preferably along with b-HCG—will simply unravel the truth!!!!

·        Any takers or differing view points ??