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So our first case is of a 27-year-old

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female who had a C-section approximately

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six days prior to presentation.

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She's now re-presenting to the ED with

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fever, foul discharge, and rule out

0:13

abscess, rule out retained products of

0:15

conception was the history that we got.

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So starting with our transabdominal view,

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there is a small fluid collection.

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This was labeled as inferior to the C-section

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scar, C-section scar being somewhere out here.

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This was not thought to be the bladder.

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This is not a vascular structure.

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There's no color doppler flow internally.

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And you can see some measurements there.

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It's, you know, 4-5 centimeters approximately.

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18 00:00:37,700 --> 00:00:39,070 And then we move to the transvaginal

0:39

view and you can see that this

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is a really limited ultrasound.

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The cervix is going to be somewhere back here.

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The fundus is back here.

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This is almost like a straight back uterus.

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It's, you know, anteverted and then it

0:49

kind of just goes straight back and that's

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going to get you far from the probe.

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So you're not going to see it that well.

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But what you do see is where

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the endometrium should be,

0:56

you see all of these echogenic foci

0:59

and some of these, maybe you're seeing

1:00

a little bit of dirty shadowing.

1:02

So if you continue to scroll through

1:04

these, you might just think again,

1:07

this is virtually non-diagnostic.

1:08

What is going on here?

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But if you take a step back, take a

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pause, take a breather and let's look

1:14

at our cine clips a little bit closer.

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So this is going to be a sagittal cine clip.

1:18

And again, notice out here,

1:19

all of these echogenic foci.

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We aren't necessarily in the

1:22

endometrium at this point.

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So it's important to think

1:24

about what's going on up here.

1:26

What is going on up here?

1:28

And again, you can see almost nothing below

1:30

until we get to the body of the uterus.

1:32

And you can see endometrium,

1:33

we have more of these foci.

1:35

She's six days post-birth.

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So could this be a little

1:37

bit of normal gas left

1:39

in the endometrium?

1:40

That's certainly possible.

1:41

That's within the realm of normal.

1:43

But if you follow these and march

1:45

these out, and it almost looks like this

1:47

is where the C-section scar should be.

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And these echogenic foci march

1:51

out that C-section scar there.

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So let's get some dedicated imaging of the lower

1:55

uterine segment where that C-section should be.

2:00

And again, not great imaging,

2:02

not beautiful imaging, right?

2:03

But we see all of these echogenic foci.

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We have shadowing posterior to it.

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And it leads out anterior to

2:11

where the C-section should be.

2:12

All of this structure out here.

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The other thing to keep in mind is

2:16

that we had that fluid collection here,

2:19

remembering that, going back to this.

2:20

So this is concerning for endometritis.

2:22

This is not a non-diagnostic

2:24

ultrasound, although it is very limited.

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But this is a good example in a patient

2:29

who has fever and foul discharge of an

2:31

endometritis appearance on ultrasound.