0:02

Our last set of cases are of an isthmocele.

0:05

So this is something that can

0:06

only occur after a C-section.

0:08

It can be a cause of pain and even

0:11

infertility or abnormal bleeding.

0:13

This is a really old ultrasound, but

0:15

it was such a pretty example that I

0:16

wanted to show this one to you first.

0:18

So here's her endometrium up here, a little

0:20

bit thickened, probably secretory phase, but

0:22

right down here at the lower uterine segment

0:24

where you'd expect

0:25

the C-section scar to be.

0:27

You see this almost triangular, fluid-

0:29

filled structure right here, right

0:31

where the C-section scar should be.

0:33

This is a C-section isthmocele.

0:36

These are important to note, again,

0:38

because they may be a cause for pain.

0:39

They may be a cause for abnormal bleeding

0:41

or intermenstrual bleeding, because

0:43

a little bit of blood product can get

0:44

stuck there and continuously come out.

0:47

Patients who have this are also at risk of a

0:49

morbidly adherent placenta in any follow-up pregnancies.

0:52

They're at a higher risk of uterine

0:53

rupture or dehiscence because of

0:55

that thin overlying myometrium there.

0:58

And they are at increased risk of ectopic

1:00

pregnancies in the C-section scar itself.

1:03

So that's why these are important to recognize.

1:05

We then have a companion case.

1:07

This was actually done for renal

1:09

ultrasound purposes, but when they were

1:10

imaging the bladder, a sonographer noted

1:12

that the uterus didn't quite look right

1:14

either, so he changed his field of view

1:16

a little bit to focus on the uterus.

1:19

This is probably the biggest

1:21

isthmocele I've ever seen.

1:22

You can see the uterus right here, fundus

1:24

up here, body, lower uterine segment,

1:26

cervix should be down here, and you

1:28

see this very large defect right here.

1:32

So she was not recently

1:34

post C-section, so this was not thought

1:36

to be a dehiscence or a rupture.

1:38

She was quite stable.

1:39

She was having absolutely no issues from this.

1:41

You can even see a little bit of heterogeneity

1:43

within the C-section isthmocele right

1:46

here, which is probably a little bit

1:48

of blood product that was just kind of

1:49

sticking around there and can again cause

1:52

some dysfunctional uterine bleeding.

1:55

So she's been followed for several years after

1:57

this ultrasound without complication from this.

1:59

She did have a history of four C-sections.

2:01

Thank you for joining us.

2:02

Which may have contributed to the larger

2:04

size than we normally see; however, she

2:06

had no additional complications from this

2:11

and our next companion case.31 00:01:03,074 --> 00:01:05,065 So that's why these are important to recognize.

1:05

We then have a companion case.

1:07

This was actually done for renal

1:09

ultrasound purposes, but when they were

1:10

imaging the bladder, a sonographer noted

1:12

that the uterus didn't quite look right

1:14

either, so he changed his field of view

1:16

a little bit to focus on the uterus.

1:19

This is probably the biggest

1:21

isthmocele I've ever seen.

1:22

You can see the uterus right here, fundus

1:24

up here, body, lower uterine segment,

1:26

cervix should be down here, and you

1:28

see this very large defect right here.

1:32

So she was not recently

1:34

post C-section, so this was not thought

1:36

to be a dehiscence or a rupture.

1:38

She was quite stable.

1:39

She was having absolutely no issues from this.

1:41

You can even see a little bit of heterogeneity

1:43

within the C-section isthmocele right

1:46

here, which is probably a little bit

1:48

of blood product that was just kind of

1:49

sticking around there and can again cause

1:52

some dysfunctional uterine bleeding.

1:55

So she's been followed for several years after

1:57

this ultrasound without complication from this.

1:59

She did have a history of four C-sections.

2:01

Thank you for joining us.

2:02

Which may have contributed to the larger

2:04

size than we normally see; however, she

2:06

had no additional complications from this

2:11

and our next companion case.

2:13

This person presented with

2:14

spotting in between periods.

2:16

You can see the endocervical canal is a

2:18

bit distended, has some fluid within it

2:20

and probably a little bit of blood clot.

2:22

As we come up a little bit further, you again

2:24

see a fairly sized isthmocele right here

2:27

again with a little bit of blood product

2:29

within it, very thin myometrium overlying it.

2:33

So this is most likely the reason

2:35

for her intermenstrual bleeding.

2:38

And so we're able to find a reason to diagnose

2:40

and therefore it could be repaired

2:42

or she could be counseled about why this

2:44

was there and what could be done about it.