Ultrasound, CT, And MRI Evaluation for Acute Postpartum Pain. The Benefits Of Ultrasound First
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Authors: Anastasia Navitski, Medical College of Georgia Abdul Rahman Abualruz, Wellstar MCG Health Stephanie Stokes, Medical College of Georgia Elsa Parra, University of Tennessee Health Science Center Memphis Lee Moore, Texas Tech University Health Sciences Center at the Permian Basin Natalia Schlabritz-Lutsevich, Advanced Fertility Center James Maher, Augusta University Dept of OB
This case highlights the value of ultrasound in the postpartum state in a patient who presented with acute post-delivery abdominal pain. Her initial evaluation showed marked fundal tenderness and possible purulent cervical discharge. She was Afebrile with stable vital signs. Non-contrast CT, which suggested retained products of conception. She was started on antibiotics, held NPO, and booked for a D&C. The final read was a non-enhancement of the right myometrium concern for uterine infarction. Radiology recommended MRI with and without contrast which was performed. While the read for the MRI was pending, a POCUS exam demonstrated that the non-enhanced site on CT was the source of her uterine tenderness. There were no signs of retained products and the tender area was likely the site of the placenta attachment. The uterus was heterogeneous on the grey scale and demonstrated prominent flow on color flow Doppler with a venous signature suggestive of pelvic congestion syndrome.