Imaging Case of the Week 83

The following ultrasound images are from a 38 year old, with a h/o 8 weeks LMP, who  presented with PV bleed. What radiological sign can you see in the images?

uterus transverse

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uterus longitudinal

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The ultrasound images (transverse and longitudinal) show multiple cysts occupying the uterine cavity, giving rise to the ‘bunch of grapes sign’. This finding is suggestive of a molar pregnancy. There is no intrauterine gestational sac seen.

molar pregnancy

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The patient had a very high serum quantitative hCG. She did not have any evidence of metastasis upon further tests. She underwent dilatation and curettage.

Molar pregnancy:

  • More common at the extremes of reproductive age.
  • Complete mole (no fetal tissue) or partial mole (fetal tissue present).
  • Clinical presentation: PV bleeding, hyperemesis, hyperthyroidism (due to stimulation of the thyroid by high circulating hCG or production of thyroid stimulating substance by the trophoblastic tissue), pre-eclampsia.
  • Very high quantitative hCG usually, but a normal hCG level is also a possibility.
  • Baseline chest radiography must to r/o metastasis.

Reference –