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?

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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.

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 – http://emedicine.medscape.com/article/254657

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