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Pelvic Varices Mimnicking Placenta Percreta at Sonography

Garin Tomaszewski, MD

Carolyn Coffin, BS, RT, RDMS, RVT

Department of Radiology, Ultrasound Section, University of Colorado Health Sciences Center, Denver, Colorado

Abnormal placentation refers to pathologic adherence of the placenta to the uterus.1-3 Three subtypes are defined based on depth of myometrial invasion by nonneoplastic chorionic villi. Superficial, deep, and transmural involvement are termed placenta accreta, increta, and percreta, respectively. Of the three, placenta percreta is the rarest type, occurring with a frequency of only 1:33,000-90,000 deliveries.³ The antepartum diagnosis of placenta percreta is crucial because the associated vascular involvement of the myometrium and surrounding pelvic structures can result in massive blood loss, fetal demise, and maternal death at delivery. An imaging feature of placenta percreta is the sonographic demonstration of abnormal vascularity within the placenta, subplacental complex, and adjacent organs such as the bladder.¹,²,⁴-8

Pelvic varices are dilated veins (T 5 mm) that can occur during pregnancy or in non pregnant women.⁹'-5 These enlarged veins commonly involve the broad ligaments and parametrium, and, as a result, they often abut or surround the uterus, lower uterine segment, and cervix. Although pelvic varices can be prominent, they rarely cause obstetrical complications (Gibbs R, personal communication).

We report a case of pelvic varices mimicking placenta percreta with bladder invasion. The antenatal diagnosis of placenta percreta radically altered the patient's management. Although only unusual pelvic varices were subsequently documented at cesarean hysterectomy, the extremely cautious care necessitated by the presumptive sonographic diagnosis of placenta percreta was warranted to avoid a potential obstetrical catastrophe.

Key Words: placenta percreta • placenta previa • OB ultrasound • pelvic varices

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