Case vignette
A 19yo F p/w gradually worsening N/V and abdominal distension/pain over the last month. She uses MJ and was diagnosed with cyclic vomiting 3 weeks ago.
HR 110, BP 90/60, RR 19, T 36.8, SpO2 99% on RA
Diffuse lower abdominal tenderness, non pertioneal, and what feels like a gravid uterus.
+urine hCG
What do you see?
OB2 Suprapubic Axial: cystic structures in endometrial cavity, reminiscent of "bunch of grapes" or "snowstorm" appearance
OB2 Suprapubic Sagittal: cystic structures in endometrial cavity, reminiscent of "bunch of grapes" or "snowstorm" appearance
What do you do next?
You suspect gestational trophoblastic disease. The patient now states her last period was 8 weeks ago. Her quantitative hCG is >100,000. You initiate fluids and obtain basic labs confirming no gross electrolyte derangements. You consult OB/GYN who accepts the patient to their service for D&C.
Teaching points. Molar pregnancy, or gestational trophoblastic disease, may present with vaginal bleeding, hyperemesis gravidarum, or lager than expected uterus for dates. On US, cystic structures in the endometrium may resemble clusters of grapes or a snowstorm (a description classically on board examinations). Molar pregnancies can be incomplete (with a non-viable fetus) or complete (with no fetus). Treatment requires D&C.
Residents: Dr. Colin Prather
Gestational Trophoblastic Disease
January 2020