This woman was 4 days post partum when she was transferred to our tertiary hospital Emergency Department from a smaller regional centre. She had developed a fever, tachycardia and hypotension on day 3 as well as some offensive PV loss. She had been treated aggressively with large volumes of IV fluids and broad spectrum antibiotics assuming she had endometritis. She then developed some shortness of breath and was transferred for ICU review.
The first video and second video show her pelvic scan. The first is without commentary so you can test yourself. The second describes and discusses the findings.
The third video shows her right and left upper quadrant views and demonstrates note worthy thoracic findings.
Video 1 : Pelvic scan without commentary
Video 2: Pelvic scan with discussion
Transabdominal and then transvaginal scans are performed.
The transabdominal image shows a catheter balloon in an empty bladder.
Behind this lies the distended uterus. It is filled with layering fine echogenic debris that would be consistent with blood or pus. In the clinical context it is most likely infected blood.
Transvaginal scan confirms the presence of pyometra / haematometra.
Free pelvic fluid containing some echogenic debris is also seen within the pelvis.
Video 3: Upper quadrant scans reveal thoracic pathology
Scans are performed in both the right and left upper quadrant. This allows the lung bases to be examined.
On the right a small pleural effusion and consolidation with ultrasound air bronchogram is seen. In this view the well filled inferior vena cava is demonstrated with no respiratory variation.
On the left another small basal pleural effusion is seen.
This patient had developed post partum sepsis, with a distended
uterine cavity, filled with infected blood.
This is unusual because in the post vaginal delivery patient the cervix usually allows free passage of its content.
Sepsis combined with aggressive fluid resuscitation had led to the basal consolidation / collapse and pleural effusions.
Simple gentle opening of the cervix allowed passage of the uterine content and recovery without further aggressive intervention occurred over the next 72 hours.
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