Hysterectomy may be indicated for severe uterine hemorrhage or rupture [2,18]. Although rare in the United States, patients with invasive mole may present with hemoperitoneum that is due to molar tissue penetrating the full thickness of the myometrium [20]. Finally, adnexal torsion or rupture may occasionally complicate theca lutein cysts, necessitating surgical removal [16]. Imaging evaluation in the setting of suspected GTN complications should be guided by location of clinical signs and symptoms. US Pelvis Transabdominal Transvaginal US has improved sensitivity and specificity in the diagnosis of uterine masses and abnormalities when compared to transabdominal US, although given the rarity of this disorder, series comparing both modalities in patients with GTD are lacking [32]. At some institutions, patients with GTN are not evaluated with transvaginal US due to the risk of major bleeding as a consequence of a nondetected vaginal metastasis [37]. US Duplex Doppler Pelvis GTN can be complicated by uterine vascular malformations such as arteriovenous shunts and pseudoaneurysms, described in up to 15% of cases following complete response to chemotherapy, and best delineated with Doppler US [44]. Although these findings are insignificant if asymptomatic and associated with a normal hCG, such malformations occasionally result in life-threatening vaginal or intraperitoneal hemorrhage [44]. Gestational Trophoblastic Disease Radiography Chest We are unaware of any recent formal assessment regarding the use of chest radiography to assess pulmonary complications in GTN. Lung infarct and secondary pulmonary arterial hypertension associated with trophoblastic tumor thrombus may be appreciated on chest radiography. Likewise, sequelae of endobronchial metastasis such as volume loss or airspace disease and pleural effusions that follow hemorrhage into parenchymal and intravascular metastases could potentially be visible [44,45].
Gestational Trophoblastic Disease. Hysterectomy may be indicated for severe uterine hemorrhage or rupture [2,18]. Although rare in the United States, patients with invasive mole may present with hemoperitoneum that is due to molar tissue penetrating the full thickness of the myometrium [20]. Finally, adnexal torsion or rupture may occasionally complicate theca lutein cysts, necessitating surgical removal [16]. Imaging evaluation in the setting of suspected GTN complications should be guided by location of clinical signs and symptoms. US Pelvis Transabdominal Transvaginal US has improved sensitivity and specificity in the diagnosis of uterine masses and abnormalities when compared to transabdominal US, although given the rarity of this disorder, series comparing both modalities in patients with GTD are lacking [32]. At some institutions, patients with GTN are not evaluated with transvaginal US due to the risk of major bleeding as a consequence of a nondetected vaginal metastasis [37]. US Duplex Doppler Pelvis GTN can be complicated by uterine vascular malformations such as arteriovenous shunts and pseudoaneurysms, described in up to 15% of cases following complete response to chemotherapy, and best delineated with Doppler US [44]. Although these findings are insignificant if asymptomatic and associated with a normal hCG, such malformations occasionally result in life-threatening vaginal or intraperitoneal hemorrhage [44]. Gestational Trophoblastic Disease Radiography Chest We are unaware of any recent formal assessment regarding the use of chest radiography to assess pulmonary complications in GTN. Lung infarct and secondary pulmonary arterial hypertension associated with trophoblastic tumor thrombus may be appreciated on chest radiography. Likewise, sequelae of endobronchial metastasis such as volume loss or airspace disease and pleural effusions that follow hemorrhage into parenchymal and intravascular metastases could potentially be visible [44,45].