Friday, November 20, 2009


A 30 year old G4P1 woman is concerned that her periods have changed in quality. They used to be regular at 29 days, heavy, lasting 5 days, but since the last few months, she's had minimal to no periods. She doesn't have any vaginal pain or discharge. Her gynecologic history is as follows: at age 18, she had an elective first trimester medical abortion; at age 22, she had a daughter at full term without complications; at age 26, she had a spontaneous first trimester abortion; and several months ago, she had to surgically terminate a second trimester pregnancy due to fetal demise. She has no significant past medical history and takes no medications. She is married but has multiple sexual partners; she does not use protection. She denies domestic violence. She smokes a pack per day. Family history is noncontributory.

A urine pregnancy test is negative. A hysterosalpingogram is shown below.

Challenge: What's the diagnosis?

Image is shown under GNU Free Documentation License.


Suheil said...

Ectopic gestation as a result of Pelvic inflammatory disease? treat with methotrexate, if it doesnt spontaneously abort, salpingostomy..

Stephanie said...

asherman's syndrome, scarring of the uterus secondary to instrumentation.

Craig Chen said...

yes, it's Asherman's! (pregnancy test was negative)


This is Asherman's syndrome, a uterine cause of secondary amenorrhea due to scarring of the endometrial lining secondary to postpartum infection or instrumentation (like a dilation and evacuation in the second trimester). The image shows corporal adhesions in the uterus.

Sources: UpToDate; Wikipedia.

Suheil said...

oh my god, i completely missed that part of the history..