MRI appearance of the pelvis in the post cesarean-section patient

Fever in the post-cesarean section patient may indicate the presence of a p otentially life-threatening complication, including abscess, ovarian vein t hrombosis, and uterine dehiscence. Imaging findings are often utilized to a scertain the presence or absence of such complications, Familiarity with th e normal findings in the postoperative period is essential in making this d etermination. The purpose of this investigation is to describe the MRI appe arance of the post-cesarean section pelvis. Over a 67-month period, 50 pati ents with persistent low-grade fevers following c-section were referred for MR imaging. Imaging was performed 3-10 days postoperatively, Axial T-1-wei ghted and T-2-weighted images were acquired in addition to sagittal T-2-wei ghted images. Coronal images were obtained in some cases, Clinical correlat ion was obtained through the patients charts, confirming discharge of the p atients in stable condition. The uterine incision site usually demonstrated findings consistent with subacute hematoma. The anterior uterine myometriu m demonstrated enlargement relative to the posterior uterine wall. Bladder flap hematomas were seen in 64% of cases. Three cases (6%) demonstrated par ametrial edema and none of these patients demonstrated ovarian vein thrombo sis. Two cases of pelvic hematoma were noted, The normal post-c-section inc ision site may demonstrate increased or decreased signal intensity on T-2-w eighted images and intact endometrial and serosal layers mitigate against t he diagnosis of incisional dehiscence, Bladder flap hematomas occurred in s lightly more than half the cases. Parametrial edema and pelvic hematoma can be seen as post-surgical changes. (C) 1999 Elsevier Science Inc.