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This is an MRI of the abdomen and pelvis in a

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patient with a known twin gestation presenting for

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further evaluation for operative planning.

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We have steady state free procession images on the left and

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turbo spin echo images on the right.

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As we scroll in Fairly we see the gravid uterus come into

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view with T2 heterogeneous. Myometrium in

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the periphery of the uterus. We see the placenta for

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the more severely located fetus.

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As we scroll inferiorly. We see a

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second gestation with a much smaller fetus present. This

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fetus was selectively reduced earlier on in

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the pregnancy due to its location.

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These are sagittal T2 weighted Mr. Images for

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the same patient again, we see a superiorly located

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fetus and amniotic sac with a

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fundal and anterior placenta. Both of which are relatively normal

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in appearance.

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On the sagittal view we're able to more clearly see

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this thin band of intervening myometrial tissue

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between the two gestational sacs.

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We see that the more inferiorly located gestational Sac

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with the smaller fetus is centered in

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the low anterior uterine segment.

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Additionally we can see that there's marked heterogeneity of

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the paraservical tissues and particularly

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the posterior lip of the cervix which has

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numerous T2 dark flow voids present internally.

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These are coronal T2 weighted images of the abdomen and pelvis in the

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same patient steady state free procession images on the

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left and turbo spin echo images on the right.

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Again, we see the superiorly located intrauterine gestation

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with a fundal placenta and a

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second trimester fetus.

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We can nicely visualize this thin band of intervening Miami

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trim between the two gestational sacs

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again with a small fetus. I want to

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point out the heterogeneity of the tissue surrounding the

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smaller fetus and highlight the fact

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that it this is really early chorionic proliferation

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and early placentation.

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Revisiting the sagittal images we can

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again see that the smaller fetus and smaller

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gestational Sac contribute to a mild amount of

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bulging and thinning of the low anterior uterine segment

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in addition to that vascular proliferation in

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the region of the cervix. And so the diagnosis for

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this case is a coexisting intrauterine gestation

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with a cesarean section scaric topic

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pregnancy.