19/02/2024
The “rail sign”: an ultrasound finding in placenta accreta spectrum indicating deep villous invasion and adverse outcomes
Incremental angiogenesis of placenta accreta spectrum and the rail sign
A–B, Color Doppler ultrasound examination for a patient with placenta previa creta. A, In this patient, only subplacental hypervascularity (indicated by “1”) existed at 30 weeks’ gestation. B, The uterovesical hypervascularity (indicated by “2”) appeared only after 33 weeks’ gestation; C–D, Color Doppler interrogation for a patient with placenta previa percreta and bladder invasion at 34 weeks’ gestation. C, Numerous newly formed, coral-shaped vessels (indicated by “3”) extended perpendicularly from the placenta to the bladder mucosa (so-called bridging vessels). D, The subplacental and uterovesical hypervascularity merged (indicated by an asterisk) and even progressed into an aneurysm (Video 2). The parallel subplacental or uterovesical hypervascularity and neovascularization of the bladder mucosa (indicated by a short arrow), together with interconnected bridging vessels (indicated by “3”), constitute the “rail sign” in (D). (E) and (F) were the corresponding images from cystoscopy and surgical findings of the patients in (C) and (D).
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