case_images: PMC8452425_01
case_images: 3D ultrasound image. White arrow indicates normal bladder line; black arrow indicates the perimetrial interruption.
case_images: CRIOG2021-2105248.001.jpg
case_images: PMC8452425_01_CRIOG2021-2105248.001.jpg
case_images: fig1
case_images: Surprisingly, most of the PAS signs were absent: abnormal placental lacunae, bladder-line interruption, and myometrial thinning which was identified (Figure 1).
case_images: (a, b) Images of utero-bladder relationship. Graphic reconstruction (a) and 3D-ultrasound image (b) of the focal myometrial invasion without involvement of the bladder and integrity of the posterior bladder wall.
case_images: CRIOG2021-2105248.002.jpg
case_images: PMC8452425_01_CRIOG2021-2105248.002.jpg
case_images: fig2
case_images: The only ultrasound findings were the partial absence of the "clear zone," that is, the loss of the hypoechoic plane in the myometrium underneath the placental bed and a moderate uterovesical hypervascularity (Figure 2).
case_images: (a, b) Intraoperative images of vesicouterine peritoneum detachment (a) and evidence of placental "bulging" (b).
case_images: CRIOG2021-2105248.003.jpg
case_images: PMC8452425_01_CRIOG2021-2105248.003.jpg
case_images: fig3
case_images: In the meantime, an inspection of the placental site was carried out: after developing a bladder flap clearing the lower uterine segment, the bulging of the invasion of the placenta in a very thin myometrium with intense vascularization was evident on the anterior surface of the external anterior uterus (Figure 3); no parameters and bladder infiltration were present.