We present a 25-year-old Caucasian woman in her first pregnancy (conceived on clomiphene) who had an uncomplicated course until 19 weeks of pregnancy. She has given written permission for the case to be reported. Booking blood tests in 2003 showed her to be blood group A positive and negative for hepatitis B virus and HIV. A nuchal translucency scan was low risk and confirmed the gestational age. She had a past history of ileo-caecal resection for Crohn's disease 4 years earlier.Between 19 and 23 weeks of gestation she had recurrent episodes of abdominal pain and vaginal bleeding warranting admission and a 2-unit blood transfusion. At 22 weeks an ultrasound scan showed normal fetal anatomy and a normal posterior, not low, placenta. However, it showed an 8.5-cm complex cystic mass on the anterior uterine wall. This was felt likely to represent a blood clot because it had not been present on the routine anomaly scan at 20 weeks. She remained an inpatient as she continued to have intermittent vaginal bleeding.After 6 days she complained of breathlessness and pleuritic chest pain. An ECG showed sinus tachycardia and a chest X-ray showed multiple rounded opacities throughout both lungs, measuring up to 2 cm in diameter, suggestive of metastases. A subsequent computed tomography pulmonary angiogram showed no evidence of embolic disease but confirmed multiple lesions highly suggestive of metastases. Renal, liver and thyroid function were normal and a quantitative b-human chorionic gonadotrophin (bhCG) measurement was 115 000 IU/l. Clinical examination of the breasts and skin revealed no abnormality and there were no palpable lymph nodes in the neck, groin and axilla.
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