 Good evening everybody. My name is Asra Khan and I'm a third-year resident from Maligarh Muslim University. I'll be presenting a paper on a rare case report on scaric topic pregnancy, a life-threatening disease if misncedosed. So we had a 25-year-old female who presented to the emergency department with complaints of two months of pneumonia and profuse bleeding for vaginom. At presentation, she was alert, oriented and vitally stable. She had passed history of caesarean suction done twice previously due to fetal distress. At the time of presentation, her urine pregnancy test was positive. The patient was then referred to the department of radiology for sonographic evaluation. The initial TVS imaging showed a heterogeneous mass in the uterine cavity which was vascular and keeping in mind the positive urine pregnancy test, this was reported as retent product of conception, following which dilatation and curatage was done and the patient was discharged subsequently. What happened was, after 20 days, the patient again presented to emergency and this time with hemorrhagic shock. This was due to continuous episodes of bleeding for vaginom since the last time the patient was admitted. Blood transfusion was initiated and the patient was stabilized. Again, the patient was referred to the radiology department for reevaluation. This time, on the TVS imaging, there was a heterogeneous mass predominantly present in the lower uterine segment. Another point that was noted was, a normal uterine fundus was noted superior to the mass. On color-dopter interrogation, it was found that the mass was ritually vascular and it was in close contact with the posterior wall of bladder with focally indistinct fat grains. This imaging led to the suspicion for a scaric-topic pregnancy, which was again supported by persistently raised beta ethyl-CG levels of the patient. Further, to confirm the diagnosis, MRI pelvis was advised. So, we have the MRI images. This is the T2 weighted images, sagittal and coronal, and the T1 weighted images, which show an altered signal intensity lesion present predominantly in the lower uterine segment in the anterior aspect. The lesion has some T2 hyperintense areas and a few T1 hyperintense areas. On further imaging, the GRE sequences showed multiple blooming foci and there was evidence of diffusion restriction on DWI. This raised the possibility of multiple hemorrhagic areas. Further, contrast was injected and the post-contrast fat saturation T1 images in sagittal section showed heterogeneous enhancement within the solid areas of the lesion with non-enhancing hemorrhagic areas. A point was noted that contrast enhancement was also noted in the superior posterior aspect of the bladder and this was indistinct with the mass. This was highly suspicious and reported as a grade 4 ectopic pregnancy that had infiltrated into the bladder. Another point that we noted was a normal upper uterine segment and fundus is noted superior to this mass and the posterior wall was predominantly normal. The patient was initiated on methotrexate therapy and subsequent beta-HCG levels showed a gradual declining trend. However, since the patient continued bleeding per vaginum, leprotomy was done, which revealed a vascularized mass adhered to the lower uterine segment at the scar site with infiltration into the bladder. Histopathology of this specimen confirmed the diagnosis of a scar ectopic pregnancy. So, as we all know that ectopic pregnancy is a medical and a surgical emergency, it refers to the implantation of a fertilized worm outside of the uterine cavity. The overall incidence of ectopic pregnancy is approximately 2% of all reported pregnancy and as we all know it is a leading cause of maternal mortality worldwide. However, the rarest form of ectopic pregnancy is the scar ectopic pregnancy, which refers to the abnormal implantation of embryo within the myometrium of a previous scar on the uterus, especially if it's a caesarean scar. So, it is of crucial importance that us radiologists be familiar with the variable appearances of ectopic pregnancy on sonographic and MRI imaging. Usually, an indefined fetal pole in the location of a caesarean scar makes the diagnosis relatively easy. However, sometimes it may present as a vascular heterogeneous mass that may mimic a placental product or an incomplete abortion, such as in our case. If there is an episode of recurrent bleeding per vaginum following the initial management and there is a history of previous caesarean scar, it is essential that we keep a high index of suspicion for a scar ectopic pregnancy. The early and accurate diagnosis with timely management can prevent pregnancy complications such as hemorrhage, uterine rupture. It can preserve fertility as well. Transvisional ultrasound remains the first line modality in the diagnosis of caesarean scar. It has a reported sensitivity of 84.6% and of course MRI is a problem solving tool capable of more precisely identifying the relationship of the ectopic pregnancy to the adjacent structures, thereby it provides an additional information for critical care and to direct appropriate medical or surgical therapy. These are the references for my case and thank you.