:::: MENU ::::

  • Caesarean Section Scar Niche

  • BSMMU Residency Exam Preparation

  • Fetal Intracardiac Echogenic Focus

Showing posts with label USG Uterus. Show all posts
Showing posts with label USG Uterus. Show all posts

Case 120: Missed Abortion || 9-10 Weeks || Ultrasound

, ,

                  

Clinical Features:

A young married female patient came with

- Amenorrhoea for 2 months.

- Pervaginal small bleeding.

- Lower abdominal pain.


Ultrasound Features:

- About 9-10 weeks of single intrauterine dead embryo.

- No cardiac activity, even on Doppler.


Remember:


Ultrasound Diagnosis:

Missed abortion of about 9-10 weeks size.


Ultrasound Images:




9-10 weeks of single intrauterine dead embryo with no cardiac activity, even on Doppler.


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link










Case 119: Adenomyosis | Uterus || Ultrasound

,

                  

Clinical Features:

A 35-year-old female patient came with

- Dysmenorrhoea

- Menorrhagia


Ultrasound Features:

- Uterus is enlarged & globular with asymmetric myometrial thickening.

- Myometrium is inhomogeneous with irregular junctional zone, subendometrial tiny cystic spaces along with echogenic lines & islands & fan-shaped shadowing without any translesional abnormal vascularity.


Remember:

Check two journals for studying adenomyosis:
1.Van den Bosch, T., Dueholm, M., Leone, F.P.G., Valentin, L., Rasmussen, C.K., Votino, A., Van Schoubroeck, D., Landolfo, C., Installé, A.J.F., Guerriero, S. and Exacoustos, C., 2015. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound in Obstetrics & Gynecology, 46(3), pp.284-298.

2. Van den Bosch, T., De Bruijn, A.M., De Leeuw, R.A., Dueholm, M., Exacoustos, C., Valentin, L., Bourne, T., Timmerman, D. and Huirne, J.A.F., 2019. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 53(5), pp.576-582.


Ultrasound Diagnosis:

Uterine Adenomyosis


Ultrasound Images:








Enlarged & globular uterus with inhomogeneous asymmetric myometrium showing irregular junctional zone, subendometrial tiny cystic spaces along with echogenic lines & islands & fan-shaped shadowing without any translesional abnormal vascularity. 
A small nabothian cyst is also seen.


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link










Case 100: Migrated Intrauterine Contraceptive Device || Ultrasound

, , ,

    

Clinical Features:

A 22-year-old female patient with

- H/o using intrauterine contraceptive device & perforation.

- H/o hysterectomy due to ruptured uterus during pregnancy.


Ultrasound Features:

A ‘T’-shaped hyperechoic foreign body surrounded by anechoic localized collection is noted at the right iliac fossa.


Remember:

3D/4D ultrasound may help visualize the IUCD location (especially with serpiginous IUCDs).


Ultrasound Diagnosis:

Migrated Intrauterine Contraceptive Device at the right iliac fossa.


Ultrasound Images:


Echogenic linear IUCD on long section at RIF with surrounding localized collection


Echogenic linear IUCD on trans section at RIF with surrounding the localized collection


Echogenic linear IUCD on long section at RIF with surrounding localized collection


Echogenic linear IUCD on long & trans sections at RIF with surrounding localized collection


On color Doppler, no surrounding abnormal vascularity







3D Ultrasound of the IUCD on different modes

YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link







Case 84: Caesarean Section Scar Niche || Ultrasound || TVS

,

 

Clinical Features:

A 28-year-old female patient with the history of previous two caesarean sections came for a folliculometry with a desire to conceive.


Ultrasound Features:

Semicircular & triangular myometrial defects & tethering of the endometrium are seen in the lower uterine segment at the region of the old cesarean scar.


Remember:

- A niche has been described as the indentation of myometrium of at least 2mm due to tethering of the endometrium.
- Due to tethering of the endometrium, blood accumulates in a niche and may serve as a source of dysfunctional uterine bleeding, accounting for spotting 2-12 days after the routine menstrual cycle.


Ultrasound Diagnosis:

Caesarean Section Scar Niche


Ultrasound Images:



Transabdominal ultrasound showing small anechoic area at the lower uterine segment


Transabdominal ultrasound showing small anechoic area at the lower uterine segment


Transvaginal ultrasound showing a bulky uterus in longitudinal section


Transvaginal ultrasound in transverse section


Transvaginal ultrasound in longitudinal section showing semicircular myometrial defect & tethering of the endometrium in the lower uterine segment at the region of the old cesarean scar.


Proximal anterior myometrial narrowing


Distal anterior myometrial narrowing


Semicircular & triangular myometrial defects & tethering of the endometrium in the lower uterine segment at the regions of the old cesarean scars.


Mild endometrial collection


Niche in transverse section


Measurement technique of a niche

YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link



Case 77: TVS: Bulky Uterus, Adenomyosis, Fibroid & Nabothian Cysts

,

 

Ultrasound Features:

- Bulky uterus.

- Posterior myometrium is thicker than the anterior one.

- Posterior myometrium is inhomogeneous with areas of fan-shaped shadowing and interrupted junctional zone.

- A well-defined oval hypoechoic area is noted at the right posterolateral myometrium of the uterine body.

- Multiple tiny well-defined anechoic cystic areas are seen in the cervical region.


Ultrasound Diagnosis:

- Bulky uterus with adenomyosis, a small fibroid (Type 4) & nabothian Cysts.

- According to FIGO classification, Type 4: Intramural.


Ultrasound Images:


TVS - Uterus LS: Bulky


TVS - Uterus TS







Small intramural fibroid


Small intramural fibroid


Small intramural fibroid


Nabothian cysts at cervix




Case 59: Retroflexed Uterus with Retained Products || Ultrasound

, ,

         

Clinical Features:

A 25 years old female patient came with lower abdominal pain & pervaginal bleeding.


Ultrasound Features:

- Bulky & retroflexed uterus

- Irregular mixed echogenic substance along with collection is noted within the uterine cavity 


Ultrasound Diagnosis:

Retroflexed bulky uterus with retained products of conception


Remember:

Urine for pregnancy test may become negative in incomplete abortion. Beta hCG may guide in confusing cases.


Ultrasound Images:




Fig: Retroflexed bulky uterus with retained products of conception




Case 54: Molar Pregnancy || Hydatidiform Mole || TVS || Doppler

, ,

          

Clinical Features:

A 22 years old female patient came with

- Amenorrhoea for 4 months

- Small pervaginal bleeding for several days


Ultrasound Features:

- Bulky uterus.

- Heterogeneously echogenic central intrauterine mass with internal diffuse cystic spaces is seen without any associated fetal part forming the ‘snow-storm’ appearance.

- Color Doppler shows low impedance flow towards the lesion.


Remember:

- Molar pregnancy can be easily diagnosed on transabdominal ultrasound. TVS & MRI help exclude invasive mole.

- Tornado-shaped bridging vessels, myometrial thinning & exophytic mass should be excluded.


Ultrasound Images:



Fig: Transabdominal ultrasound, longitudinal section of the uterus; Bulky uterus with heterogeneously echogenic central intrauterine mass with internal diffuse cystic spaces without any associated fetal part forming the ‘snow-storm’ appearance suggesting molar pregnancy.


Fig: Transabdominal ultrasound, transverse section of the uterus; Bulky uterus with heterogeneously echogenic central intrauterine mass with internal diffuse cystic spaces without any associated fetal part forming the ‘snow-storm’ appearance suggesting molar pregnancy.


Fig: Transabdominal ultrasound, longitudinal section of the uterus; Color Doppler shows predominantly peripheral vascularity


Fig: Transvaginal ultrasound (TVS), longitudinal section of the uterus; Bulky uterus with heterogeneously echogenic central intrauterine mass with internal diffuse cystic spaces without any associated fetal part forming the ‘snow-storm’ appearance suggesting molar pregnancy.


Fig: Tranvaginal ultrasound (TVS), longitudinal section of the uterus; Color Doppler shows predominantly peripheral vascularity


Fig: Tranvaginal ultrasound (TVS), longitudinal section of the uterus;  Color Doppler shows low impedance flow towards the lesion.


YouTube Video Link:

https://youtu.be/T5Mz7Aw0D3s