Interactive Transcript
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Our next case is of a 69-year-old
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patient who presented to the ED
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with abnormal vaginal bleeding.
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Just going to show you our
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sagittal uterus imaging right here.
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And so we have a couple incidental findings.
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She definitely has fluid in the endometrial
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canal and maybe some nodularity right here.
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Could that be a polyp?
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Could that be a little bit of blood products?
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We have lots of echogenic foci
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out in the periphery.
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These may be calcified vessels given her age.
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And then we have this focal mass-like,
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very echogenic structure back here in the myometrium.
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And so when you're thinking on
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ultrasound, what's your differential
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for very bright structures?
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We have calcium, which this is not.
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If this is this heavily calcified and
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this large, it should be shadowing.
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And this is clearly not shadowing.
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You can think about air.
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However, similar type of thing.
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If you have this much large kind of globule of
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air, you would see dirty shadowing behind it.
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You wouldn't see the
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structures behind it nicely.
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So this isn't air.
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Other things that are bright on ultrasound,
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of course, are going to be fat.
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So this is probably fat in
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the uterus or a lipoleiomyoma.
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So this is fatty degeneration of a fibroid.
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So here's your color Doppler imaging.
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We're not seeing too much color Doppler flow
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in there, nor do we actually see color Doppler
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flow in the structure within the endometrium.
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So it might just be a little
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bit of blood products in there.
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Patient also had a CT scan.
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I like to look at the uterus
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on your sagittal images.
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And again, this is not
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the greatest for contrast
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purposes, but it's good enough to diagnose.
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So here you can see right here, we have this
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hypodense structure in the anterior uterus
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and put a Hounsfield unit on it, negative
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nine, which is going to be very similar to
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the mesenteric fat or subcutaneous fat that
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confirms if you weren't 100% sure.
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We now know this is a fatty lesion.
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This is a lipoleiomyoma.
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56 00:01:57,635 --> 00:01:57,955 Alright.
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One last thing to consider here
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too, because this is a nice example.
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We talked earlier in this about retroversion,
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anteversion, and that kind of stuff.
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So this is a retroverted
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uterus, and it is retroflexed.
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And that means that this is still going
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to be the anterior part of the uterus.
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This is not posterior, and it proves
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that too in the CT right here.
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It's in the anterior uterus, not the
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posterior wall of the uterine structure.
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