Interactive Transcript
0:02
So we've reviewed the
0:03
normal positioning of IUDs.
0:04
Let's look at some abnormal
0:05
positioning examples.
0:07
So starting with this case right here,
0:08
I'll go through a few of the still images.
0:11
Once they're abnormally positioned,
0:13
I find the still images can be really
0:15
hard to figure out exactly where it is.
0:17
Even sometimes on the cine clips, I
0:19
can still have a hard time figuring
0:20
out exactly how it's positioned, even
0:22
though you can tell it's abnormal.
0:24
So here they labeled this an oblique fundal IUD.
0:27
We're not seeing anything that we expect.
0:29
Like that last case, we definitely
0:30
see shadowing from the IUD, but I have
0:32
no idea where it is at this point.
0:34
Sagittal image right here, then you can
0:36
see a bit of it, but I expect it to be a
0:38
long, that long arm of the T to come all
0:40
the way down here, that body of the T, we
0:42
don't see that, so where the heck is this?
0:44
Tech also nicely measured
0:46
here that it's too low, right?
0:47
We talked about four millimeters
0:48
from the top of the endometrium.
0:50
This one is nearly 12 millimeters.
0:52
That's already too low.
0:53
So we know this is a malpositioned IUD.
0:56
Now we just have to figure
0:57
out how is it malpositioned.
0:59
So here is your 3D right here.
1:02
And I think this is just so helpful.
1:04
We'll look at the cine clips in a moment,
1:05
but here is your uterine contour right here.
1:08
There's a bit of the endometrium right here,
1:10
following along right here.
1:11
This is sort of the left right
1:13
here and we lose the right.
1:14
But here's your IUD.
1:15
Here are your arms right here.
1:17
Here's the long body.
1:19
The long body is actually pointing
1:20
out towards the left fallopian tube.
1:22
So this thing flipped and sort of rotated as well.
1:26
It's almost completely
1:27
upside down and then rotated.
1:28
So here's your arms here.
1:29
Here's the body here.
1:30
So this is completely abnormal.
1:32
So we know that's abnormal, but
1:34
what we have to decide next is not
1:36
just that it's abnormal, needs to be
1:37
removed, which is definitely step one.
1:40
But we also need to know, is
1:41
this embedded in the myometrium?
1:43
Is it perforating through?
1:44
If it's just abnormally positioned, a lot
1:46
of times they can just, in the office,
1:47
go ahead and remove this, potentially.
1:50
But if it's deeply embedded or out
1:52
through the serosa, they're going to
1:54
need sedation to remove that basically.
1:56
And then obviously if it's completely
1:57
perforated through and into the
1:59
cavity, you need a full surgery.
2:01
So I'll just show you on here as well.
2:04
Here's your sagittal cine view.
2:05
She had a C-section scar right here.
2:08
I found it very difficult to figure
2:11
out exactly where this IUD is.
2:12
And I do try to look first before I look at
2:14
the 3D just to see if I can figure it out.
2:17
And you can follow this for sure, but
2:20
it's really hard to visualize, at least
2:21
for me, exactly how that's positioned,
2:23
where the 3D just shows you right there.
2:26
And if you still weren't sure, for some
2:28
reason that was unbeknownst to me, she
2:30
actually ended up getting an MRI of
2:32
her pelvis, I assume for other reasons.
2:34
And you're teaching we did imaging right here.
2:37
There you go.
2:38
You can prove it right there as well.
2:40
There's your IUD it's flipped
2:41
and it's rotated, right?
2:43
Here's the long portion of it, not
2:45
embedded into the myometrium here.
2:48
See the arm right here,
2:49
not embedded, not embedded.
2:50
I would not suggest getting
2:51
an MRI to look for an IUD.
2:53
The ultrasound itself should be more
2:55
than sufficient and was in this case.
2:57
But the IUD, you can see it nicely via MRI.
3:00
So you should definitely look for it.
3:02
If you have an MRI with a person
3:03
with an IUD, always comment on it.
© 2024 MRI Online. All Rights Reserved.