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Abnormal Position – Question of Embedded IUD

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So we've reviewed the

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normal positioning of IUDs.

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Let's look at some abnormal

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positioning examples.

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So starting with this case right here,

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I'll go through a few of the still images.

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Once they're abnormally positioned,

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I find the still images can be really

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hard to figure out exactly where it is.

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Even sometimes on the cine clips, I

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can still have a hard time figuring

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out exactly how it's positioned, even

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though you can tell it's abnormal.

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So here they labeled this an oblique fundal IUD.

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We're not seeing anything that we expect.

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Like that last case, we definitely

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see shadowing from the IUD, but I have

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no idea where it is at this point.

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Sagittal image right here, then you can

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see a bit of it, but I expect it to be a

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long, that long arm of the T to come all

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the way down here, that body of the T, we

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don't see that, so where the heck is this?

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Tech also nicely measured

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here that it's too low, right?

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We talked about four millimeters

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from the top of the endometrium.

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This one is nearly 12 millimeters.

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That's already too low.

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So we know this is a malpositioned IUD.

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Now we just have to figure

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out how is it malpositioned.

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So here is your 3D right here.

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And I think this is just so helpful.

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We'll look at the cine clips in a moment,

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but here is your uterine contour right here.

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There's a bit of the endometrium right here,

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following along right here.

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This is sort of the left right

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here and we lose the right.

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But here's your IUD.

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Here are your arms right here.

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Here's the long body.

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The long body is actually pointing

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out towards the left fallopian tube.

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So this thing flipped and sort of rotated as well.

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It's almost completely

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upside down and then rotated.

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So here's your arms here.

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Here's the body here.

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So this is completely abnormal.

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So we know that's abnormal, but

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what we have to decide next is not

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just that it's abnormal, needs to be

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removed, which is definitely step one.

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But we also need to know, is

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this embedded in the myometrium?

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Is it perforating through?

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If it's just abnormally positioned, a lot

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of times they can just, in the office,

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go ahead and remove this, potentially.

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But if it's deeply embedded or out

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through the serosa, they're going to

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need sedation to remove that basically.

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And then obviously if it's completely

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perforated through and into the

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cavity, you need a full surgery.

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So I'll just show you on here as well.

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Here's your sagittal cine view.

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She had a C-section scar right here.

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I found it very difficult to figure

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out exactly where this IUD is.

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And I do try to look first before I look at

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the 3D just to see if I can figure it out.

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And you can follow this for sure, but

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it's really hard to visualize, at least

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for me, exactly how that's positioned,

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where the 3D just shows you right there.

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And if you still weren't sure, for some

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reason that was unbeknownst to me, she

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actually ended up getting an MRI of

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her pelvis, I assume for other reasons.

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And you're teaching we did imaging right here.

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There you go.

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You can prove it right there as well.

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There's your IUD it's flipped

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and it's rotated, right?

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Here's the long portion of it, not

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embedded into the myometrium here.

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See the arm right here,

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not embedded, not embedded.

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I would not suggest getting

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an MRI to look for an IUD.

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The ultrasound itself should be more

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than sufficient and was in this case.

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But the IUD, you can see it nicely via MRI.

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So you should definitely look for it.

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If you have an MRI with a person

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with an IUD, always comment on it.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

Ultrasound

Trauma

Non-infectious Inflammatory

MRI

Iatrogenic

Gynecologic (GYN)

Fallopian Tubes

Body

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