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Abnormal Retroverted IUD – Embedded

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Our next case is of a 50-year-old

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again for an IUD check.

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I'm just going to start at

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this point with our cine clips.

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This is a sagittal uterus.

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We'll let you know that this is a

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retroverted and retroflexed uterus.

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Those again are very hard

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to get in a single plane.

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Sometimes even sagittally it can be difficult

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and sometimes it can be near impossible

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to get it in a good transverse plane.

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So that's why it looks,

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can look a little tricky here.

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So as we're scrolling through this

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one, we can see some IUD for sure.

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I see shadowing down here.

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It's definitely an IUD.

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We have a fibroid right here,

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but I do not see an IUD up here closer

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to the fundus where it should be.

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We'll go to our, you know, quote-unquote

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transverse plane, which is as best as we could get.

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And you can already see there's

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uterus endometrium over here

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and there's shadowing over here.

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I don't know where this structure is,

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but that doesn't look okay.

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So we follow it up towards the fundus.

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Again, I see nothing where it should be.

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There's no IUD up towards the fundus.

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Fibroid here, fibroid here.

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Lots going on in this busy uterus.

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And some IUD way over here.

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Another fibroid coming into view.

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Really hard to tell until we get

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down to here where we definitely see

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that classic shadowing from the IUD.

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So I don't know exactly where this is again.

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I do know that it's

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extraordinarily abnormal, however.

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So if we go to our 3D imaging here at the end.

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Here's our 3D imaging.

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Remembering this is a retroverted, retroflexed.

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3D still works for them.

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You might have to play around with it a little bit

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more, but you can get diagnostic images from it.

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So this is flipped.

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Here's the fundus down here in this

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particular case, and here's your IUD.

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So that's that long body of it that we were

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seeing, that shadowing, really low right here.

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The left arm is over here,

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the right arm is over here.

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So now I understand exactly how

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that IUD is positioned right there.

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I can't tell definitively if it's embedded,

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but based off of this, anything I'm worried

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about is either going to be the body right

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here, and maybe that right arm. The left

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arm looks like it's going to be okay.

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So with that in mind, I'll go back to

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my cine clips one more time to try and

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figure out exactly what's going on.

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So we'll do that here.

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This is another transverse cine

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clip that they took again later on.

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We're going to follow it again down here.

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We can follow this over here, endometrium over

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here, and then this, paraovarian cyst right

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there, is not in the endometrium right here.

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So I think now that we know what's going

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on a little bit better based off of

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that 3D, we can follow this up again.

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We can try and follow those arms to see

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what is embedded in these particular cases.

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So again, I think that 3D not only helps

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because you can visualize it better, but

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now you can go back to your cine clips

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and try and decide whether something is

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embedded or not, and if so, how much.

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So it can be a little bit difficult when that

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endometrium, like in this case, is really

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super thin to figure out what's going on.

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

Iatrogenic

Gynecologic (GYN)

Body

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