Interactive Transcript
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All right, we have another
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patient for an IUD check.
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She had bleeding and pain post-IUD
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placement for about the last two weeks.
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She's about 26 years old.
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And here's her sagittal uterus.
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We have our parametral vessels over here.
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We're going to scroll through these.
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And again, we already see the
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endometrium starting, and we have no IUD
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where it should be.
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It's definitely low.
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We have all of our artifacts right here.
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It's not really shadowing,
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but we have those artifacts.
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The IUD is low.
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We've got that.
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And we have this structure way out here.
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That's definitely shadowing.
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Is that a uterine
0:34
calcification in a 26-year-old?
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That would be a little weird.
0:37
And atherosclerosis again,
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she's too young for that.
0:40
This thing kind of keeps going.
0:44
And so again, looking at this, trying to
0:45
figure out what the heck is happening.
0:47
Here's my measurement of approximately
0:48
how far down it was, and it's
0:50
probably even underestimated.
0:51
Definitely too low, but again,
0:53
just giving our surgeons an idea.
0:55
So then we can go to the transverse uterus,
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to see if that helps us figure out exactly what's
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going on as we start to scroll through here.
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Right there.
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That's not normal.
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We have the endometrium down here, right?
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This is not in the endometrium.
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This is clearly and definitely
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in the myometrium right there.
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We follow this down.
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We do get into the
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endometrium right here, right?
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That's good.
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But then there's shadowing.
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We don't see the echogenic part, but
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we do see the shadowing continues
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posteriorly into the myometrium.
1:25
So a 3D in this particular case
1:27
isn't going to help you because we
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already know it's in the myometrium.
1:30
You're not going to get it in the right planes.
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It's not in the plane of the endometrium.
1:33
So, you can pick and choose what
1:36
you even try to 3D reconstruct.
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We don't need it.
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Not helpful in this particular case.
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What is important, we know we very clearly
1:43
have embedment, significant embedment.
1:45
Next question is, do we
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have serosal perforation?
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There is this echogenic structure right here
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that maybe it is, but it's hard to tell.
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Is this contiguous with this?
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If you're following that line, is that it?
1:58
Is it not?
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Because that could change
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management potentially.
2:02
So we got another cine clip
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and here's your IUD body.
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That's the structure of it right there.
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And then you have this echogenic
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structure, which looks just like an arm.
2:11
And so what she did was she stayed
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perfectly still in this area,
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let all the bowel move around it.
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So you knew this wasn't just, you know,
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some echogenic bowel contents or bowel gas
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in it.
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This structure stays still, and as
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she just breathes and things move a
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little bit, this moves with the uterus.
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So this structure is part of the IUD.
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It has perforated through and through.
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So this IUD has only a bit
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of itself in the endometrium.
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Most of it is in the myometrium,
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both anteriorly and posteriorly, and
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then perforates out through the serosa.
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One thing to keep in mind is perforation is
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more frequent in patients who are lactating or
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who are less than six months postpartum, and
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this patient actually was about eight or nine
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months postpartum at that point, so she was
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sort of within that window, at least close to it.
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So again, this is a myometrial penetration and
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then a perforation through the serosa as well.
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This would have to be surgically removed.
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