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Malpositioned IUD – Embedded in Myometrium

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Our next case is a 31-year-old

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who came in for an IUD check.

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We'll start with the cine clips.

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So on our transverse cine clip through it again,

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trying to figure out how that IUD is placed,

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see a little bit of shadowing over here.

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There's your IUD off to one

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side, which is abnormal.

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So you come down towards the cervix,

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you see a sort of branch point.

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So maybe these are the arms down here and it's

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really hard to tell honestly what's going on

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there, except that it's definitely abnormal.

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Maybe it's completely flipped

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upside down and tilted.

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The still images didn't really

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help either, as you could imagine.

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But we got 3D images on this particular patient.

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This was an older machine, so the 3D technology

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was a little bit different at that point.

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So this is all what our sonographer

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had to actually manually take out.

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And so she gave us a couple of different

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examples, and that's why these are

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going to look a little bit different

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from some of the 3Ds I've shown before.

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This is going to be in general

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your fundal contour up here.

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And here you can see a shadowing

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of an IUD right here, right?

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Those look like the arms right here.

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She tries a little bit more to figure

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out if this, you know, is the better view.

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And here, I think you can really

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see the contour a bit better.

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You can even see the endometrial cavity

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up here, and now you can see the arms a

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little bit better, and here's the body of

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that IUD. And so what's happening here is

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if you follow the endometrium right here,

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you see it's almost tenting right here.

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It's pushed right here, and that's by this

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arm right here, so this is not embedded in the

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myometrium per se. It's just pushing on, it's

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kind of tenting there; it didn't go through it.

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However, this one just kind of

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keeps going and going and going.

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So we thought this right arm was

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embedded into the myometrium.

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And sometimes they can remove these if

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it's just embedded a little bit, but if

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it looks to be significantly embedded,

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and again, that's a subjective term.

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They might need hysteroscopic removal

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with some sedation to get that out.

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So it's important to note whether it's embedded

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into the myometrium, and if so, how much.

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Again, embedded is referring

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to the myometrium itself.

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And perforation is in regard to going

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through the uterine serosa, either partially

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or totally into the abdominal cavity.

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And those are always going

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to be surgical management.

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Here's another one that she tried.

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This was a grayscale one.

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We flipped it onto its side right here.

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The endometrium is over here.

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The fundus would be somewhere up here.

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Again, there's your IUD right there.

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Again, we're just kind of playing around,

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trying to figure out the best way to show

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you that this one was tenting and that

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this one was going through and through,

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embedding deep into the myometrium.

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And it's always important to remember,

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too, that if you do not find the IUD, you

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can try and look with an ultrasound to

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see if you can see it nearby the uterus.

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I've had luck with that one time, one time only.

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But your differential then is either it

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expelled and the patient didn’t know, which

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is more common than you might imagine.

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But you always need to get an abdominal

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X-ray at that point to look to see if

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it’s in the abdominal cavity or not.

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Because that’s a diagnosis

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of exclusion is an expulsion.

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Otherwise, you have to look

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for it in the abdominal cavity.

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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