Interactive Transcript
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So our first case is of a 27-year-old
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female who had a C-section approximately
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six days prior to presentation.
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She's now re-presenting to the ED with
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fever, foul discharge, and rule out
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abscess, rule out retained products of
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conception was the history that we got.
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So starting with our transabdominal view,
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there is a small fluid collection.
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This was labeled as inferior to the C-section
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scar, C-section scar being somewhere out here.
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This was not thought to be the bladder.
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This is not a vascular structure.
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There's no color doppler flow internally.
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And you can see some measurements there.
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It's, you know, 4-5 centimeters approximately.
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18 00:00:37,700 --> 00:00:39,070 And then we move to the transvaginal
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view and you can see that this
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is a really limited ultrasound.
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The cervix is going to be somewhere back here.
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The fundus is back here.
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This is almost like a straight back uterus.
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It's, you know, anteverted and then it
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kind of just goes straight back and that's
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going to get you far from the probe.
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So you're not going to see it that well.
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But what you do see is where
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the endometrium should be,
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you see all of these echogenic foci
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and some of these, maybe you're seeing
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a little bit of dirty shadowing.
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So if you continue to scroll through
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these, you might just think again,
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this is virtually non-diagnostic.
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What is going on here?
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But if you take a step back, take a
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pause, take a breather and let's look
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at our cine clips a little bit closer.
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So this is going to be a sagittal cine clip.
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And again, notice out here,
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all of these echogenic foci.
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We aren't necessarily in the
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endometrium at this point.
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So it's important to think
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about what's going on up here.
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What is going on up here?
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And again, you can see almost nothing below
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until we get to the body of the uterus.
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And you can see endometrium,
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we have more of these foci.
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She's six days post-birth.
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So could this be a little
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bit of normal gas left
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in the endometrium?
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That's certainly possible.
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That's within the realm of normal.
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But if you follow these and march
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these out, and it almost looks like this
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is where the C-section scar should be.
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And these echogenic foci march
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out that C-section scar there.
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So let's get some dedicated imaging of the lower
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uterine segment where that C-section should be.
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And again, not great imaging,
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not beautiful imaging, right?
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But we see all of these echogenic foci.
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We have shadowing posterior to it.
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And it leads out anterior to
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where the C-section should be.
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All of this structure out here.
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The other thing to keep in mind is
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that we had that fluid collection here,
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remembering that, going back to this.
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So this is concerning for endometritis.
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This is not a non-diagnostic
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ultrasound, although it is very limited.
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But this is a good example in a patient
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who has fever and foul discharge of an
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endometritis appearance on ultrasound.
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