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Endometritis (After C-Section)

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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.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Uterus

Ultrasound

Infectious

Iatrogenic

Gynecologic (GYN)

Body

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