scholarly journals Spontaneous Rupture of Pyometra Causing Peritonitis in Elderly Female Diagnosed on Dynamic Transvaginal Ultrasound

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Sharad M. Malvadkar ◽  
Madhuri S. Malvadkar ◽  
Shilpa V. Domkundwar ◽  
Shariq Mohd
Keyword(s):  
Spontaneous Rupture ◽  
Rare Complication ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Uterine Wall ◽  
Transvaginal Sonography ◽  
Inflammatory Cell Infiltrate ◽  
Emergency Laparotomy ◽  
First Case ◽  
Enhanced Computed Tomography

Pyometra is collection of pus within the uterine cavity and is usually associated with underlying gynaecological malignancy or other benign causes. Spontaneous rupture of pyometra is a rare complication. We report a case of a 65-year-old female who presented with acute abdomen and was diagnosed with a ruptured uterus secondary to pyometra and consequent peritonitis on dynamic transvaginal sonography (TVS) which was later confirmed on contrast enhanced computed tomography (CECT). An emergency laparotomy was performed and about 800 cc of pus was drained from the peritoneal cavity. A rent was found in the anterior uterine wall and hence hysterectomy was performed. Histopathology revealed mixed inflammatory cell infiltrate with no evidence of malignancy. There are only 31 cases of ruptured pyometra reported till date, most of which were definitively diagnosed only on laparotomy. In only two of these cases the preoperative diagnosis was made on CECT. We report this case, as the correct and definitive diagnosis was made preoperatively on dynamic TVS. To our knowledge,this is the first case report revealing spontaneous ruptured pyometra being diagnosed preoperatively on dynamic TVS. This report is aimed at giving emphasis on the use of simple dynamic TVS for accurate diagnosis of rare spontaneous ruptured pyometra causing peritonitis.

scholarly journals Spontaneous intra-abdominal bleeding in twin pregnancy: Case report

2008 ◽  
Vol 136 (5-6) ◽  
pp. 299-301 ◽  
Author(s):  
Milica Berisavac ◽  
Radmila Sparic ◽  
Miroslava Pervulov ◽  
Ljubica Arsenijevic ◽  
Svetlana Spremovic-Radjenovic ◽  
...  
Keyword(s):  
Spontaneous Rupture ◽  
Twin Pregnancy ◽  
Clinical Symptoms ◽  
Unknown Origin ◽  
Uterine Wall ◽  
Emergency Laparotomy ◽  
Recurrent Bleeding ◽  
Third Trimester ◽  
Abdominal Bleeding ◽  
In Pregnancy

INTRODUCTION Spontaneous rupture of utero-ovarian vessels is a rare cause of haemoperitoneum in pregnancy, leading to significant maternal and foetal morbidity and mortality. Aetiopathogenesis of this condition is still unclear. Establishing clinical diagnosis of this condition is difficult, but very important. Clinical symptoms are nonspecific, and the diagnosis is usually made at laparotomy. CASE OUTLINE We report a case of spontaneous haematoperitoneum in the third trimester of twin pregnancy. Differential diagnosis included uterine rupture and placental abruption. Due to the deteriorated condition of the patient, it was decided to perform laparotomy which established the diagnosis of ruptured venous varices on the posterior uterine wall. Delivery was performed by caesarean section. The postoperative period was uneventful. CONCLUSION The clinical presentation of spontaneous rupture of utero-ovarian blood vessels is not specific and clinical examination and ultrasonographic scanning may be insufficient for diagnosis. Once the diagnosis of spontaneous haematoperitoneum in pregnancy is established, emergency laparotomy is indicated. Following caesarean delivery, it is necessary to establish surgical haemostasis. There are some authors who suggest leaving the pregnancy intact in cases when the fetus is not viable, although one must have in mind the possibility of recurrent bleeding. The safety of this procedure requires further investigation. It is necessary to have in mind the possibility of blood vessel rupture in all cases of abdominal pain and hypotension of unknown origin during pregnancy.

scholarly journals Prediction of chronic endometritis using 2D and 3D transvaginal ultrasound examination in infertile women

2021 ◽  
Vol 10 (3) ◽  
pp. 865
Author(s):  
Tamer H. Said
Keyword(s):  
Ultrasound Examination ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Reproductive Age ◽  
University Hospital ◽  
Transvaginal Sonography ◽  
Chronic Endometritis ◽  
Infertile Women ◽  
3D Ultrasonography ◽  
2D And 3D

Background: Chronic endometritis is a pathology of continuous and hidden inflammatory process characterized by the infiltration of plasma cells into the endometrial stroma. Transvaginal bi-dimensional ultrasonography is in need to be evaluated in prediction of chronic endometritis in women with delayed pregnancy or infertility as a non-invasive, cheap, acceptable, and safe tool of diagnosis. Previously, 3D ultrasonography had been described as a novel for diagnosis of chronic endometritis and correlation of the images with hysteroscopic view results. Objectives were to predict the presence of chronic endometritis in infertile women during their reproductive age through examination of the uterine cavity by 2D and 3D transvaginal sonography to elicit proposed ultrasonographic signs of endometritis.Methods: This observational prospective study took place at Shatby university hospital, Alexanderia universtiy and was done on two hundred infertile women. Women were assigned for ultrasonographic evaluation as a part of pre-treatment assessment. Detailed history was taken from all the patients included in the study. General examination and routine laboratory investigations were done according to hospital protocol. All patients were asked to do ultrasound examination immediately postmenstrual and at the time of ovulation. We used 2D transvaginal ultrasound to predict chronic endometritis, we searched for 1) presence of persistent endometrial focal or diffuse thickening postmenstrual, 2) presence of focal echogenic foci in the triple line endometrium during ovulation. The 3D ultrasonography was done as confirmatory examination. Office hysteroscopy as the main method for diagnosis of endometritis was performed to all patients either after menses if the first sign was detected or at the time of ovulation if the second sign was detected.Results: The combination of persistent endometrial shreds and/or endometrial focal thickening or echogenicity can significantly predict presence of endometritis as the sensitivity and specificity of the combination were 94.90 and 81.37, respectively.Conclusions: Bi-dimensional ultrasonography done to infertile women at 2 phases of the menstrual period can predict the presence of chronic endometritis as a subtle cause of infertility and might be an indication for hysteroscopic evaluation for these patients.

Sonohysterography in a suspected case of uterine perforation after dilatation and curettage for retained placenta

2017 ◽  
Vol 6 (2) ◽  
Author(s):  
Norihito Yoshioka ◽  
Junichi Hasegawa ◽  
Akiko Tozawa ◽  
Kentaro Nakamura ◽  
Tai Kawahara ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Pathological Examination ◽  
Emergency Laparotomy ◽  
Uterine Perforation ◽  
Suspected Case ◽  
Safe Procedure ◽  
Fast Evaluation ◽  
Retained Placenta ◽  
Dilatation And Curettage

Abstract A 35-year-old woman, gravida 3, para 2, spontaneously delivered an infant without any major complications. On the 38th day after delivery, she returned to the hospital due to irregular bleeding. Transvaginal ultrasound showed a mass in the cervix; therefore, dilatation and curettage was performed, using placental forceps, to remove the retained placenta. During the procedure, a uterine perforation was suspected. Sonohysterography was performed in order to confirm the uterine perforation. The sonohysterogram revealed that the high echogenic mass that was suspected to be retained placenta was adhered on the posterior uterine myometrium. Saline that had been injected into the uterine cavity escaped into the Douglas pouch via a small hole in the posterior uterine wall. An emergency laparotomy was performed. Pathological examination of the removed uterus revealed placenta increta in the posterior wall, as well as an adjacent perforated fistula. Sonohysterographic diagnosis of uterine perforation in the present case was not only validated with diagnosis, but also the residual placenta was clearly visible. The use of sonohysterography for detection of a suspected case of uterine perforation after dilatation and curettage was accurate and provided a safe procedure for fast evaluation.

scholarly journals Isthmocele: an overview of diagnosis and treatment

2019 ◽  
Vol 65 (5) ◽  
pp. 714-721 ◽  
Author(s):  
Thaysa Guglieri Kremer ◽  
Isadora Bueloni Ghiorzi ◽  
Raquel Papandreus Dibi
Keyword(s):  
Cesarean Section ◽  
Surgical Management ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Cost Effective ◽  
Uterine Wall ◽  
Large Defect ◽  
Cesarean Scar ◽  
Incomplete Closure ◽  
Previous Cesarean

SUMMARY An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.

scholarly journals Evaluation of abnormal uterine bleeding with transvaginal sonography

2017 ◽  
Vol 6 (7) ◽  
pp. 2794 ◽  
Author(s):  
Monika Jain ◽  
Saptrishi Chakraborty
Keyword(s):  
Diagnostic Accuracy ◽  
Transvaginal Ultrasound ◽  
Tertiary Care ◽  
Uterine Cavity ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Transvaginal Sonography ◽  
Age Group ◽  
Perimenopausal Women ◽  
Sensitivity Specificity

Background: Abnormal uterine bleeding (AUB) is an important cause of health hazard in perimenopausal women. Accurate diagnosis for the causative factor of AUB in this age group is of utmost importance so that appropriate management can be established. Objective pf present study was to estimate the diagnostic accuracy, efficacy, sensitivity and specificity of transvaginal ultrasound in evaluation of uterine cavity lesion in perimenopausal women with abnormal uterine bleedingMethods: This is a prospective study. This study was carried out in the Department of Obstetrics and Gynecology of Mahatma Gandhi Medical College and Hospital, Jaipur. We included 50 patients of perimenopausal age group who attended the gynecology department with the complaint of AUB. After selecting the patients who fulfill the eligibility criteria in the OPD detailed clinical history, obstetrical and gynecological history taken and detail clinical examination was done as per proforma followed by TVS.Results: In the present study, maximum no of cases between age group of 40 to 44 with 48%, and 38% of cases between age group of 45-49 yr. This suggests abnormal uterine bleeding is common in perimenopausal women. In present study overall sensitivity, specificity, PPV, NPV of TVS were 76%, 94%, 76% and 94%.Conclusions: In conclusion, abnormal uterine bleeding which often prevails as an important and common gynecological ailment. The Sensitivity, Specificity, PPV, NPV of TVS was 76%, 94%, 76% and 94%. The result showed that Transvaginal sonography has a moderate diagnostic accuracy in detecting endometrial hyperplasia and other intrauterine pathology. TVS is safe, acceptable and easily available in most secondary and tertiary care setting and is noninvasive. It should be continued as 1st line diagnostic tool in patients with AUB in perimenopausal women.

A Giant Coronary Sinus Aneurysm with Secondary Vena Cava Aneurysms

2016 ◽  
Vol 19 (1) ◽  
pp. 028
Author(s):  
Shengjun Wu ◽  
Peng Teng ◽  
Yiming Ni ◽  
Renyuan Li
Keyword(s):  
Computed Tomography ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Unusual Case ◽  
Superior Vena ◽  
Vena Cava ◽  
Final Diagnosis ◽  
Rare Entity ◽  
First Case ◽  
Enhanced Computed Tomography

Coronary sinus aneurysm (CSA) is an extremely rare entity. Herein, we present an unusual case of an 18-year-old symptomatic female patient with a giant CSA. Secondary vena cava aneurysms were also manifested. The final diagnosis was confirmed by enhanced computed tomography (CT) and cardiac catheterization. As far as we know, it is the first case that such a giant CSA coexists with secondary vena cava aneurysms. Considering the complexity of postoperative reconstruction, we believe that heart transplantation may be the optimal way for treatment. The patient received anticoagulant due to the superior vena cava (SVC) thrombosis while waiting for a donor.

scholarly journals Ruptured intra-abdominal testicular seminoma with hemorrhage shock, after inadequate surgical exploration for undescended testis: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hirotake Gonda ◽  
Takuya Saito ◽  
Takaaki Osawa ◽  
Shintaro Kurahashi ◽  
Tatsuki Matsumura ◽  
...  
Keyword(s):  
Undescended Testis ◽  
Pelvic Mass ◽  
Major Axis ◽  
Retroperitoneal Lymph Node Dissection ◽  
Emergency Laparotomy ◽  
Testicular Seminoma ◽  
Increased Risk ◽  
Pathological Evaluation ◽  
Risk Of Malignancy ◽  
Enhanced Computed Tomography

Abstract Background Undescended testes are associated with an increased risk of malignancy and infertility, and surgical treatment in childhood is recommended. Case presentation A 35-year-old man presented to the emergency department with abdominal pain and vomiting. Despite a history of surgery for a left undescended testis in infancy, his left-sided scrotum appeared underdeveloped. Contrast-enhanced computed tomography showed a pelvic mass, involving a major axis of approximately 15 cm, with high-density ascites suggestive of hemorrhage. A ruptured gastrointestinal stromal tumor was suspected. As he was in hemorrhagic shock, an emergency laparotomy was indicated. The active bleeding mass was controlled through complete resection. A pathological evaluation of the mass revealed a seminoma arising from an undescended testis. His post-operative course was uneventful, and he was discharged on post-operative day 6. Recurrence on the retroperitoneal lymph nodes was detected 1 year postoperatively, and a retroperitoneal lymph node dissection was performed after chemotherapy. He remains well without any apparent signs of recurrence. Conclusions Paying close attention to an empty scrotum is advisable, even postoperatively, for undescended testis because of possible subsequent potential malignancy presenting with hemorrhage, as our patient demonstrated.

scholarly journals Risk Assessment of Endometrial Hyperplasia or Endometrial Cancer with Simplified Ultrasound-Based Scoring Systems

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 442
Author(s):  
Norbert Stachowicz ◽  
Agata Smoleń ◽  
Michał Ciebiera ◽  
Tomasz Łoziński ◽  
Paweł Poziemski ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Menopausal Status ◽  
Power Doppler ◽  
Uterine Cavity ◽  
Abnormal Uterine Bleeding ◽  
Scoring Systems ◽  
Diagnostic Challenge

Background: Abnormal uterine bleeding (AUB) represents a common diagnostic challenge, as it might be related to both benign and malignant conditions. Endometrial cancer may not be detected with blind uterine cavity sampling by dilatation and curettage or suction devices. Several scoring systems using different ultrasound image characteristics were recently proposed to estimate the risk of endometrial cancer (EC) in women with AUB. Aim: The aim of the present study was to externally validate the predictive value of the recently proposed scoring systems including the Risk of Endometrial Cancer scoring model (REC) for EC risk stratification. Material and methods: It was a retrospective cohort study of women with postmenopausal bleeding. From June 2012 to June 2020 we studied a group of 394 women who underwent standard transvaginal ultrasound examination followed by power Doppler intrauterine vascularity assessment. Selected ultrasound features of endometrial lesions were assessed in each patient. Results: The median age was 60.3 years (range ±10.7). The median body mass index (BMI) was 30.4 (range ± 6.0). Histological examination revealed 158 cases of endometrial hyperplasia (EH) and 236 cases of EC. Of the studied ultrasound endometrial features, the highest areas under the curve (AUCs) were found for endometrial thickness (ET) (AUC = 0.76; 95% CI: 0.71–0.81) and for interrupted endomyometrial junction (AUC = 0.70, 95% CI: 0.65–0.75). Selected scoring systems presented moderate to good predictive performance in differentiating EC and EH. The highest AUC was found for REC model (AUC = 0.75, 95% CI: 0.70–0.79) and for the basic model that included ET, Doppler score and interrupted endometrial junction (AUC = 0.77, 95% CI: 0.73–0.82). REC model was more accurate than other scoring systems and selected single features for differentiating benign hyperplasia from EC at early stages, regardless of menopausal status. Conclusions: New scoring systems, including the REC model may be used in women with AUB for more efficient differentiation between benign and malignant conditions.

scholarly journals Ascending Tonic Clonic Seizure Syndrome after Percutaneous Vertebroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Guido Zarattini ◽  
Adam Farrier ◽  
Federico Sibona
Keyword(s):  
Percutaneous Vertebroplasty ◽  
Rare Complication ◽  
Cement Leakage ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Leg Pain ◽  
Compression Fractures ◽  
First Case ◽  
Seizure Syndrome ◽  
Osteoporotic Compression Fractures

Background Context. Cement leakage is not a rare complication of vertebroplasty, but ascending tonic clonic seizure syndrome is exceptionally rare. We herein report the first case to our knowledge of this complication related to vertebroplasty.Purpose. We herein report the first case of ascending tonic clonic seizure syndrome following epidural cement leakage after percutaneous vertebroplasty in a patient with multiple osteoporotic compression fractures.Study Design. Case report.Methods. A 64-year-old woman with T8, T10, L2, and L4 osteoporotic compression fractures underwent percutaneous vertebroplasty using polymethylmethacrylate. 40 minutes after the procedure the patient started suffering back and leg pain, having repetitive myoclonic jerks lasting 15 seconds of the lower extremities, spasm of the back, dyspnea, sinus tachycardia, hypoxemia, and metabolic acidosis.Results. The patient recovered completely due to a combination of early effective resuscitation and considered definitive management.Conclusions. Percutaneous vertebroplasty with polymethylmethacrylate is relatively safe but has few dangerous complications, which should be prevented by a meticulous technique and excellent image quality.

MODERN ASPECTS OF ULTRASOUND DIAGNOSIS OF ENDOMETRIOID HETEROTOPIAS OF PELVIC CAVITY ORGANS

2020 ◽  
pp. 87-92
Author(s):  
A. S. Novikova ◽  
I. Yu. Kuzmina
Keyword(s):  
Transvaginal Ultrasound ◽  
Clinical Signs ◽  
Transvaginal Ultrasonography ◽  
Transvaginal Sonography ◽  
Pelvic Cavity ◽  
Imaging Method ◽  
Visual Methods ◽  
Timely Diagnosis ◽  
Ultrasound Diagnostics ◽  
Choice Of Treatment

Diagnosis of endometrioid heterotopias of the pelvic cavity is often complicated, because at the initial stage there are no characteristic sonographic signs of this pathology. However, transvaginal ultrasound can be used as the main imaging method in the patients with suspected endometriosis. Due to a wide variety of forms and degrees of endometriosis, the similarity of clinical signs of other diseases, frequent asymptomatic course of the disease are objective difficulties in the correct and timely diagnosis of endometrioid heterotopias of the pelvic cavity. Ultrasonography can be used both to detect and to monitor the dynamics of endometriosis. Transvaginal sonography allows a qualitative detection of endometrioid heterotopias of the pelvis and with a high probability to reveal endometrioid cysts, hydrosalpinx, hematosalpinx, peritoneal endometriosis and is considered the best method of visualization of the endometrium. There were examined 57 patients with various forms of endometrioid heterotopias of the pelvic organs by transvaginal ultrasonography, which was performed on the 5th−9th day of the menstrual cycle. Adenomyosis of various degrees has been diagnosed, which should be understood as a disease consisting of ectopic location of endometrial glands and stroma as well as muscle changes. Due to the variety of forms and degrees of endometriosis, combination with clinical signs of other diseases, often asymptomatic course of the disease, which leads to severe damage to the reproductive system, there are objective difficulties in correct and timely diagnosis of endometrioid heterotopias and pelvic cavity organs. Modern visual methods of transvaginal ultrasonography are the key to correctly determining the stage and extent of endometriosis, which will directly affect the choice of treatment. Key words: endometriosis, heterotopia, ultrasound diagnostics, pelvic cavity.

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