Saturday, April 21, 2007

The case for sonohysterography:

For some time, sonohysterography was considered essential to diagnose endometrial polyps. Until, high resolution ultrasound and endovaginal probes challenged that assumption with stunning images on routine ultrasound scan. These images by Dr. Allen Worrall, Alaska, USA, show an instance, wherein, sonohysterography may well be advisable, to confirm the presence of a doubtful polyp

Wednesday, April 04, 2007

A comparison of sonographic features of intrauterine contraceptive devices (IUCD’s):

The Mirena IUCD

Mirena IUCD used in USA

Copper - T, IUCD

The copper- T, IUCD used in India.
Dr. Allen Worrall, of Fairbanks Clinic, Alaska, USA has this to say about IUCD or IUDs:
The hormone-containing Mirena IUCD is quite popular in the US now. It has a somewhat different sonographic signature than other IUCDs. (in the US, IUD mostly stands for IntraUterine Device). The presence and location of the Mirena IUCD is mostly from its acoustic shadow - you tend not to see the actual echo of the device very well.

This case is interesting because as I (Dr. Allen) scanned the uterus transversely, starting at the cervix, I could see the string as a bright echo with hardly any shadow, then suddenly there was no echo but an intense shadow, representing the shaft of the IUCD. The Mirena has two curved arms at the top that are supposed to extend out when the IUCD is properly positioned. On transverse view of the upper part of the uterus I could see that the arms were properly deployed.

This patient had this IUCD or IUD only for a few weeks and was complaining of cramps and bleeding. The doctor who put the IUD in wanted to be sure it was in proper position. I reported that it was OK.

This IUD was put in place because the patient was complaining of excessively heavy menses, and the Mirena IUD, because of its hormone content often results is less bleeding. Interesting to me, who can remember when IUDs had the reputation of causing abnormal, excessive, prolonged bleeding. Now they are used to treat those symptoms.
Images courtesy of Dr. Allen Worrall and Dr. Joe Antony.