Diagnostic ultrasound ( PDFDrive )

552 PART II Abdominal and Pelvic Sonography
A
B
FIG. 15.23 Synechia. (A) During sonohysterography (SHG) a bridging band of tissue (long arrow) is seen within the luid in the endometrial
cavity. Fluid also extends into the cesarean section defect (short arrow). Patients often experience pain during SHG owing to nondistensibility of
the endometrial cavity when many adhesions are present. Calipers show the luid in the endometrial cavity. (B) TVS in secretory phase shows a
band of tissue similar in echogenicity to myometrium (arrow) spanning anterior to posterior. Note that a uterine septum would be oriented in the
vertical plane extending from the fundus downward. A band of tissue in the short axis of the uterus therefore is not due to a müllerian abnormality.
See also Video 15.10.
A
B
FIG. 15.24 Endometrial Ablation. (A) Sagittal TVS shows no distinct endometrial borders, a common inding after endometrial ablation. (B)
Sagittal TVS on left side of uterus shows luid collection due to a cornual hematometra. In this patient, there is also trace luid extending into the
intramural portion of the fallopian tube (arrow).
evaluating for these complications, it may be helpful to perform
imaging when the patient is symptomatic, because luid in
the obstructed area may be resorbed during the rest of the
menstrual cycle. 180
SONOGRAPHY OF CONTRACEPTIVE
DEVICES
Intrauterine Contraceptive Devices
Intrauterine contraceptive devices (IUCDs or IUDs) are usually
easily identiied with ultrasound (Fig. 15.25). Most devices
encountered in North America are T-shaped, although a circular
IUD has been used in China and one may rarely still encounter
a patient with a Lippes loop IUD (Ortho Pharmaceutical, Raritan,
NJ). 182 he copper IUD (ParaGard, Teva Women’s Health, North
Wales, PA) can be let in place for up to 10 years. A levonorgestrelreleasing
IUD (Mirena, Bayer HealthCare Pharmaceuticals,
Pittsburgh, PA) can also be used to treat abnormal uterine bleeding
rather than primarily for contraception and can be let in place
for up to 5 years. Another levonorgestrel-releasing IUD (Skyla,
Bayer HealthCare Pharmaceuticals) is slightly smaller than the
Mirena IUD and can be let in place for up to 3 years.
In general, the shat of an IUD is brightly echogenic and
easily identiied, although the levonorgestrel-releasing IUDs may