Diagnostic ultrasound ( PDFDrive )

CHAPTER 15 The Uterus 553
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G H I
FIG. 15.25 Devices in the Uterus. (A) Sagittal TVS shows copper intrauterine device (IUD), with marked acoustic shadowing, in normal position.
(B) Sagittal TVS shows a levonorgestrel-releasing IUD in normal position. Compared with copper IUDs, these IUDs are often not as echogenic and
may have less intense acoustic shadowing. (C) Transverse TAS shows a circular IUD that had been placed in China. (D) Coronal reconstructed
image from three-dimensional (3-D) ultrasound shows a levonorgestrel-releasing IUD in appropriate position. (E) Coronal reconstructed image from
3-D ultrasound shows an IUD that is low, being in the cervix and lower uterine segment, with the left arm (arrow) of the IUD embedded in the
myometrium and cervical stroma. (F) String (arrow) of the IUD is seen in the cervix. IUD was normally positioned and is not visible in this image.
Care should be taken to not mistake the string for the IUD itself. (G) TVS shows an IUD in low position, extending from the midcervix into the
lower uterus. See also Video 15.11. (H) Transverse TVS shows tubal occlusion device (arrows) in their expected location in the cornual region of
the uterus bilaterally. (I) Coronal reconstructed image from 3-D ultrasound shows tubal occlusion devices in their expected location in the cornual
region of the uterus bilaterally.
be more diicult to identify than the copper IUD on 2-D
ultrasound. 183 If a brightly echogenic interface of a levonorgestrelreleasing
IUD is not seen, one should look carefully for acoustic
shadowing originating from the shat or arms to help in locating
the IUD. Occasionally one may encounter endometrial calciications
that simulate an IUD, but the discontinuous nature of the
calciications should help prevent confusion. he upper end of
the IUD and the arms of the IUD should normally be in the
superior most portion of the endometrium. If the IUD is located
lower in the uterus (Video 15.11), one should suspect that one
or both arms of the IUD are embedded in the myometrium.
3-D ultrasound may help in identifying abnormal position of
IUDs. 184 he most common location of a malpositioned IUD is
the lower uterus or cervix. 185 he string of many IUDs is brightly
echogenic and should not be confused for the shat
(Fig. 15.25F).