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Section: OB/GYN

 




Other Radiology articles from the OB/GYN section OB/GYN

Torsion of a Myomatous, Non-gravid Uterus: CT Findings by Elizabeth Hui Ting Cheong et al.

Published: 2018 Apr
Issue: 12(4) :: Pages: 6-14


Free full text article: Torsion of a Myomatous, Non-gravid Uterus:  CT Findings

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Abstract: Uterine torsion is a rare condition which is part of a spectrum of gynecological emergencies. If diagnosis is delayed or the condition is left untreated, severe consequences such as infertility and life-threatening complications can arise. As presenting features are often non-specific and can be similar to commonly encountered gastrointestinal and urinary conditions, computed tomography is usually the first imaging modality utilized in an emergency setting. It is therefore important that the radiologist is familiar with recognizing computed tomography features of uterine torsion. We share our findings in a patient with uterine torsion in a non-gravid uterus, diagnosed on contrast-enhanced computed tomography with multiplanar reconstruction.


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Computed Tomography, Clinical image, Table





Other Radiology articles from the OB/GYN section OB/GYN

Cesarean-Section Scar Endometrioma: A Case Report and Review of the Literature by Madison Kocher et al.

Published: 2017 Dec
Issue: 11(12) :: Pages: 16-26


Free full text article: Cesarean-Section Scar Endometrioma:  A Case Report and Review of the Literature

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Abstract: Endometriomas can occur after any surgery where there is endometrial manipulation, and there are a number of reports of endometriomas developing in the abdominal wall at the site of the Pfannenstiel incision following Cesarean-section. Although this is ultimately a histopathologically-confirmed diagnosis, preoperative imaging including ultrasound, computed tomography, and magnetic resonance imaging may be helpful in the diagnosis and assessment. We report a pathology-confirmed case of Cesarean-section endometrioma with a classic, clinical presentation and imaging findings on computed tomography. A comprehensive literature review and discussion of the multi-modality imaging appearance of Cesarean-section endometrioma is also provided.


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Computed Tomography, Macroscopic pathology, Clinical image, Microscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Hydrothorax, ascites and an abdominal mass: not always signs of a malignancy - Three cases of Meigs` syndrome by Kim E Kortekaas et al.

Published: 2018 Jan
Issue: 12(1) :: Pages: 17-26


Free full text article: Hydrothorax, ascites and an abdominal mass:  not always signs of a malignancy -  Three cases of Meigs` syndrome

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Abstract: This case report presents three cases of Meigs` syndrome: a benign ovarian tumor with ascites and a hydrothorax. After removal of the ovarian tumor, the symptoms resolved and the patients became asymptomatic. In daily practice, Meigs` syndrome is at first sight often mistaken for ovarian cancer. With this case report we would like to emphasize that the clinical presentation of an ovarian tumor might be ovarian cancer, but can masquerade as something uncommon like Meigs` syndrome. In a time span of two years we encountered three cases.


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Conventional Radiography, Computed Tomography, Microscopic pathology, Macroscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Spontaneous Rupture of the Uterine Artery in an Otherwise Normal Pregnancy by Nicholas Hardin et al.

Published: 2017 Jan
Issue: 11(1) :: Pages: 7-13


Free full text article: Spontaneous Rupture of the Uterine Artery in an Otherwise Normal Pregnancy

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Abstract: Spontaneous rupture of a uterine artery in pregnancy is associated with a high rate of mortality. Although uterine artery rupture has been associated with postpartum hemorrhage, it is rarely found during pregnancy. Unfortunately, clinical signs and symptoms are usually vague and nonspecific. We report a case of a 36-year-old woman at 20 weeks gestation presenting with abdominal pain who was found to have a spontaneous uterine artery rupture. To our knowledge, this is the first case report demonstrating imaging findings in a patient with this condition. Our patient underwent successful ligation of the uterine vessel with preservation of both mother and fetus. We will discuss possible etiologies of uterine artery rupture during pregnancy, associated imaging findings, and management options.


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Ultrasound, Computed Tomography, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Disseminated Peritoneal Leiomyomatosis Status Post Laparoscopic Hysterectomy with Morcellation by Neil Anand et al.

Published: 2016 Dec
Issue: 10(12) :: Pages: 12-18


Free full text article: Disseminated Peritoneal Leiomyomatosis Status Post Laparoscopic Hysterectomy with Morcellation

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Abstract: Uterine leiomyomas (fibroids) are common benign neoplasms, which develop from the muscular tissue of the uterus with an estimated incidence of 20-40% in women of reproductive age. In the early nineties, power morcellators were introduced and became commonly used during hysterectomy for symptomatic fibroids. However, if all fragments are not removed, they may parasitize to other blood supply and present as abdominal or pelvic masses. Unfortunate cases have also been reported in which uterine sarcomas seeded throughout the abdomen and pelvis secondary to morcellation. The Food and Drug Administration (FDA) estimates that 1 in 350 women undergoing hysterectomy or myomectomy for fibroids is found to have an unsuspected uterine sarcoma. As a result, the FDA issued a press release in 2014 discouraging the use of power morcellators. Recently, the FDA approved a new containment device, the PneumoLiner, for use with certain power morcellation devices. However, it is unknown if this device will help to reduce the risk of seeding fibroids and unsuspected uterine malignancies. We present a case in which a patient who underwent morcellation therapy for symptomatic fibroids presented with recurrent abdominal and pelvic leiomyomas mimicking malignancy.


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Ultrasound, Computed Tomography, Macroscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Endometrial stromal sarcoma: An aggressive uterine malignancy by Chaitra P Adiga et al.

Published: 2016 Sep
Issue: 10(9) :: Pages: 35-43


Free full text article: Endometrial stromal sarcoma:  An aggressive uterine malignancy

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Abstract: Endometrial stromal sarcoma (ESS) is an aggressive uterine sarcoma. We report a case of a large endometrial stromal sarcoma in a 42 year nulliparous woman with chronic kidney disease presenting with acute urinary retention and irregular per vaginal bleeding. Ultrasound and Doppler imaging revealed a heterogeneous mass in the endometrial cavity with internal vascularity. Magnetic resonance imaging (MRI) revealed a large lobulated mass in the endometrial cavity extending into the vagina, causing local mass effect. Multiple linear hypointense bands on magnetic resonance T2 weighted (T2wt) images were characteristic of ESS. MRI is a very useful imaging modality in characterizing the lesion and also for the staging. It is necessary to distinguish these tumors from benign as well as other uterine malignancies for better management. We also review relevant literature discussing imaging findings of ESS.


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Ultrasound, Magnetic Resonance Imaging, Microscopic pathology, Computed Tomography, Table





Other Radiology articles from the OB/GYN section OB/GYN

CHAOS: Prenatal imaging findings with post mortem contrast radiographic correlation by Kanika Gupta et al.

Published: 2016 Aug
Issue: 10(8) :: Pages: 39-49


Free full text article: CHAOS: Prenatal imaging findings with  post mortem contrast radiographic correlation

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Abstract: Congenital high airway obstruction syndrome is a rare fetal anomaly with characteristic constellation of prenatal findings on ultrasound and MRI. The typical triad of imaging features are enlarged and echogenic lungs, flattening or inversion of diaphragm and fetal hydrops. Early prenatal recognition of congenital high airway obstruction syndrome by ultrasound and/or MRI is mandatory for the appropriate perinatal management. We report a case of a male fetus with typical imaging findings of congenital high airway obstruction syndrome on ultrasound and MRI at 19 weeks of gestation. The role of contrast radiographs of fetal airways, including retrograde laryngogram, in confirming the postnatal diagnosis of this fetal condition is demonstrated. The prenatal imaging findings were correlated with contrast radiographs of upper airways, sonography of aborted fetus and fetal autopsy findings.


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Ultrasound, Magnetic Resonance Imaging, Conventional Radiography, Macroscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Intravenous leiomyomatosis disguised as a large deep vein thrombosis by Camille C Gunderson et al.

Published: 2016 May
Issue: 10(5) :: Pages: 29-35


Free full text article: Intravenous leiomyomatosis disguised as a large deep vein thrombosis

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Abstract: Intravenous leiomyomatosis is a benign smooth muscle tumor which despite its histology can have devastating consequences. Furthermore, the clinical manifestations are variable and nonspecific, typically leading to delayed or missed diagnosis. Thus, it is critical for clinicians to be aware of this condition and have a high index of suspicion in a middle-aged woman with a history of uterine leiomyoma presenting with an inferior vena cava mass to enable early diagnosis and treatment. We report a case of a large intravenous leiomyoma which was initially considered to be a very large deep venous thrombosis; with thorough preoperative planning, it was successfully removed intact and in entirety with a single-stage operation.


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Ultrasound, Computed Tomography, Macroscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Isolated Fallopian Tube Torsion With Fimbrial Cyst In A 10 Year-old Girl Diagnosed By Ultrasound: A Case Report by Maria Constancia Olveda Ormasa et al.

Published: 2015 Dec
Issue: 9(12) :: Pages: 29-36


Free full text article: Isolated Fallopian Tube Torsion With Fimbrial Cyst In A 10 Year-old Girl Diagnosed By Ultrasound:  A Case Report

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Abstract: Torsion of the fallopian tube without the involvement of the ipsilateral ovary is a rare but important cause of acute abdominal pain in women as it is a surgical emergency. Although uncommon, it should be considered as one of the differential diagnosis in female children presenting with acute lower abdominal or pelvic pain. The diagnosis of isolated fallopian tube torsion is difficult pre-operatively and is often made during laparoscopic or surgical exploration because diagnostic features are usually non-specific. In this report, we present a case of isolated fallopian tube torsion with fimbrial cyst in a young female patient diagnosed pre-operatively by ultrasound.


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Conventional Radiography, Ultrasound, Macroscopic pathology, Microscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Hemorrhagic heterotopic pregnancy in a setting of prior tubal ligation and re-anastomosis by Jason Esterle et al.

Published: 2015 Jul
Issue: 9(7) :: Pages: 38-46


Free full text article: Hemorrhagic heterotopic pregnancy in a setting of prior tubal ligation and re-anastomosis

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Abstract: Heterotopic pregnancy is the occurrence of simultaneous intrauterine and extrauterine pregnancies. Heterotopic pregnancy most commonly occurs during the first trimester of pregnancy in women who have significant risk factors including assisted reproductive therapy, prior ectopic pregnancy, and prior pelvic surgery or pelvic inflammatory disease. Although rare, heterotopic pregnancy must be recognized using ultrasound so as to provide appropriate treatment to the extrauterine pregnancy with the goal of preserving the intrauterine pregnancy. The case presented describes a patient with a pathologically proven (figure 8A and 8B), surgically treated 1st trimester heterotopic pregnancy.


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Ultrasound, Other, Microscopic pathology, Table





Other Radiology articles from the OB/GYN section OB/GYN

Placental site trophoblastic tumor: a case report and review of the literature by Rita Lucas et al.

Published: 2015 Apr
Issue: 9(4) :: Pages: 14-22


Free full text article: Placental site trophoblastic tumor:  a case report and review of the literature

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Abstract: We present a case of a gravida 1 para 1 woman, who presented with an 11-month history of amenorrhea after cesarean delivery. The patient was taking birth control pills at the time of presentation. She was observed with a slight elevation of serum β-hCG level, an enlarged heterogeneous uterus and hematometra. A biopsy was performed, and the patient was diagnosed with placental site trophoblastic tumor; the patient then underwent surgery. Placental site trophoblastic tumor is the rarest form of gestational trophoblastic disease, derived from intermediate trophoblast cells. It does not have a pathognomonic appearance; therefore, correlation with medical history, as well as results of laboratory tests and pathological analysis is mandatory. It is a relatively chemoresistant tumor, posing considerable therapeutic challenges; patients with localized disease are managed with surgery and those with metastatic disease require additional chemotherapy. Herein, we review the main features of this entity and top differential diagnosis, as the rarity of this tumor is associated with imaging and pathological pitfalls, reinforcing the need for further experience in this field.


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Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Amniotic band syndrome with sacral agenesis and umbilical cord entrapment: A case report emphasizing the value of evaluation of umbilical cord by Kanika Gupta et al.

Published: 2015 Mar
Issue: 9(3) :: Pages: 12-19


Free full text article: Amniotic band syndrome with sacral agenesis and umbilical cord entrapment: A case report emphasizing the value of evaluation of umbilical cord

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Abstract: Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts by fibrous amniotic bands in utero. The congenital anomalies seen in this syndrome vary widely and defects may be isolated or multiple and do not follow a specific pattern. Asymmetric distribution of defects is the hallmark of this syndrome. The diagnosis is difficult to make on ultrasound and relies on identification of amniotic bands. We report a case of amniotic band syndrome with sacral agenesis diagnosed on routine antenatal ultrasound scan in the second offspring of a recently diagnosed diabetic mother. The associated features were entrapment of umbilical cord, caudal adhesions and lower limb anomalies. Medical termination of pregnancy was done and all the fetal anomalies as well as umbilical cord abnormalities were confirmed. The importance of meticulous scanning to evaluate for amniotic bands and the umbilical cord in addition to the fetal structures is emphasized.


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Ultrasound, Macroscopic pathology, Conventional Radiography, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review by Mariana Horta et al.

Published: 2014 Nov
Issue: 8(11) :: Pages: 30-41


Free full text article: Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review

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Abstract: Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.


Available image modalities: (click on modality to browse for other articles)
Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Case report: Incarceration of the gravid uterus: a radiologic and obstetric challenge by Inge Dierickx et al.

Published: 2014 Jul
Issue: 8(7) :: Pages: 28-36


Free full text article: Case report: Incarceration of the gravid uterus:  a radiologic and obstetric challenge

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Abstract: We will present the fourth case in the English-language literature of a mid-gestational colonoscopy-assisted manual reposition of an incarcerated uterus. Despite the ready availability of ultrasound, a great number of incarcerations are not recognized before term. Since early diagnosis is the key to a successful treatment, it is important that providers acquire prompt knowledge of this obstetric disorder. Magnetic Resonance Imaging has an important additional value to ultrasound in the detailed scanning of this potentially perilous condition.


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Magnetic Resonance Imaging, Table





Other Radiology articles from the OB/GYN section OB/GYN

Diagnosis of a sigmoid volvulus in pregnancy: ultrasonography and magnetic resonance imaging findings by Stefano Palmucci et al.

Published: 2014 Feb
Issue: 8(2) :: Pages: 54-62


Free full text article: Diagnosis of a sigmoid volvulus in pregnancy: ultrasonography and magnetic resonance imaging findings

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Abstract: Sigmoid volvulus complicating pregnancy is a rare, non-obstetric cause of abdominal pain that requires prompt surgical intervention (decompression) to avoid intestinal ischemia and perforation. We report the case of a 31-week pregnant woman with abdominal pain and subsequent development of constipation. Preoperative diagnosis was achieved using magnetic resonance imaging and ultrasonography: the large bowel distension and a typical whirl sign - near a sigmoid colon transition point - suggested the diagnosis of sigmoid volvulus. The decision to refer the patient for emergency laparotomy was adopted without any ionizing radiation exposure, and the pre-operative diagnosis was confirmed after surgery. Imaging features of sigmoid volvulus and differential diagnosis from other non-obstetric abdominal emergencies in pregnancy are discussed in our report, with special emphasis on the diagnostic capabilities of ultrasonography and magnetic resonance imaging.


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Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Giant cystic leiomyoma of the uterus occupying the retroperitoneal space by Kaoru Funaki et al.

Published: 2013 Dec
Issue: 7(12) :: Pages: 35-40


Free full text article: Giant cystic leiomyoma of the uterus occupying the retroperitoneal space

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Abstract: A 31-year-old nulliparous woman visited our hospital complaining of abdominal distension. Abdominal ultrasonography and computed tomography revealed a 40 40 30-cm, multilocular cystic mass extending from the upper abdomen to the pelvis. Magnetic resonance imaging (MRI) revealed a cystic tumor that was hypointense on T1-weighted images and was heterogeneously hyperintense on T2-weighted images. The final diagnosis was an 8 kg leiomyoma with cystic degeneration. Uterine leiomyomas are common benign tumors in females of reproductive age. However, subserosal leiomyomas with complete cystic degeneration of the retroperitoneal space are rare, and they are difficult to accurately diagnosis without pathological examination.


Available image modalities: (click on modality to browse for other articles)
Ultrasound, Computed Tomography, Magnetic Resonance Imaging, Macroscopic pathology, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Bilateral Subependymal Heterotopia, Ventriculomegaly and Cerebellar Asymmetry: Fetal MRI findings of a rare association of brain anomalies by Lucia Manganaro et al.

Published: 2013 Nov
Issue: 7(11) :: Pages: 38-45


Free full text article: Bilateral Subependymal Heterotopia, Ventriculomegaly and Cerebellar Asymmetry: Fetal MRI findings of a rare association of brain anomalies

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Abstract: Subependymal heterotopia (SEH) is a neuronal migration disorder characterized by nodules of gray matter along the lateral ventricular walls and often associated with other brain malformations. We present two cases of SEH associated with ventriculomegaly and cerebellar abnormalities diagnosed by fetal magnetic resonance imaging (MRI) at 20 and 23 weeks` gestation respectively. Fetal MRI findings of this association of abnormalities have never been reported in literature. This report emphasizes the role of fetal MRI in recognition of subependymal heterotopia and other associated brain anomalies at early age of gestation along with its importance for a more targeted counseling and management strategies.


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Ultrasound, Magnetic Resonance Imaging, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Ruptured Interstitial Ectopic Pregnancy at 18 Weeks Gestation Diagnosed by MRI: A Case Report by Ehab SM Hamouda et al.

Published: 2013 Oct
Issue: 7(10) :: Pages: 34-42


Free full text article: Ruptured Interstitial Ectopic Pregnancy at 18 Weeks Gestation Diagnosed by MRI: A Case Report

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Abstract: Ectopic pregnancy in the interstitial part of the fallopian tube is a rare event, associated with a high rate of complications due to delayed diagnosis. Rupture of such pregnancy often results in catastrophic hemorrhage. Several reports highlighted the role of magnetic resonance imaging in establishing the diagnosis of interstitial pregnancy, but magnetic resonance imaging findings of a ruptured advanced interstitial ectopic pregnancy have not been published before. The authors therefore present characteristic findings on magnetic resonance imaging of a ruptured interstitial ectopic pregnancy which had reached 18 weeks, in a 25-year-old woman who presented with acute abdominal pain.


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Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Graph, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Adenoma Malignum Detected on a Trauma CT by James McEachern et al.

Published: 2013 Apr
Issue: 7(4) :: Pages: 22-28


Free full text article: Adenoma Malignum Detected on a Trauma CT

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Abstract: Adenoma malignum is a rare subtype of cervical adenocarcinoma. Clinical presentation is variable with watery vaginal discharge being the most commonly associated finding. We report a case of adenoma malignum incidentally detected on pelvic computed tomography (CT) performed for a trauma patient. The cervical mass was further characterized by magnetic resonance (MR) imaging and remained compatible with adenoma malignum. Local cervical biopsy was suggestive of the diagnosis which was subsequently confirmed by gross surgical pathology. We briefly discuss adenoma malignum with particular attention to CT and MR imaging features.


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Computed Tomography, Magnetic Resonance Imaging, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Large leiomyoma in a woman with Mayer-Rokitansky-Kuster-Hauser syndrome by Kishan S Rawat et al.

Published: 2013 Mar
Issue: 7(3) :: Pages: 39-46


Free full text article: Large leiomyoma in a woman with Mayer-Rokitansky-Kuster-Hauser syndrome

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Abstract: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a rare congenital anomaly characterized as aplasia or hypoplasia of uterus and vagina in women with normal development of secondary sex characteristics. It affects 1 in 4000-5000 female births. Women with this syndrome present with primary amenorrhoea. MRKH syndrome may be associated with renal, skeletal, cardiac and auditory anomalies. Women with MRKH syndrome may develop leiomyoma from a rudimentary uterus, though very rare. Initial investigation in women having MRKH syndrome with leiomyoma is ultrasonography (USG). However, CT and MRI are more accurate to evaluate the pelvic anatomy and pathologies.


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Ultrasound, Computed Tomography, Magnetic Resonance Imaging, Macroscopic pathology, Microscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Iatrogenic uterine perforation with abdominal extrusion of fetal parts: A rare radiological diagnosis by Narvir Singh Chauhan et al.

Published: 2013 Jan
Issue: 7(1) :: Pages: 41-47


Free full text article: Iatrogenic uterine perforation with abdominal extrusion of fetal parts: A rare radiological diagnosis

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Abstract: Background: Failure to detect uterine perforation during surgical abortion may result in adverse patient outcome besides having medicolegal implications. This rare case of uterine perforation was diagnosed seven days after abortion and underscores the importance of remaining vigilant for this complication during and after the procedure. Case: A female underwent surgical abortion at sixteen weeks gestation and was discharged after the procedure, assuming no complication. She presented with abdominal pain seven days after the event. Ultrasound and CT revealed uterine perforation with abdominal expulsion of fetal parts. Conclusion: A patient complaining of abdominal pain following recent abortion related instrumentation should alert the clinician regarding possibility of perforation. Secondary signs on ultrasound may reveal the diagnosis even if rent is not identified. CT is valuable in emergent situations.


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Ultrasound, Computed Tomography, Macroscopic pathology, Table

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Other Radiology articles from the OB/GYN section OB/GYN

Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization. by Michael C. Chang et al.

Published: 2012 Sep
Issue: 6(9) :: Pages: 18-22


Free full text article: Venous Intravasation: A Potential Pitfall of Confirmatory Hysterosalpingogram Following Essure Hysteroscopic Sterilization.

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Abstract: Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs.


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Fluoroscopy, Computed Tomography, Table

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Other Radiology articles from the OB/GYN section OB/GYN

One Not to Miss: Ovarian Vein Thrombosis Causing Pulmonary Embolism with Literature Review by Franco Verde et al.

Published: 2012 Sep
Issue: 6(9) :: Pages: 23-28


Free full text article: One Not to Miss: Ovarian Vein Thrombosis Causing Pulmonary Embolism with Literature Review

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Abstract: Ovarian vein thrombosis (OVT) is an uncommon entity typically seen in the post-partum, patients with pelvic surgery, infection, or inflammation, and hypercoagulabilty. Concurrent pulmonary embolism (PE) may occur in these patients; however, is an uncommon complication. Treatment commonly involves anti-coagulation and antibiotics in the setting of pelvic inflammatory disease. Presented is a case report of ovarian vein thrombosis leading to pulmonary embolism in the setting of malignancy, underscoring the importance of inspecting the gonadal vein during interpretation, particularly in the emergency setting.


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Other Radiology articles from the OB/GYN section OB/GYN

Mayer-Rokitansky-Kuster-Hauser Syndrome diagnosed by Magnetic Resonance Imaging. Role of Imaging to identify and evaluate the uncommon variation in development of the female genital tract. by Valeria Fiaschetti et al.

Published: 2012 Apr
Issue: 6(4) :: Pages: 17-24


Free full text article: Mayer-Rokitansky-Kuster-Hauser Syndrome diagnosed by Magnetic Resonance Imaging. Role of Imaging to identify and evaluate the uncommon variation in development of the female genital tract.

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Abstract: Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a spectrum of Muellerian duct anomalies characterized by congenital aplasia of the uterus and of the upper part (2/3) of the vagina, in young women presenting otherwise with normal endocrine status. The ovaries and fallopian tubes are present. It is one of the most common causes of primary amenorrhea and affects at least 1 out of 4500 women. Its penetrance varies, as does the involvement of other organ systems and itcan be isolated (type I) or associated with other malformations (type II). The MRKH syndrome usually remains undetected until the patient presents with primary amenorrhea despite normal development of secondary sexual characteristics, so imaging evaluation can demonstrate in one setting, non invasively, the anomalies in development of genital tract. We report a case of MRKH syndrome in a 16-year-old woman who presented with primary amenorrhea, stressing the role and benefit of imaging in the differential diagnosis.


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Herlyn-Werner-Wunderlich syndrome: a rare presentation with pyocolpos by Deven Cox et al.

Published: 2012 Mar
Issue: 6(3) :: Pages: 9-15


Free full text article: Herlyn-Werner-Wunderlich syndrome: a rare presentation with pyocolpos

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Abstract: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome with only a few hundred reported cases described since 1922. Only a handful of these cases have been associated with pyocolpos. Mullerian duct anomalies have an incidence of 2-3%. While OHVIRA constitutes 0.16-10% of these Mullerian duct anomalies. Symptoms usually present shortly after menarche when hematocolpos develops during menstruation resulting in dysmenorrhea and a pelvic mass. The pelvic mass is the collection of blood products within the obstructed hemivagina. The first study in the diagnostic work-up is usually ultrasonography, which typically demonstrates a pelvic fluid collection which can simulate other disease processes thus confounding the diagnosis. MRI findings of the pelvis reveal a didelphic uterus. Imaging of the abdomen reveals agenesis of the ipsilateral kidney. MRI is beneficial in characterizing the didelphic uterus and vaginal septum for pre-operative planning. Understanding the imaging findings, in conjunction with the clinical presentation, is critical for early diagnosis in attempting to prevent complications such as endometriosis or adhesions from chronic infections with subsequent infertility.


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MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine by Vinay Nyapathy et al.

Published: 2012 Feb
Issue: 6(2) :: Pages: 1-8


Free full text article: MRgFUS treatment of uterine fibroid in a nulliparous woman with acute retention of urine

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Abstract: Uterine fibroids are the most common tumors of the female reproductive tract. Although most fibroids are asymptomatic, about 25% are associated with symptoms that can have a significant impact on patient`s quality of life, including prolonged or excessive menstrual bleeding, pelvic pain or bulkiness, dyspareunia, increased urinary frequency, and infertility. Various treatment options available for symptomatic uterine fibroids include hysterectomy, myomectomy (abdominal or laparoscopic), uterine artery embolization, MR-guided Focused Ultrasound (MRgFUS), and hormonal therapy, which also is sometimes used as adjuvant to other therapies. MRgFUS is a non-invasive treatment approach for symptomatic uterine fibroids. The following case report demonstrates successful treatment of a fibroid that is hyper-intense on T2WIs by MRgFUS with immediate alleviation of pressure symptoms on the urinary bladder.


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Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Common presentation of an unusual variation by Luther Adair II et al.

Published: 2011 Jan
Issue: 5(1) :: Pages: 1-8


Free full text article: Uterus didelphys with unilateral distal vaginal agenesis and ipsilateral renal agenesis: Common presentation of an unusual variation

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Abstract: Mullerian duct abnormalities are congenital malformations that are easily missed and can lead to incorrect diagnosis and unnecessary operative procedures. In this case, a young female presented with cyclic pelvic pain that continued after previous surgical resection of an ovarian cyst. Further investigation with clinical examinations and multimodality imaging demonstrated ipsilateral renal agenesis and a Class III Mullerian duct anomaly (MDA) requiring a second operative procedure. It is believed that this case is a variant of the described obstructed hemi-vagina with ipsilateral renal agenesis (OVIRA) anomaly as pathologically there was ipsilateral renal agenesis and complete vaginal agenesis in our case. It is imperative to have a high clinical suspicion of mullerian duct abnormalities when encountering a patient with other urogenital anomalies. This will decrease the amount of misdiagnoses, guide appropriate surgical intervention, and decrease the risk of future reproductive complications.


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Ultrasound, Magnetic Resonance Imaging, Macroscopic pathology, Graph, Table

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Hepatic Endometriosis Mimicking Metastatic Disease: A Case Report and Review of the Literature by Mohamed Asran et al.

Published: 2010 Nov
Issue: 4(11) :: Pages: 26-31


Free full text article: Hepatic Endometriosis Mimicking Metastatic Disease: A Case Report and Review of the Literature

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Abstract: Endometriosis of the liver is an uncommon disease characterized by the presence of endometrial tissue in the liver. There are no pathognomonic radiological features for hepatic endometriosis and preoperative diagnosis is difficult by imaging. Most cases are diagnosed after surgery. We report atypical imaging features of hepatic endometriosis in a 61 year- old female that mimic metastatic disease to the liver. She was referred to our institution with a presumed diagnosis of metastatic neuroendocrine tumors to the liver. After imaging guided core biopsy and histologic and immunohistochemical analysis, the diagnosis of hepatic endometrial stromal proliferation was made. We review the literature and provide imaging features that may help in reaching the correct diagnosis of hepatic endometriosis.


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Computed Tomography, Microscopic pathology, Table

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Expectant and medical management of placenta increta in a primiparous woman presenting with postpartum haemorrhage: The role of Imaging by Papa Dasari et al.

Published: 2010 May
Issue: 4(5) :: Pages: 32-40


Free full text article: Expectant and medical management of placenta increta in a primiparous woman presenting with postpartum haemorrhage: The role of Imaging

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Abstract: We report a case of postpartum hemorrhage due to adherent placenta. A 28 year old primiparous woman who underwent manual removal of placenta for primary postpartum haemorrhage soon after delivery was referred to our Institute on her third postnatal day because of persistent tachycardia and low grade fever. Placenta accreta was suspected on initial ultrasonographic examination. MRI examination confirmed the diagnosis of placenta accreta in few areas and revealed increta in other areas. On expectant management she developed genital tract sepsis and hence she was treated with intravenous Methotrexate after controlling infection with appropriate antibiotics. Doppler Imaging showed decreased blood flow to the placental mass and increased echogenecity on gray scale USG after Methotrexate administration. She expelled the whole placental mass on 35th postnatal day and MRI performed the next day showed empty uterine cavity. Morbid adhesion of placenta should be suspected even in primiparous women without any risk factors when there is history of post-partum hemorrhage. MRI is the best modality for evaluation of adherent placenta.


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Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses by Artur Velcani et al.

Published: 2010 Feb
Issue: 4(2) :: Pages: 9-17


Free full text article: Sonographic features of tubo-ovarian abscess mimicking an endometrioma and review of cystic adnexal masses

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Abstract: A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian mass on different imaging modalities.


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Complete cloacal duplication imaged before and during pregnancy by Omar Ragab et al.

Published: 2009 Nov
Issue: 3(11) :: Pages: 24-28


Free full text article: Complete cloacal duplication imaged before and during pregnancy

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Abstract: The authors describe a 31 year-old female who presented emergently with abdominal pain and was found at CT to have complete genitourinary duplication including separate urinary bladders, uteri, cervices, and vaginas, and also duplication of the rectum. No etiology for abdominal pain was identified. The patient was referred to urology for further evaluation, and an intravenous urographic study was obtained, which confirmed complete lower urinary tract duplication. The patient presented emergently 9 months later during a subsequent pregnancy for further evaluation of abdominal pain. A second CT scan was ordered to rule out appendicitis. Findings consistent with cloacal duplication were again noted. There was also dilatation of the urinary collecting systems, more prominently on the right side. A Cesarean section was performed and confirmed total genitourinary and rectal duplication.


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Computed Tomography, Ultrasound, Conventional Radiography

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A Leiomyoma in a Cachectic Woman Presenting as a Giant Abdominal Mass by Ian Amber et al.

Published: 2009 Oct
Issue: 3(10) :: Pages: 23-29


Free full text article: A Leiomyoma in a Cachectic Woman Presenting as a Giant Abdominal Mass

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Abstract: Fibroids are the most common gynecologic tumors. Our case discusses the outcome of a 47-year-old woman who presented to our clinic with cachexia, and a giant abdominal mass. An initial diagnostic imaging workup consisted of X-Ray, CT, and ultrasound and indicated a possible diagnosis of leiomyosarcoma. However, after surgical evaluation, she was diagnosed pathologically with an atypical presentation of a uterine leiomyoma. Our case reviews the epidemiology and presentation of both pathologies, along with the imaging workup, and the operative correlation in our patient.


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Fetal Acrania - Prenatal Sonographic Diagnosis and Imaging Features of Aborted Fetal Brain by Muhammad Umar Amin et al.

Published: 2009 Jul
Issue: 3(7) :: Pages: 27-34


Free full text article: Fetal Acrania - Prenatal Sonographic Diagnosis and Imaging Features of Aborted Fetal Brain

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Abstract: We report a 35 year old female patient referred to our ultrasound department to rule out congenital anomalies. The fetus was found to have a completely formed brain, base of the skull and facial structures but lacking a cranium. The fetus was therapeutically aborted. We correlated our antenatal sonographic findings with gross pathological features and CT Scan of the fetal head. Despite an extensive search, CT features of aborted fetal brain and base of skull were not found in the literature.


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Hydatid cysts in abdominal wall and ovary in a case of diffuse abdominal hydatidosis: Imaging and pathological correlation by Muhammad Umar Amin et al.

Published: 2009 May
Issue: 3(5) :: Pages: 25-31


Free full text article: Hydatid cysts in abdominal wall and ovary in a case of diffuse abdominal hydatidosis: Imaging and pathological correlation

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Abstract: We report a case of diffuse abdominal hydatidosis with correlation of imaging findings with gross pathology. The patient had involvement of liver, diaphragm, pelvic cavity, ovary and abdominal wall. Hydatid cysts were morphologically different from each other including calcified, uniloculated and multiloculated cystic lesions. Our case is rare as ovary and abdominal wall involvement is described in less than 1 % cases of hydatid disease.


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Clinical image, Conventional Radiography, Ultrasound, Computed Tomography, Macroscopic pathology

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Postpartum pneumoperitoneum and peritonitis after water birth by Vanessa Brown et al.

Published: 2009 Apr
Issue: 3(4) :: Pages: 1-4


Free full text article: Postpartum pneumoperitoneum and peritonitis after water birth

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Abstract: Pneumoperitoneum (the presence of free gas in the peritoneal cavity) usually indicates gastrointestinal perforation with associated peritoneal contamination. We describe the unusual case of a 28-year-old female, who was 7 days postpartum and presented with features of peritonitis that were initially missed despite supporting radiological evidence. The causes of pneumoperitoneum are discussed. In the postpartum period the female genital tract provides an alternative route by which gas can enter the abdominal cavity and cause pneumoperitoneum. In the postpartum period it is important to remember that the clinical signs of peritonism, guarding and rebound tenderness may be diminished or subtle due to abdominal wall laxity.


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Conventional Radiography, Ultrasound, Macroscopic pathology

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Synchronous primary tumors of the kidney and the ovaries: Imaging findings by Athina C. Tsili et al.

Published: 2008 Nov
Issue: 2(5) :: Pages: 2-8


Free full text article: Synchronous primary tumors of the kidney and the ovaries: Imaging findings

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Abstract: The simultaneous presence of primary carcinomas in the same patient is uncommon and synchronous primary tumors involving the kidney and ovary are extremely rare. There are a few reports in the English literature of synchronous primary malignancies of the kidney and the ovaries, but no data regarding their imaging features. We present a case of an elderly woman, diagnosed with bilateral ovarian clear cell carcinomas and a simultaneous clear cell carcinoma of the right kidney, evaluated by multidetector CT and MR imaging.


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Computed Tomography, Magnetic Resonance Imaging, Microscopic pathology

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