Question:

An intravesicular NuvaRing® should have what density on noncontrast CT scan?
1. Metallic
2. Calcium
3. Hypodense to urine
4. Isodense to urine
5. Hyperdense to urine





Answer:

The correct answer for the question "An intravesicular NuvaRing® should have what density on noncontrast CT scan?" is:

3. Hypodense to urine



Explanation
1. No metal is present with a NuvaRing® and therefore the device will not be of metallic density on CT. [CT readily demonstrates an intravesicular NuvaRing® as a circular ring hypodense to surrounding urine [2-4,10].]
2. An intravesicular NuvaRing® will not have significant calcification after a single menstrual period. [CT readily demonstrates an intravesicular NuvaRing® as a circular ring hypodense to surrounding urine [2-4,10].]
3. An intravesicular NuvaRing® will be hypodense to urine on CT scan. [CT readily demonstrates an intravesicular NuvaRing® as a circular ring hypodense to surrounding urine [2-4,10].]
4. If an intravesicular NuvaRing® was isodense to urine on CT, it would be fairly difficulty to detect. As our case shows, an intravesicular NuvaRing® is readily demonstrated as a ring hypodense to surrounding urine on CT. [CT readily demonstrates an intravesicular NuvaRing® as a circular ring hypodense to surrounding urine [2-4,10].]
5. In addition to a potential air locule, an intravesicular NuvaRing® will actually be hypodense to urine on CT scan. [CT readily demonstrates an intravesicular NuvaRing® as a circular ring hypodense to surrounding urine [2-4,10].]



From the manuscript:
Inadvertent intravesicular placement of a vaginal contraceptive ring: a case report and review of literature
Radiology Case. 2014 Dec; 8(12):22-28


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From the manuscript

Inadvertent intravesicular placement of a vaginal contraceptive ring: a case report and review of literature

Free full text article: Inadvertent intravesicular placement of a  vaginal contraceptive ring:  a case report and review of literature

Abstract
The NuvaRing is a deformable, ring-shaped hormonal contraceptive device which is typically vaginally self-inserted by the patient. While there are several potential side effects of usage, essentially all of them result from hormone delivery. Complications from incorrect placement are rare. We present the case of a 31 year old female who presented to our emergency department after being unable to retrieve a NuvaRing for its scheduled removal. CT scan showed a hypodense intravesicular NuvaRing which the patient had inadvertently placed transurethrally 3 weeks prior. Cystoscopy was performed and retrieval using a 3-pronged grasper was eventually successful after several failed attempts with an alligator grasper. Our purpose in presenting this case is to introduce the reader to a rare complication of incorrect NuvaRing placement, explain how this complication may occur as a result of NuvaRing construction/functionality, describe how alternative cystoscopic instruments may aid in cystoscopic retrieval, and review the 3 other case reports of intravesicular NuvaRing placement to discuss the utility of various imaging modalities when clinical suspicion of the complication is high.






References



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