36 yo female from the ER with vaginal bleeding and cramping. Pt states positive home pregnancy and she is undergoing IVF. She is AMA, GR-3, P-1, ab-1.
Pt had a CT earlier reporting a structure in rt adnexa.
Sonographic findings: No evidence of IUP, empty uterus
Rt and Lt ovary measurements WNL
What is the structure in the rt adnexa?
13 comments:
When I look at very first image, I thought it is ovary with follicles, but nancy pointed out nicely it is not ovary, but right adnexa region. I got hint from it.
It seems like hyrdosalpinx. All images are shown anechoic tubular structures in adnexa area. This finding is compatible with hydrosalpinx.The patient had cramping and vaginal bledding which are part of symptoms. Also, The success of IVF had significantly lower with hydrosalpinx
Grace, I am in agreement with your comments. I also think it is a hydrosalpinx. Since the patient is going through IVF, her chances of getting pregnant are increased if she has tubal surgery. "Laparoscopic surgery is performed to remove adhesions, dilate a tube or create a new tubal opening. Tubal surgery is more successful when the blocked or narrowed part of the tube is closer to the ovary than to the uterus. Tubal blockage close to your uterus may increase your risk of ectopic pregnancy. In these and other severe cases of blockage or hydrosalpinx, removal of your tubes (salpingectomy) can improve your chances of pregnancy with in vitro fertilization." http://www.mayoclinic.com/health/female-infertility/DS01053/DSECTION=treatments-and-drugs
I think it's possible the third image is showing a hematosalpinx in that region of the fallopian tube. This may indicate a tubal pregnancy, as a "number of causes may account for a hematosalpinx, by far the most common being a tubal pregnancy", and should be considered a possibility in the absence of an IUP with a positive pregnancy test.
http://en.wikipedia.org/wiki/Hematosalpinx
The treatment options for hydrosalpinx are salpingostomy ( reopening fallopian tube),physical therapy and salpingectomy ( surgically removal of fallopian tube)
http://my-hydrosalpinx.com/treatment
Hi, Nancy
I saw a simliar case at my clinical site last week. It looked like a bladder filled of urine, so to make sure my CI let the patient go to the restroom one more time. However, anechoic oval structure stayed the same. The measurement was about 8cmx5cm and the shape was oval to tubular. I wondered what it was and now I think I found an answer of it. Thanks for updating your study case to understand and solve my clinical mystery.
Hye said
do you know that A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. the tubal blockage and tubal infertility is usually a result of previous pelvic infection such as pelvic inflammatory disease, but also can be caused by endometriosis and other conditions.
Hi All,
Yes, hydrosalpynx! Great info on the pathology. Alexia and Grace Great tie in with the IVF factoid.
Abby, concure with your observation.
Pay attention this evening. I will have more for you, the week is not over yet! (:
Zouliath Said
Yes, it is an hydrosalpynx.A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.
As PID is the major cause of hydrosalpinx formation, steps to reduce sexually transmitted disease will reduce hydrosalpinx. Also, as hydrosalpinx is a sequel to a pelvic infection, adequate and early antibiotic treatment of a pelvic infection is called for.
Hydrosalpinx is usually caused by a PID, or STDs. Hydrosalpinx is a sequel to pelvic infection, so early diagnosis and antibiotic treatment of PID is necessary to prevent hydrosalpinx.
A dilated fallopian tube (hyrdosalpinx) can look like an adnexal cyst. How can you determine if it is a cyst or not? In hydrosalpinx the cystic structure is not round it has an irregular boarder. I would put color all over both adnexal areas to look for a ring of fire sign to help rule out an ectopic pregnancy. Great case Nancy!
Hydrosalpinx is a blocked fallopian tube in distal area that filled with the serouse or clear fluid. Fallopian tube filled with blood is a hematosalpinx. If it filled with the pus it is called pyosalpinx.
Abortion, intrauterine devices (IUD), endometriosis, abdominal surgery and even childbirth may play a role in hydrosalpinx formation. Whereas some women with a hydrosalpinx display no symptoms, many suffer from severe, chronic pain.
Hydrosalpinx is a serious threat to fertility. It not only renders the affected tube totally ineffective, it may also lessen the effectiveness of various infertility treatments (IVF). Hydrosalpinx also increases the likelihood of miscarriage. Fluid from a tube which spills into the uterus is considered to be toxic to embryos; thus it decreases the chance for successful embryo implantation.
Hydrosalpinx in one tube often affects the other, resulting in two abnormal tubes.
www.healthline.com
awesome blog, do you have twitter or facebook? i will bookmark this page thanks. jasmin holzbauer
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