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Ryu S, Lee CM, Kang BK, Kim M. Retroperitoneal Ectopic Pregnancy Detected by CT: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:217-221. [PMID: 38362382 PMCID: PMC10864160 DOI: 10.3348/jksr.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 02/17/2024]
Abstract
Retroperitoneal ectopic pregnancy is a rare form of ectopic pregnancy. Owing to its rarity and nonspecific symptoms, diagnosing retroperitoneal ectopic pregnancy at the initial presentation poses a significant challenge. Typically, the diagnosis relies on non-radiation imaging modalities, such as ultrasonography and MRI, whereas CT is infrequently used. Herein, we report a rare case of a retroperitoneal ectopic pregnancy, which was diagnosed using CT.
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Wang JJ, Hui CC, Ji YD, Xu W. Computed tomography diagnosed left ovarian venous thrombophlebitis after vaginal delivery: A case report. World J Clin Cases 2023; 11:896-902. [PMID: 36818636 PMCID: PMC9928707 DOI: 10.12998/wjcc.v11.i4.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postpartum ovarian vein thrombophlebitis (POVT) is a rare but serious postpartum complication that affects mostly postpartum women. A high index of suspicion is required when faced with sudden postpartum abdominal pain.
CASE SUMMARY A 25-year-old healthy woman who accepted a vaginal delivery procedure suffered fever (temperature 39.6℃) one day after delivery, accompanied with left lower abdominal pain. Physical examination indicated mild tenderness in the left lower abdomen, accompanied with rebound pain. The patient was confirmed to have left ovarian venous thrombosis with inflammation after receiving a multi-detector row computed tomography scan.
CONCLUSION POVT is a rare and dangerous postpartum complication. A high index of suspicion is required for the occurrence of ovarian venous thrombosis when faced with postpartum abdominal pain and fever. Early application of Doppler ultrasound, computed tomography, magnetic resonance imaging and other auxiliary examinations is conducive to timely and accurate diagnosis of POVT, thus reducing maternal mortality.
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Affiliation(s)
- Jin-Jin Wang
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Chu-Chu Hui
- Department of Ultrasound, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Yi-Ding Ji
- Department of Radiology, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
| | - Wei Xu
- Department of Emergency Medicine, The Ninth People’s Hospital of Suzhou City, Suzhou 215200, Jiangsu Province, China
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Alsheef M, Abuzied Y, Alosaimi M, Altamimi A, Alwazna Q, Almahmood Q, AlBulushi NA, Almutair J, Zaidi ARZ, Gray J, Abu-Shaheen A. Clinical Characteristics and Management of Ovarian Vein Thrombosis: A Case Series. Front Cardiovasc Med 2022; 9:916920. [PMID: 35783843 PMCID: PMC9243581 DOI: 10.3389/fcvm.2022.916920] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ovarian vein thrombosis (OVT) is an uncommon condition, occurring in ~1 in every 600–2,000 pregnancies. It is associated with various conditions, including thrombophilia, malignancy, sepsis, intra-abdominal and pelvic inflammatory conditions, pregnancy, and the postpartum period, and specific surgical interventions, particularly gynecological surgeries. Thus, this study aims to identify the associated factors for OVT and elaborate on the standard treatment strategies for its management. Methods Retrospective data collection was used. Our study consists of 18 patients diagnosed with OVT between 2005 and 2016; the data was collected from the Health Information Management system at King Fahad Medical City, Riyadh, Saudi Arabia using a standard format. Results Our study found that OVT involves the right ovarian vein more often than the left and mainly occurs in women during their postpartum period. These patients other associated factor included hypertension, diabetes, and a higher body mass index (BMI) of above 25 kg/m2. The most frequently presenting complaints were abdominal pain and fever. The most common treatment was the administration of enoxaparin (a low molecular weight heparin) for an average duration of one to three months, which resulted in a low recurrence rate of OVT. Conclusions Physicians should be vigilant for suspicion of OVT in female patients presenting with lower abdominal pain and fever in their postpartum period. Additionally, it is suggested to use low molecular weight heparin as initial therapy for OVT for one to three months, resulting in a high remission rate.
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Affiliation(s)
- Mohammed Alsheef
- Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
- *Correspondence: Mohammed Alsheef
| | - Yacoub Abuzied
- Spinal Cord Injury Unit, Nursing Department, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Muteb Alosaimi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amer Altamimi
- Adult Hematology Department, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Qusai Alwazna
- College of Medicine, Al-Imam Muhammad ibn Saudi Islamic University, Riyadh, Saudi Arabia
| | - Qusai Almahmood
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Jehan Almutair
- College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia
| | | | - Jenny Gray
- Dentistry Administration, King Fahad Medical City, Riyadh, Saudi Arabia
- Jenny Gray
| | - Amani Abu-Shaheen
- Department of Scientific Writing, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Dogan F, Karakas E, Karakas O, Camuzcuoglu H, Camuzcuoglu A, Kilicaslan N, Guldur ME. Does diffusion weighted imaging have a prognostic value in differentiating gynecological diseases? Radiography (Lond) 2022; 28:711-717. [PMID: 35490049 DOI: 10.1016/j.radi.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Apparent diffusion coefficient (ADC) values are effective in the diagnosis of different gynecological lesions. METHODS A retrospective evaluation was made of 12 patients with uterine cervix carcinoma and 151 patients with uterine lesions, comprising endometrial cancer, endometrial polyps, carcinosarcoma, submucous myoma, adenomyosis, endometrial hyperplasia, gestational trophoblastic neoplasm (GTN), and leiomyomas. As a control group, 20 healthy volunteers with normal endometrium and normal cervix were also evaluated. In three series, one-shot, spin echo, echo planar, b = 1000 s/mm2 value and diffusion-weighted imaging (DWI) were applied to all subjects and ADC values were obtained. RESULTS The mean ADC values of Group 1 (Endometrial carcinoma) were lower than those of all the other groups (P < 0.001) and the mean ADC value of group 6 (GTN) was higher than that all other groups (P < 0.001). A statistically significant difference was found between the groups in terms of the lesion-myometrium ADC ratios (P < 0.001). CONCLUSION There are few studies in literature related to ADC measurements in GTN. The ADC values of GTN were found to be significantly higher than the other uterine lesions. These results will aid in the design of future studies and might be used to guide management of patients with GTN. IMPLICATIONS FOR PRACTICE Diffusion-weighted MRI seems to be a promising imaging technique in differentiating different uterine lesions.
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Affiliation(s)
- F Dogan
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey.
| | - E Karakas
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey.
| | - O Karakas
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey.
| | - H Camuzcuoglu
- Harran University, Faculty of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey.
| | - A Camuzcuoglu
- Harran University, Faculty of Medicine, Department of Obstetrics and Gynecology, Sanliurfa, Turkey.
| | - N Kilicaslan
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey.
| | - M E Guldur
- Harran University, Faculty of Medicine, Department of Medical Pathology, Sanliurfa, Turkey.
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Role of Ultrasound in the Assessment and Differential Diagnosis of Pelvic Pain in Pregnancy. Diagnostics (Basel) 2022; 12:diagnostics12030640. [PMID: 35328194 PMCID: PMC8947205 DOI: 10.3390/diagnostics12030640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023] Open
Abstract
Pelvic pain (PP) is common in pregnant women and can be caused by several diseases, including obstetrics, gynaecological, gastrointestinal, genitourinary, and vascular disorders. Timely and accurate diagnosis as well as prompt treatment are crucial for the well-being of the mother and foetus. However, these are very challenging. It should be considered that the physiological changes occurring during pregnancy may confuse the diagnosis. In this setting, ultrasound (US) represents the first-line imaging technique since it is readily and widely available and does not use ionizing radiations. In some cases, US may be conclusive for the diagnosis (e.g., if it detects no foetal cardiac activity in suspected spontaneous abortion; if it shows an extrauterine gestational sac in suspected ectopic pregnancy; or if it reveals a dilated, aperistaltic, and blind-ending tubular structure arising from the cecum in suspicious of acute appendicitis). Magnetic resonance imaging (MRI), overcoming some limits of US, represents the second-line imaging technique when an US is negative or inconclusive, to detect the cause of bowel obstruction, or to characterize adnexal masses.
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Abstract
Although ovarian vein thrombosis (OVT) is classically considered a puerperal pathology, it can also occur in nonpuerperal settings such as endometritis, pelvic inflammatory disease, Crohn's disease, pelvic or gynaecological surgeries and thrombophilia. Hypercoagulation conditions such as antiphospholipid syndrome, systemic lupus erythematosus, factor V Leiden and protein C and S deficiency are all recognised risk factors. It is also a known complication during pregnancy often presenting with fever and lower abdominal pain within weeks after delivery. Its incidence is exceedingly rare, occurring in 0.05% of all pregnancies that result in live births and peaking around 2-6 days after delivery. Its preferential involvement of the right ovarian vein may be explained by the compression of the inferior vena cava and the right ovarian vein due to dextrorotation of the uterus during pregnancy. Furthermore, antegrade flow of blood and multiple incompetent valves in the right ovarian vein favours bacterial infection. Complications may include sepsis and thrombus extension to the inferior vena cava or left renal vein and rarely, pulmonary embolism. The authors present the case of a 27-year-old woman with lower abdominal pain 5 weeks after an elective caesarean section. Although the diagnosis of postpartum endometritis was initially considered, a CT suggested a right OVT. She commenced treatment with low-molecular weight heparin. A high index of clinical suspicion is required in order to establish the diagnosis of this rare cause of abdominal pain, which can mimic an acute abdomen.
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Affiliation(s)
- Louise Dunphy
- Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Aie Wei Tang
- Obstetrics, Liverpool Women's Hospital, Liverpool, UK
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Ami O, Maran JC, Musset D, Dubray C, Mage G, Boyer L. Human Birth Imaging Using MRI demonstrates fetal head moldability and brain compression : Prospective cohort study (Preprint). JMIR Form Res 2021; 6:e27421. [DOI: 10.2196/27421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/14/2021] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Abrantes J, Teixeira E, Gomes F, Fernandes C. Postpartum ovarian vein thrombosis and venous anatomical variation. BMJ Case Rep 2019; 12:12/6/e228399. [PMID: 31229971 DOI: 10.1136/bcr-2018-228399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 34-year-old multipara presented 72 hours postpartum with acute right-sided abdominal pain. The investigation revealed mild leucocytosis with positive D-dimer and elevated C reactive protein. Abdominal ultrasound and abdominopelvic CT demonstrated an enlarged right ovarian vein with endoluminal thrombus, representing postpartum ovarian vein thrombosis. The patient became asymptomatic 48 hours after starting broad-spectrum antibiotic treatment and anticoagulant therapy. She completed the treatment in ambulatory regimen and control abdominopelvic CT imaging was performed and revealed a duplicated right ovarian vein and a small residual subacute thrombus in the lumen of the distal right ovarian vein. The patient remained asymptomatic in the clinical follow-up.
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Affiliation(s)
- João Abrantes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
| | | | - Fernanda Gomes
- Centro Hospitalar Barreiro Montijo EPE, Barreiro, Portugal
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Nepal P, Ojili V, Lu SC, Nagar A. Utility of MRI in Management of a Rare Case of Unilateral Dichorionic-Diamniotic Twin Tubal Ectopic Pregnancy. Curr Probl Diagn Radiol 2019; 50:551-553. [PMID: 31208757 DOI: 10.1067/j.cpradiol.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022]
Abstract
Twin tubal ectopic pregnancies are rare events but critical diagnoses to make in emergency settings. They are common in patients who received in vitro- fertilization and in those with history of PID. Unless 2 embryos are live with detectable heart beats, ultrasound cannot definitely diagnose twin tubal EP. In clinically stable patients, MRI may provide other concrete findings to establish the diagnosis and lead to better management. In literature, to best of our knowledge, there has been no reported case of twin tubal EP evaluated with MRI. In this article, we have briefly reviewed the role of MRI in different types of EP and its limitations. We report an interesting case of ruptured tubal twin EP diagnosed with MRI which was sub optimally evaluated with ultrasound.
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Affiliation(s)
| | | | | | - Arpit Nagar
- Ohio State University Wexner Medical Center, OH
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11
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The use of ultrasound in the evaluation of postpartum paravaginal hematomas. Am J Obstet Gynecol MFM 2019; 1:82-88. [DOI: 10.1016/j.ajogmf.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 11/19/2022]
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Fazecas TM, Araujo Júnior E, Werner H, Daltro P, Peixoto AB, Lima GM, Barbosa AD. Applicability of Magnetic Resonance Imaging in the Assessment of Fetal Urinary Tract Malformations. Can Assoc Radiol J 2019; 70:83-95. [PMID: 30691568 DOI: 10.1016/j.carj.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 07/09/2018] [Accepted: 10/20/2018] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To assess the applicability of magnetic resonance imaging (MRI) to complement ultrasound in the diagnosis of fetal urinary tract anomalies. METHODS This was a retrospective cohort study that included 41 women between 19 weeks and 37 weeks and 6 days of gestation carrying fetuses with malformations of the urinary tract which were initially diagnosed by ultrasound and then referred for MRI. In all cases, the diagnosis was confirmed after birth either through imaging or autopsy. A surface coil was positioned over the abdomen and T2-weighted sequences were obtained in the axial, coronal, and sagittal planes; T1 in at least one plane; and three-dimensional (3-D) TRUFI in fetuses with dilatation of the urinary tract. RESULTS Mean gestational age at the time of MRI examination was 28.21 weeks. The rapid T2 sequences allowed all the anomalies of the fetal urinary tract to be assessed, whereas 3-D TRUFI sequencing proved very useful in evaluating anomalies involving dilatation of the urinary tract. The signs of pulmonary hypoplasia characterized by hypointense signal in the T2-weighted sequences were identified in 13 of the 41 fetuses. CONCLUSION MRI confirmed and added information to the ultrasound regarding fetal urinary tract anomalies, as well as information related to the other associated malformations, their progress in the prenatal period, and possible postnatal prognosis.
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Affiliation(s)
- Tatiana Mendonça Fazecas
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil; Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil.
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Pedro Daltro
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Glaucia Macedo Lima
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
| | - Adauto Dutra Barbosa
- Department of Maternal and Child, Fluminense Federal University (UFF), Niteroi, Rio de Janeiro, Brazil
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Oppenheimer DC, Mazaheri P, Ballard DH, Yano M, Fowler KJ. Magnetic resonance imaging of the placenta and gravid uterus: a pictorial essay. Abdom Radiol (NY) 2019; 44:669-684. [PMID: 30196361 PMCID: PMC6529811 DOI: 10.1007/s00261-018-1755-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The placenta is commonly overlooked on magnetic resonance imaging of the pregnant patient, which is frequently performed for alternative reasons such as to characterize fetal or uterine anomalies or to investigate the etiology of acute pelvic pain in pregnancy. Placental disorders have potential for significant maternal and fetal morbidity and peripartum complications if not recognized and treated in a timely manner. The radiologist must be familiar with normal placental variants and the spectrum of benign to life-threatening conditions affecting the placenta so that the Obstetrician can be promptly notified and patient management altered, if necessary. In this pictorial essay, we will describe our MR protocol for placental imaging, provide an image-rich review of the normal placenta, placental variants, and a variety of pathological conditions affecting the placenta and gravid uterus.
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Affiliation(s)
- Daniel C Oppenheimer
- Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, P.O. Box no. 648, Rochester, NY, 14642, USA.
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Motoyo Yano
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
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Mamouni N, Boumhaoued S, Erraghay S, Boubou M, Bouchikhi C, Banani A. [Clinical and radiological features of gestational trophoblastic tumors]. Pan Afr Med J 2018; 28:228. [PMID: 29629014 PMCID: PMC5882204 DOI: 10.11604/pamj.2017.28.228.13267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/31/2017] [Indexed: 11/11/2022] Open
Abstract
Gestational trophoblastic disease incorporates a group of diseases which differ from each other by their regressive evolution, their evolution to metastasis and to recurrence. It is a severe disease that affects women of childbearing age. Gestational trophoblastic tumors (GTT) are the malignant forms of gestational trophoblastic diseases. They are always a result of pregnancy, more often molar pregnancy (hydatidiform mole). The most common type of gestational trophoblastic tumors (GTT) is the invasive mole because, in most cases, the diagnosis is made when cancer is still confined to the uterus. Choriocarcinoma is a more rare type of tumor, often developing distant metastases. When there is a progression to a trophoblastic tumor, the assessment of locoregional extension and distant metastases is essential to establish an appropriate treatment protocol. We here report three clinical cases of GTT by describing their clinical presentations and the use of imaging techniques in the diagnosis and management of these disorders.
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Affiliation(s)
- Nisrine Mamouni
- Service de Gynécologie Obstétrique I, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
| | - Siham Boumhaoued
- Service de Gynécologie Obstétrique I, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
| | - Sanae Erraghay
- Service de Gynécologie Obstétrique I, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
| | - Meriem Boubou
- Service de Radiologie, Hôpital Mère Enfant, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
| | - Chahrazed Bouchikhi
- Service de Gynécologie Obstétrique I, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
| | - Abdelaziz Banani
- Service de Gynécologie Obstétrique I, Hôpital Mère Enfant, CHU Hassan II, Fès, Université sidi Mohamed ben Abdellah, Maroc
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15
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Martínez Díaz RA, Quintero Avendaño LJ, García González CA, Fernández De Castro Asis AM. Embarazo ectópico cervical: diagnóstico preciso y enfoque de manejo médico. Reporte de caso. UNIVERSITAS MÉDICA 2018. [DOI: 10.11144/javeriana.umed59-1.ecto] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
<p>El embarazo ectópico cervical es una condición exótica. Su diagnóstico y manejo plantean un desafío importante, dada su asociación con desenlaces maternos graves. La sospecha clínica y la juiciosa aplicación de los criterios diagnósticos permiten establecer modalidades de terapia conservativa. Este artículo reporta un caso de embarazo ectópico cervical con diagnóstico de imágenes de ultrasonido y resonancia nuclear magnética en el que se administró tratamiento con metotrexato. El seguimiento clínico, de los exámenes paraclínicos y de ultrasonido mostraron la resolución completa de la condición. Se revisan aspectos relacionados con el diagnóstico y tratamiento.</p>
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Benson DG, Schiebler ML, Nagle SK, François CJ. Magnetic Resonance Imaging for the Evaluation of Pulmonary Embolism. Top Magn Reson Imaging 2017; 26:145-151. [PMID: 28777163 DOI: 10.1097/rmr.0000000000000133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pulmonary embolism (PE) is a leading cause of acute cardiovascular death throughout the world. Although computed tomography angiography (CTA) is the primary imaging study used to diagnose acute PE, pulmonary magnetic resonance angiography (MRA) is increasingly being used in patients with contraindications for CTA. This manuscript reviews the MRA techniques used for the diagnosis of PE and discuss how these techniques can be implemented in routine clinical practice. In addition, the efficacy and effectiveness of these techniques will be compared to other modalities.
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Affiliation(s)
- Donald G Benson
- *Department of Radiology †Department of Medical Physics ‡Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
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17
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Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc 2017. [DOI: 10.1007/s00464-017-5637-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Benson DG, Schiebler ML, Repplinger MD, François CJ, Grist TM, Reeder SB, Nagle SK. Contrast-enhanced pulmonary MRA for the primary diagnosis of pulmonary embolism: current state of the art and future directions. Br J Radiol 2017; 90:20160901. [PMID: 28306332 DOI: 10.1259/bjr.20160901] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
CT pulmonary angiography (CTPA) is currently considered the imaging standard of care for the diagnosis of pulmonary embolism (PE). Recent advances in contrast-enhanced pulmonary MR angiography (MRA) techniques have led to increased use of this modality for the detection of PE in the proper clinical setting. This review is intended to provide an introduction to the state-of-the-art techniques used in pulmonary MRA for the detection of PE and to discuss possible future directions for this modality. This review discusses the following issues pertinent to MRA for the diagnosis of PE: (1) the diagnostic efficacy and clinical effectiveness for pulmonary MRA relative to CTPA, (2) the different pulmonary MRA techniques used for the detection of PE, (3) guidance for building a clinical service at their institution using MRA and (4) future directions of PE MRA. Our principal aim was to show how pulmonary MRA can be used as a safe, effective modality for the diagnosis of clinically significant PE, particularly for those patients where there are concerns about ionizing radiation or contraindications/allergies to the iodinated contrast material.
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Affiliation(s)
- Donald G Benson
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mark L Schiebler
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael D Repplinger
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,2 Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Thomas M Grist
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,4 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott B Reeder
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,2 Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,4 Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.,5 Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Scott K Nagle
- 1 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,3 Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.,6 Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
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Sefidbakht S, Hosseini F, Bijan B, Hamedi B, Azizi T. Qualitative and quantitative analysis of diffusion-weighted imaging of gestational trophoblastic disease: Can it predict progression of molar pregnancy to persistent form of disease? Eur J Radiol 2016; 88:71-76. [PMID: 28189211 PMCID: PMC5317177 DOI: 10.1016/j.ejrad.2016.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 12/19/2022]
Abstract
The incidence of GTD in Iran is significantly higher than America and Europe. ADC value of GTD is (1.96 ± 0.32 × 10−3 mm2/s). GTD in T1 and T2-weighted images shows heterogeneous “snow-storm” appearance. Focal intratumoral hemorrhage is bright in DWI and low signal in the ADC map. ADC value and DWI are not helpful to predict progression of HM to persistent disease.
Purpose To describe the diffusion-weighted imaging (DWI) appearance of gestational trophoblastic disease (GTD) and to determine its apparent diffusion coefficient (ADC) values. To evaluate the feasibility of DWI to predict progression of hydatidiform mole (HM) to persistent disease. Methods During a period of 6 months, women with preliminary diagnosis of GTD, based on ultrasound and ßhCG levels, underwent 1.5T MRI (T2 high-resolution and DWI; b values 50, 400, 800; sagittal and perpendicular to the endometrium; and T1, T2 Turbo Spin Echo [TSE] axial images). Patients were followed for 6–12 months to monitor progression to persistent form of the disease. ADC values and image characteristics were compared between HM and persistent neoplasia and between GTD and non-molar pregnancy using Mann–Whitney U and Fisher’s exact tests, respectively. Results Among the 23 studied patients, 19 (83%) were classified as molar and 4 (17%) as non-molar, based on pathology reports. After 6–12 months of follow-up, 5 (26%) cases progressed to persistent disease and 14 (74%) cases were benign HM. There was no significant difference between ADC values for HM (1.93 ± 0.33 × 10−3 mm2/s) and persistent neoplasia (2.03 ± 0.28 × 10−3 mm2/s) (P = 0.69). The ADC of non-molar pregnancies was (0.96 ± 0.46 × 10−3 mm2/s), which was significantly different from GTD (1.96 ± 0.32 × 10−3 mm2/s) (P = 0.001). Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity were more common in GTD compared to non-molar pregnancy (P < 0.05). Conclusion Heterogeneous snowstorm appearance, focal intratumoral hemorrhage, myometrial contraction, and prominent myometrial vascularity are among the imaging characteristics of GTD. We cannot use ADC values to predict progression to persistent disease.
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Affiliation(s)
- Sepideh Sefidbakht
- Medical imaging research center, Department of Radiology and Imaging, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Hosseini
- Medical imaging research center, Department of Radiology and Imaging, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bijan Bijan
- Abdominal Imaging/MR and Nonvascular Interventional Division, University of California, Davis, CA, USA
| | - Bahareh Hamedi
- Obstetrics& Gynecology Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayyebeh Azizi
- Obstetrics& Gynecology Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
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Lima LDLA, Parente RCM, Maestá I, Amim Junior J, de Rezende Filho JF, Montenegro CAB, Braga A. Clinical and radiological correlations in patients with gestational trophoblastic disease. Radiol Bras 2016; 49:241-250. [PMID: 27777478 PMCID: PMC5073391 DOI: 10.1590/0100-3984.2015.0073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Gestational trophoblastic disease is an abnormality of pregnancy that encompasses
a group of diseases that differ from each other in their propensity for
regression, invasion, metastasis, and recurrence. In the past, it was common for
patients with molar pregnancy to present with marked symptoms: copious bleeding;
theca lutein cysts; uterus larger than appropriate for gestational age; early
preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early
diagnosis made by ultrasound, most patients are diagnosed while the disease is
still in the asymptomatic phase. In cases of progression to trophoblastic
neoplasia, staging-typically with Doppler flow studies of the pelvis and chest
X-ray, although occasionally with computed tomography or magnetic resonance
imaging-is critical to the choice of an appropriate antineoplastic therapy
regimen. Because it is an unusual and serious disease that affects women of
reproductive age, as well as because its appropriate treatment results in high
cure rates, it is crucial that radiologists be familiar with gestational
trophoblastic disease, in order to facilitate its early diagnosis and to ensure
appropriate follow-up imaging.
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Affiliation(s)
- Lana de Lourdes Aguiar Lima
- Master's Student in the Perinatal Health Program at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Izildinha Maestá
- PhD, Adjunct Professor of Obstetrics at the Faculdade de Medicina da Universidade Estadual Paulista "Júlio de Mesquita Filho" (Unesp), Botucatu, SP, Brazil
| | - Joffre Amim Junior
- PhD, Associate Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Director of the Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Jorge Fonte de Rezende Filho
- PhD, Full Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Carlos Antonio Barbosa Montenegro
- PhD, Full Member Emeritus of the Academia Nacional de Medicina, Full Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antônio Braga
- PhD, Adjunct Professor of Obstetrics at the Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, and at the Faculdade de Medicina da Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
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Gupta R, Bajaj SK, Kumar N, Chandra R, Misra RN, Malik A, Thukral BB. Magnetic resonance imaging - A troubleshooter in obstetric emergencies: A pictorial review. Indian J Radiol Imaging 2016; 26:44-51. [PMID: 27081223 PMCID: PMC4813073 DOI: 10.4103/0971-3026.178292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The application of magnetic resonance imaging (MRI) in pregnancy faced initial skepticism of physicians because of fetal safety concerns. The perceived fetal risk has been found to be unwarranted and of late, the modality has attained acceptability. Its role in diagnosing fetal anomalies is well recognized and following its safety certification in pregnancy, it is finding increasing utilization during pregnancy and puerperium. However, the use of MRI in maternal emergency obstetric conditions is relatively limited as it is still evolving. In early gestation, ectopic implantation is one of the major life-threatening conditions that are frequently encountered. Although ultrasound (USG) is the accepted mainstay modality, the diagnostic predicament persists in many cases. MRI has a role where USG is indeterminate, particularly in the extratubal ectopic pregnancy. Later in gestation, MRI can be a useful adjunct in placental disorders like previa, abruption, and adhesion. It is a good problem-solving tool in adnexal masses such as ovarian torsion and degenerated fibroid, which have a higher incidence during pregnancy. Catastrophic conditions like uterine rupture can also be preoperatively and timely diagnosed. MRI has a definite role to play in postpartum and post-abortion life-threatening conditions, e.g., retained products of conception, and gestational trophoblastic disease, especially when USG is inconclusive or inadequate.
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Affiliation(s)
- Rohini Gupta
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil Kumar Bajaj
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nishith Kumar
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ranjan Chandra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ritu Nair Misra
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amita Malik
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Brij Bhushan Thukral
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Hypertriglyceridemia-induced acute pancreatitis in pregnancy causing maternal death. Obstet Gynecol Sci 2016; 59:148-51. [PMID: 27004207 PMCID: PMC4796086 DOI: 10.5468/ogs.2016.59.2.148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/13/2015] [Accepted: 09/01/2015] [Indexed: 12/02/2022] Open
Abstract
Acute pancreatitis in pregnancy is rare and occurs in approximately 3 in 10,000 pregnancies. It rarely complicates pregnancy, and can occur during any trimester, however over half (52%) of cases occur during the third trimester and during the post-partum period. Gallstones are the most common cause of acute pancreatitis. On the other hand, acute pancreatitis caused by hypertriglyceridemia due to increase of estrogen during the gestational period is very unusual, but complication carries a higher risk of morbidity and mortality for both the mother and the fetus. We experienced a case of pregnant woman who died of acute exacerbation of hypertriglyceridemia-induced acute pancreatitis at 23 weeks of gestation. We report on progress and management of this case along with literature reviews.
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Si MJ, Gui S, Fan Q, Han HX, Zhao QQ, Li ZX, Zhao JM. Role of MRI in the early diagnosis of tubal ectopic pregnancy. Eur Radiol 2015; 26:1971-80. [DOI: 10.1007/s00330-015-3987-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/28/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
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Jenayah AA, Saoudi S, Boudaya F, Bouriel I, Sfar E, Chelli D. Ovarian vein thrombosis. Pan Afr Med J 2015; 21:251. [PMID: 26526119 PMCID: PMC4607796 DOI: 10.11604/pamj.2015.21.251.6908] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/29/2015] [Indexed: 02/04/2023] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare cause of abdominal pain that may mimic a surgical abdomen. It is most often diagnosed during the postpartum period. In this report, we present four cases of postoperative ovarian vein thrombosis. The complications of OVT can be significant, and the diagnosis relies on a careful examination of the radiographic findings. It can occur with lower quadrant abdominal pain, especially in the setting of recent pregnancy, abdominal surgery, pelvic inflammatory disease, or malignancy. Diagnosis can be made with confidence using ultrasound, computed tomography or magnetic resonance imaging. Treatment of ovarian vein thrombosis is particularly important in the post-partum patients, with anticoagulation therapy being the current recommendation.
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Affiliation(s)
- Amel Achour Jenayah
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Sarra Saoudi
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Fethia Boudaya
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Ines Bouriel
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Ezzeddine Sfar
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
| | - Dalenda Chelli
- Department A of Gynecology and Obstetrics, Center of Maternity and Neonatology of Tunis, Tunisia
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Breast magnetic resonance imaging performance: safety, techniques, and updates on diffusion-weighted imaging and magnetic resonance spectroscopy. Top Magn Reson Imaging 2015; 23:373-84. [PMID: 25463410 DOI: 10.1097/rmr.0000000000000035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance imaging (MRI) is a well-established, highly sensitive technique for the detection and evaluation of breast cancer. Optimal performance of breast MRI continues to evolve. This article addresses breast MRI applications, covers emerging breast MRI safety concerns; outlines the technical aspects of breast MRI, including equipment and protocols at 3 T and 1.5 T; and describes current promising areas of research including diffusion-weighted imaging and magnetic resonance spectroscopy.
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Amant F, Han SN, Gziri MM, Vandenbroucke T, Verheecke M, Van Calsteren K. Management of cancer in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:741-53. [PMID: 25797199 DOI: 10.1016/j.bpobgyn.2015.02.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 12/20/2022]
Abstract
A multidisciplinary discussion is necessary to tackle a complex and infrequent medical problem such as cancer occurring during pregnancy. Pregnancy does not predispose to cancer, but cancers occurring in women of reproductive age are encountered during pregnancy. Ultrasonography and magnetic resonance imaging are the preferred staging examinations, but also a sentinel node staging procedure is possible during pregnancy. Standard cancer treatment is aimed for. Operations can safely be performed during pregnancy, but surgery of genital cancers can be challenging. The observation that chemotherapy administered during the second or third trimester of pregnancy, that is, after the period of organogenesis, has little effect on the long-term outcome of children adds to the therapeutic armamentarium during pregnancy. Cancer treatment during pregnancy adds in the continuation of the pregnancy and the prevention of prematurity.
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Affiliation(s)
- Frédéric Amant
- Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium.
| | - Sileny N Han
- Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Mina Mhallem Gziri
- Department of Obstetrics and Gynecology, Cliniques Universitaires St Luc, UCL, Brussels, Belgium
| | - Tineke Vandenbroucke
- Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Magali Verheecke
- Gynecological Oncology, Department of Obstetrics and Gynecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Himoto Y, Kido A, Moribata Y, Yamaoka T, Okumura R, Togashi K. CT and MR imaging findings of systemic complications occurring during pregnancy and puerperal period, adversely affected by natural changes. Eur J Radiol Open 2015; 2:101-10. [PMID: 26937442 PMCID: PMC4750569 DOI: 10.1016/j.ejro.2015.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/23/2015] [Indexed: 12/27/2022] Open
Abstract
Dynamic physiological and anatomical changes for delivery may adversely induce various specific non-obstetric complications during pregnancy and puerperal period. These complications can be fatal to both the mother and the fetus, thus a precise and early diagnosis ensued by an early treatment is essential. Along with ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) have assumed an increasing role in the diagnosis. This article aims to discuss the pathophysiology of these complications, the indications for CT and MRI, and the imaging findings.
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Affiliation(s)
- Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Toshihide Yamaoka
- Department of Radiology, Kyoto Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan
| | - Ryosuke Okumura
- Department of Radiology, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka-shi, Osaka-fu 530-8480, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract 2014; 2014:842751. [PMID: 25126425 PMCID: PMC4122023 DOI: 10.1155/2014/842751] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 06/28/2014] [Indexed: 11/20/2022] Open
Abstract
Gestational trophoblastic disease is a condition of uncertain etiology, comprised of hydatiform mole (complete and partial), invasive mole, choriocarcinoma, and placental site trophoblastic tumor. It arises from abnormal proliferation of trophoblastic tissue. Early diagnosis of gestational trophoblastic disease and its potential complications is important for timely and successful management of the condition with preservation of fertility. Initial diagnosis is based on a multimodality approach: encompassing clinical features, serial quantitative β-hCG titers, and pelvic ultrasonography. Pelvic magnetic resonance imaging (MRI) is sometimes used as a problem-solving tool to assess the depth of myometrial invasion and extrauterine disease spread in equivocal and complicated cases. Chest radiography, body computed tomography (CT), and brain MRI have been recommended as investigative tools for overall disease staging. Angiography has a role in management of disease complications and metastases. Efficacy of PET (positron emission tomography) and PET/CT in the evaluation of recurrent or metastatic disease has not been adequately investigated yet. This paper discusses the imaging features of gestational trophoblastic disease on various imaging modalities and the role of different imaging techniques in the diagnosis and management of this entity.
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Affiliation(s)
- Sunita Dhanda
- Department of Diagnostic Imaging, National University Hospital, Level 2, Main Building, 5 Lower Kent Ridge Road, Singapore 119074
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Subhash Ramani
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
| | - Meenkashi Thakur
- Tata Memorial Hospital, Dr. E. Borges Marg, Parel, Mumbai, Maharashtra 400012, India
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Park SB. Features of the hypointense solid lesions in the female pelvis on T2-weighted MRI. J Magn Reson Imaging 2014; 39:493-503. [PMID: 24532374 DOI: 10.1002/jmri.24512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Sung Bin Park
- Department of Radiology; Chung-Ang University Hospital, Chung-Ang University College of Medicine; Seoul Korea
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Masselli G, Gualdi G. MR imaging of the placenta: what a radiologist should know. ACTA ACUST UNITED AC 2014; 38:573-87. [PMID: 22797659 DOI: 10.1007/s00261-012-9929-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Imaging of the placenta can have a profound impact on patient management, owing to the morbidity and mortality associated with various placental conditions. Placental conditions affecting the mother and fetus include molar pregnancies, placental hematoma, abruption, previa, accreta, vasa previa, chorioangioma, and retained products of conception. Although uncommon, abnormalities of the placenta are important to recognize owing to the potential for maternal and fetal morbidity and mortality. Sonography remains the first imaging modality for evaluation of the placenta. Magnetic resonance (MR) imaging has many unique properties that make it well-suited for imaging of the placenta: the multi-planar capabilities, the improved tissue contrast that can be obtained using a variety of pulse sequences and parameters and the lack of ionizing radiation; MR imaging can be of added diagnostic value when further characterization is required. In this article, we review the appearances and the role of MRI in diagnosis and management of these conditions. We present our clinical perspective on diagnosing these challenging problems with MRI and review the imaging findings that can lead to a correct diagnosis.
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Affiliation(s)
- Gabriele Masselli
- Radiology Department, First Faculty of Medicine, Università di Roma Sapienza, Viale del Policlinico 155, Rome, Italy.
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Renfroe S, Dajani NK, Pandey T, Magann EF. Role of serial MRI assessment in the management of an abdominal pregnancy. BMJ Case Rep 2013; 2013:bcr-2013-200495. [PMID: 24127374 DOI: 10.1136/bcr-2013-200495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 33-year-old woman was admitted to the hospital with an abdominal pregnancy at a gestational age of 20 weeks. An initial MRI mapping of fetal location and placental vascular invasion was obtained. The patient refused surgical intervention until fetal survival would be possible. Serial MRIs were essential in timing delivery and avoiding an emergency surgical situation. The baby was delivered at 24 weeks with the assistance of a multidisciplinary surgical team. The mother as well as the baby survived. This case report highlights the role of serial MRI evaluations in the diagnosis and expectant management of an abdominal pregnancy. It also highlights the importance of interdisciplinary communication for a successful outcome.
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Affiliation(s)
- Shyann Renfroe
- Univeristy of Arkansas for Medical Sciences, Hensley, Arkansas, USA
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Semere LG, McElrath TF, Klein AM. Neuroimaging in pregnancy: a review of clinical indications and obstetric outcomes. J Matern Fetal Neonatal Med 2013; 26:1371-9. [PMID: 22862157 DOI: 10.3109/14767058.2012.713053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine indications and outcomes of pregnant women requiring neurologic imaging at a tertiary care center. METHODS We reviewed medical records of women receiving magnetic resonance (MR) head imaging during pregnancy to determine indications for such imaging and their pregnancy outcomes. RESULTS Between April 2007 and December 2008, 60 pregnant women presented to Brigham and Women's Hospital with severe headache or other acute neurologic complaint and underwent head imaging. Two patients were found to have significant findings considered to be neurologic emergencies: a right thalamic hemorrhage and a subarachnoid hemorrhage. Nine patients had abnormal findings not requiring immediate intervention but deeming further evaluation. Sixteen patients had abnormal findings determined to be incidental and unrelated to their indication for imaging. Thirty-three patients had unremarkable imaging studies. The most common presenting symptoms included headache (70%) and visual disturbances (48%). The most common imaging studies obtained were MR brain without contrast (87%) and MR angiography head without contrast (73%). The majority of patients (96%) delivered in the third trimester without significant complications. CONCLUSIONS Most women who receive head imaging in pregnancy do not have adverse findings and have good obstetrical outcomes.
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Affiliation(s)
- Luwam G Semere
- Department of Obstetrics and Gynecology, Department of Medicine, Division of General Internal Medicine, University of California, Los Angeles Robert Wood Johnson Foundation Clinical Scholars Program, Los Angeles, CA, USA
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Breast diseases during pregnancy and lactation. Obstet Gynecol Sci 2013; 56:143-59. [PMID: 24327995 PMCID: PMC3784111 DOI: 10.5468/ogs.2013.56.3.143] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/15/2013] [Accepted: 04/17/2013] [Indexed: 11/26/2022] Open
Abstract
Breast is a typical female sexual physiologic organ that is influenced by steroid hormone from menarche until menopause. Therefore various diseases can be developed by continuous action of estrogen and progesterone. Breast diseases are mainly categorized as benign and malignant. It is very important to distinguish the malignancy from breast diseases. However, it is very difficult to diagnose malignancy in pregnant and lactating women even though the same breast diseases took place. Therefore, we will review breast diseases such as breast carcinoma during pregnancy and lactation.
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A multimodal approach to acute biliary pancreatitis during pregnancy: a case series. Surg Laparosc Endosc Percutan Tech 2013; 22:429-32. [PMID: 23047387 DOI: 10.1097/sle.0b013e31825e38bb] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The treatment of acute biliary pancreatitis during pregnancy remains controversial. We present our experience of treating 7 pregnant women with acute biliary pancreatitis and verified or suspected choledocholithiasis, by using magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and sphincterotomy followed by laparoscopic cholecystectomy. MRCP was performed in all patients to confirm the presence of common bile duct stones, their size and number. ERCP and sphincterotomy were performed without the use of radiation. The procedure was terminated only when all stones (the number clarified at MRCP), were retrieved into the duodenum. All patients underwent laparoscopic cholecystectomy the following day. Neither post-ERCP nor postoperative major complications were noted. All but one patient reached a healthy natural-term labor. One patient had a planned cesarean section on 35th week. The combination of MRCP, nonradiation ERCP, and immediate laparoscopic cholecystectomy provides definite treatment and seems to put both mother and fetus at lower risk than presumed.
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MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites. Jpn J Radiol 2012; 31:75-80. [DOI: 10.1007/s11604-012-0151-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/01/2012] [Indexed: 02/03/2023]
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Sierra A, Burrel M, Sebastia C, Radosevic A, Barrufet M, Albela S, Buñesch L, Domingo MA, Salvador R, Real I. Utility of Multidetector CT in Severe Postpartum Hemorrhage. Radiographics 2012; 32:1463-81. [DOI: 10.1148/rg.325115113] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Casciani E, Masselli G, Luciani ML, Polidori NF, Piccioni MG, Gualdi G. Errors in Imaging of Emergencies in Pregnancy. Semin Ultrasound CT MR 2012; 33:347-70. [DOI: 10.1053/j.sult.2012.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E. MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 2012; 32:317-34. [PMID: 22411935 DOI: 10.1148/rg.322115057] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical diagnosis of the cause of abdominal pain in a pregnant patient is particularly difficult because of multiple confounding factors related to normal pregnancy. Magnetic resonance (MR) imaging is useful in evaluation of abdominal pain during pregnancy, as it offers the benefit of cross-sectional imaging without ionizing radiation or evidence of harmful effects to the fetus. MR imaging is often performed specifically for diagnosis of possible appendicitis, which is the most common illness necessitating emergency surgery in pregnant patients. However, it is important to look for pathologic processes outside the appendix that may be an alternative source of abdominal pain. Numerous entities other than appendicitis can cause abdominal pain during pregnancy, including processes of gastrointestinal, hepatobiliary, genitourinary, vascular, and gynecologic origin. MR imaging is useful in diagnosing the cause of abdominal pain in a pregnant patient because of its ability to safely demonstrate a wide range of pathologic conditions in the abdomen and pelvis beyond appendicitis.
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Affiliation(s)
- Lucy B Spalluto
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Rhode Island Hospital, Providence, RI, USA.
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Galván A, Van Leijenhorst L, McGlennen KM. Considerations for imaging the adolescent brain. Dev Cogn Neurosci 2012; 2:293-302. [PMID: 22669033 PMCID: PMC6987696 DOI: 10.1016/j.dcn.2012.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 11/30/2022] Open
Abstract
In recent years the number of functional neuroimaging studies on adolescence has exploded. These studies have led to important new insights about the relation between functional brain development and behavior. However, special consideration is warranted when working with adolescents. In this review, we review variables, including pubertal stage, sleep patterns and pregnancy, which are particularly relevant for developmental cognitive neuroscience studies involving adolescents. Consideration of the unique challenges associated with adolescence will help the growing field of developmental neuroimaging standardize procedures and will eventually facilitate interpretation across studies.
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Affiliation(s)
- Adriana Galván
- Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA.
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Mkpolulu CA, Ghobrial PM, Catanzano TM. Nontraumatic abdominal pain in pregnancy: imaging considerations for a multiorgan system problem. Semin Ultrasound CT MR 2012; 33:18-36. [PMID: 22264900 DOI: 10.1053/j.sult.2011.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nontraumatic abdominal pain in the pregnant patient can present a clinician with a variety of diagnostic possibilities. The overlap between signs and symptoms expected in normal pregnancy and these many pathologic possibilities does little to help focus the clinician's diagnostic efforts. Fear of ionizing radiation's effects on the fetus has driven efforts to refine medical imaging algorithms in such a way as to attempt to eliminate its use at all cost. In today's world, we are nearly there. In this review the differential diagnosis of nontraumatic abdominal pain in the pregnant patient will be explored. Of note is the recurring theme that much of what can be done today with regard to diagnostic imaging, both in general and with regard to this specific subset of patients, centers on the use of the non-ionizing modalities of ultrasound and magnetic resonance imaging.
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Affiliation(s)
- Chiedozie A Mkpolulu
- Department of Radiology, Tufts School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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Kani KK, Lee JH, Dighe M, Moshiri M, Kolokythas O, Dubinsky T. Gestatational trophoblastic disease: multimodality imaging assessment with special emphasis on spectrum of abnormalities and value of imaging in staging and management of disease. Curr Probl Diagn Radiol 2012; 41:1-10. [PMID: 22085657 DOI: 10.1067/j.cpradiol.2011.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Gestational trophoblastic disease is a spectrum of disorders of varying malignant potential arising from trophoblastic cells and encompassing hydatidiform moles and persistent trophoblastic neoplasia. Ultrasound is the initial imaging investigation of choice when gestational trophoblastic disease is suspected. Complete hydatiform mole, the most common form of molar pregnancy, usually has a characteristic "cluster of grapes" appearance, especially on second-trimester ultrasounds. Persistent trophobastic neoplasia usually appears as a focal, hypervascular myometrial mass on pelvic ultrasound. Pelvic magnetic resonance imaging is often used as a problem-solving tool in equivocal or complicated cases of gestational trophoblastic disease to assess the degree of invasion into the myometrium and surrounding tissues. Chest x-ray, brain magnetic resonance imaging, and body computed tomography scans are primarily used for the evaluation of metastatic disease, which usually occurs in the context of choriocarcinomas. Choriocarcinoma metastases are usually hypervascular and have a tendency to bleed, features that are reflected in their imaging appearance.
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Use of magnetic resonance analysis for clinical evaluation of the peripheral area of gestational sac in bleeding and non-bleeding ectopic pregnancy cases. Reprod Med Biol 2011; 11:95-100. [PMID: 29699113 DOI: 10.1007/s12522-011-0114-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/19/2011] [Indexed: 10/14/2022] Open
Abstract
Purpose To evaluate preoperative magnetic resonance (MR) imaging features of bleeding and non-bleeding ectopic pregnancy (EP) by comparison with surgical findings. Methods Eighteen suspected EP cases underwent preoperative MR imaging. We classified 8 cases as the bleeding group and 7 cases as the non-bleeding group with or without intra-abdominal bleeding and/or hematoma at the site of EP, and compared, retrospectively, gestational sac (GS)-like structure, particularly the peripheral area of the GS via MR analysis. Excluded were 3 cases that were insufficient for assessing extrauterine GS-like structure: ruptured tubal pregnancy and uterine horn pregnancy. Results GS-like structures were typically observed as low intensity on T1-weighted image (T1WI) and as high intensity on T2-weighted image (T2WI). In non-bleeding cases, most peripheral areas of the GS were of intermediate intensity on T1WI and high intensity on T2WI. Most bleeding cases were of high intensity on T1WI and low to high intensity on T2WI. Furthermore, the peripheral area of the GS was of higher intensity on T1WI with fat suppression than on T1WI. Conclusions It is clear that MR imaging is effective for diagnosis of cases of suspected EP. EP conditions may be predicted by signal intensity of the peripheral area of the GS via MR analysis.
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Ruptured intramural pregnancy with myometrial invasion treated conservatively. Case Rep Obstet Gynecol 2011; 2011:965910. [PMID: 22567521 PMCID: PMC3335711 DOI: 10.1155/2011/965910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/23/2011] [Indexed: 01/26/2023] Open
Abstract
Background. Intramural pregnancy is a rare form of ectopic pregnancy, difficult to diagnose and generally complicated by uterine rupture. Case. A 38-year-old woman, gravida 5 para 1, was diagnosed with intramural pregnancy by ultrasound and confirmed with MRI. A uterine rupture occurred, which lead to laparotomy and a conservative treatment. Conclusion. Early diagnosis is necessary for conservative treatment.
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Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc 2011; 25:3479-92. [PMID: 21938570 DOI: 10.1007/s00464-011-1927-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/24/2011] [Indexed: 12/11/2022]
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Nulman I, Edell H. Paediatric outcomes following in utero exposure to the diagnosis and treatment of maternal malignancy. Eur J Cancer 2011; 47 Suppl 3:S217-29. [DOI: 10.1016/s0959-8049(11)70168-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lidder S, Lang K, Lee HJ, Masterson S, Kankate R. Bilateral Hip Fractures Associated with Transient Osteoporosis of Pregnancy. J ROY ARMY MED CORPS 2011; 157:176-8. [DOI: 10.1136/jramc-157-02-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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