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Zhu GG, Ludwig DR, Rogers DM, Olpin JD, Barker E, Freeman EA, Eisenberg DL, Siegel CL. CT imaging of intrauterine devices (IUD): expected findings, unexpected findings, and complications. Abdom Radiol (NY) 2024; 49:237-248. [PMID: 37907685 DOI: 10.1007/s00261-023-04052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
Intrauterine devices (IUDs) are a commonly used form of long-acting reversible contraception, which either contain copper or levonorgestrel to prevent pregnancy. Although symptomatic patients with indwelling IUDs may first undergo ultrasound to assess for device malposition and complications, IUDs are commonly encountered on CT in patients undergoing evaluation for unrelated indications. Frequently, IUD malposition and complications may be asymptomatic or clinically unsuspected. For these reasons, it is important for the radiologist to carefully scrutinize the IUD on any study in which it is encountered. To do so, the radiologist must recognize that normally positioned IUDs are located centrally within the uterine cavity. IUDs are extremely effective in preventing pregnancy, though inadvertent pregnancy risk is higher with malpositioned IUDs. Presence of fibroids or Mullerian abnormalities may preclude proper IUD placement. Radiologists play an important role in identifying complications when they arise and special considerations when planning for an IUD placement. There is a wide range of IUD malposition, affecting IUDs differently depending on the type of IUD and its mechanism of action. IUD malposition is the most common complication, but embedment and/or partial perforation can and can lead to difficulty when removed. Retained IUD fragments can result in continued contraceptive effect. Perforated IUDs do not typically cause intraperitoneal imaging findings.
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Affiliation(s)
- Grace G Zhu
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA.
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA.
| | - Daniel R Ludwig
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Jeffrey D Olpin
- Department of Radiology, University of Utah Health, 30 North Mario Capecchi Dr, 2 South, Salt Lake City, UT, 84112, USA
| | - Emily Barker
- Planned Parenthood of St. Louis Region, 4251 Forest Park Avenue, St. Louis, MO, 63108, USA
| | - Emily A Freeman
- OB/GYN and Women's Health Clinic, Cleveland Clinic, 850 Columbia Road Suite 330, Cleveland, OH, 44145, USA
| | - David L Eisenberg
- Department of Obstetrics and Gynecology, Washington University in St. Louis, 660 S. Euclid Ave, Mailstop 8064-37-1005, St. Louis, MO, 63110, USA
| | - Cary L Siegel
- Mallickrodt Institute of Radiology, Washington University in St. Louis, 510 South Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
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Mansouri H, Zemni I, souissi M, Henchiri H, Boukhris S, Ayadi MA, Achouri L. Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231181009. [PMID: 37480326 PMCID: PMC10363873 DOI: 10.1177/17455057231181009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called Actinomyces israelii. The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity.
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Affiliation(s)
- Houyem Mansouri
- Department of Surgical Oncology, Regional Hospital of Jendouba, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ines Zemni
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microorganisms and Active Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Malek souissi
- Department of Radiology, Taoufik Hospitals Group, Tunis, Tunisia
| | - Houda Henchiri
- Department of Surgical Oncology, Regional Hospital of Jendouba, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sabrine Boukhris
- Department of Surgical Oncology, Regional Hospital of Jendouba, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Ali Ayadi
- Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Laboratory of Microorganisms and Active Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Leila Achouri
- Department of Surgical Oncology, Regional Hospital of Jendouba, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Hakan Yardimci V, Hande Yardimci A. Is appendectomy always the adequate treatment? Clinical manifestations of isolated actinomycosis in appendix. Turk J Surg 2021; 37:403-407. [DOI: 10.47717/turkjsurg.2021.4015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022]
Abstract
Isolated appendiceal actinomycosis is a rare chronic progressive suppurative infection. Causative agent in humans is gram-positive saprophytic an- aerobic bacteria, Actinomyces Israelii. Herein, it was aimed to present a case of acute appendicitis that developed in a 54-year-old female due to isolated appendiceal actinomycosis. Diagnosis of appendiceal actinomycosis causing acute appendicitis is generally performed postoperatively histopathologi- cally, and appendectomy alone is not sufficient in treatment. It is an important point that should be considered by clinicians that definitive treatment of the infection is possible by appropriate antibiotic use.
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Džupová O, Kulichová J, Beneš J. Disseminated Pelvic Actinomycosis Caused by Actinomyces Naeslundii. Antibiotics (Basel) 2020; 9:antibiotics9110748. [PMID: 33137889 PMCID: PMC7694143 DOI: 10.3390/antibiotics9110748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/16/2022] Open
Abstract
Actinomycosis is a chronic bacterial infection characterized by continuous local spread, irrespective of anatomical barriers, and granulomatous suppurative inflammation. Due to its expansive local growth, it can simulate a malignant tumour. Subsequent hematogenous dissemination to distant organs can mimic metastases and further increase suspicion for malignancy. A case of severe disseminated pelvic actinomycosis associated with intrauterine device is described here. The patient presented with a pelvic mass mimicking a tumour, bilateral ureteral obstruction, ascites, multinodular involvement of the liver, lungs and spleen, inferior vena cava thrombosis and extreme cachexia. Actinomycosis was diagnosed by liver biopsy and confirmed by culture of Actinomyces naeslundii from extracted intrauterine contraceptive device (IUD). Prolonged treatment with aminopenicillin and surgery resulted in recovery with moderate sequelae.
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Affiliation(s)
- Olga Džupová
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
- Correspondence:
| | - Jana Kulichová
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
| | - Jiří Beneš
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic;
- Department of Infectious Diseases, Hospital Na Bulovce, 100 81 Prague, Czech Republic;
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Kim S, Kang SI, Kim S, Jang MH, Kim JH. Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report. Ann Coloproctol 2019; 36:417-420. [PMID: 32054258 PMCID: PMC7837399 DOI: 10.3393/ac.2019.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.
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Affiliation(s)
- Sungjin Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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Chinnakkulam Kandhasamy S, Rajendar B, Sahoo AK, Nachiappa Ganesh R, Goneppanavar M, Nelamangala Ramakrishnaiah VP. Rare Abdominopelvic Actinomycosis Causing an Intestinal Band Obstruction and Mimicking an Ovarian Malignancy. Cureus 2018; 10:e2721. [PMID: 30079287 PMCID: PMC6067810 DOI: 10.7759/cureus.2721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Actinomyces israelii, a commensal of the bronchial and gastrointestinal tracts, is responsible for the majority of actinomycostic infections in humans. Actinomycosis has widely varying clinical presentations ranging from asymptomatic states to infiltrative mass lesions that mimic malignant abdominopelvic disease. Described as one of the most misdiagnosed diseases, actinomycosis poses challenges to accurate preoperative diagnosis. A 67-year-old woman with no significant medical history presented with features of acute intestinal obstruction. Computed tomography revealed a terminal ileal stricture causing intestinal obstruction and a right ovarian mass lesion. On laparotomy, a granular mass (2×2 cm) at the base of the mesentery and a right ovarian hard nodular growth (3×3 cm) were found that were connected by a dense fibrotic band, causing ileal obstruction with a transitional zone that was 10 cm proximal to the ileocecal junction. The mesenteric granular mass was excised together with the dense fibrotic band, and a right salpingo-oophorectomy was also undertaken. On postoperative histopathological examination, band formations by dense inflammatory tissue with neutrophilic infiltration were observed; moreover, there were sulfur granules that showed a positive reaction on Periodic Acid Schiff staining. The resected ovarian parenchyma showed infiltration by bacterial colonies with Splendore-Hoeppli phenomenon and evoked dense neutrophilic infiltration. The postoperative period was uneventful, and the patient was placed on penicillin therapy for a year. Abdominopelvic actinomycosis should constitute part of the differential diagnosis when evaluating mass lesions, especially in elderly women with a history of intrauterine device (IUD) use.
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Affiliation(s)
| | - Byshetty Rajendar
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Ashok Kumar Sahoo
- General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Rajesh Nachiappa Ganesh
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Mangala Goneppanavar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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Gatti M, Gasparini LE, Grimaldi CM, Abbati D, Clemente S, Brioschi PR, Fumagalli R, Scaglione F. Septic shock due to NSTI caused by Actinomyces Turicensis: the role of clinical pharmacology. Case report and review of the literature. J Chemother 2017; 29:372-375. [PMID: 28398176 DOI: 10.1080/1120009x.2017.1306154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Critical septic patients affected by necrotizing soft tissue infections (NSTI) require an early, aggressive and multidisciplinary treatment. Pharmacokinetic alterations in antibiotic therapy are peculiar in these infections. Clinical pharmacology represents a first step in this setting. We report a case of septic shock due to NSTI in which clinical pharmacology is taken into account.
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Affiliation(s)
- Milo Gatti
- a Department of Oncology and Hemato-oncology , University of Milan , Milan , Italy
| | - Laura Elisa Gasparini
- b Intensive Care Unit 1 , ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Chiara Maria Grimaldi
- c Department of Clinical Microbiology , ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Daniela Abbati
- d Department of Diagnostic Radiological , ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Stefano Clemente
- e Intensive Care Unit , ASST Nord Milano Città Sesto San Giovanni , Italy
| | | | - Roberto Fumagalli
- b Intensive Care Unit 1 , ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Francesco Scaglione
- a Department of Oncology and Hemato-oncology , University of Milan , Milan , Italy
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Zamani F, Sohrabi M. Clinical, endoscopic, and histopathological aspects of sigmoid actinomycosis; a case report and literature review. Middle East J Dig Dis 2015; 7:41-4. [PMID: 25628853 PMCID: PMC4293800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/18/2014] [Indexed: 10/28/2022] Open
Abstract
Actinomycosis is a rare and chronic infectious disease caused by a non-spore gram- positive, anaerobic bacterium that rarely infects the colon, in particular the left colon. A 53-year-old woman was referred to us due to chronic abdominal pain, bloating, a few episodes of bloody-mucous rectal discharge, and change of bowel habits. Her medical history and physical examination were unremarkable. Colonoscopy revealed a polypoid mass like lesion located 20 cm proximal to the anal verge above the rectosigmoid junction. Several biopsy samples were taken. Histopathological evaluation showed actinomycosis infection. Consequently the patient was treated with intravenous and then six months oral penicillin. Her complaints and colonic mass resolved totally. Diagnosis of colonic actinomycosis is not an easy task. It is advisable to keep this infection in mind among the differential diagnoses of unusual abdominal masses. Colonoscopy and histopathological examination can be the preferred modality for diagnosis of colonic actinomycosis infection.
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Affiliation(s)
- Farhad Zamani
- 1. GastoIntestinal and Liver Disease Research Centre(GILDRC), Iran University of Medical Sciences, Tehran, Iran
, Corresponding Author: Farhad Zamani, MD Gasterointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran Telefax: + 98 21 88941831
| | - Masoudreza Sohrabi
- 1. GastoIntestinal and Liver Disease Research Centre(GILDRC), Iran University of Medical Sciences, Tehran, Iran
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