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Causa Andrieu PI, Wahab SA, Nougaret S, Petkovska I. Ovarian cancer during pregnancy. Abdom Radiol (NY) 2023; 48:1694-1708. [PMID: 36538079 PMCID: PMC10627077 DOI: 10.1007/s00261-022-03768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 05/01/2023]
Abstract
Adnexal masses during pregnancy are a relatively uncommon entity. Their clinical management is challenging given the overlapping features of certain entities on imaging and histopathology, which can mimic malignancy, and the potential side effects to the mother and fetus, whether expectant management versus surgery is pursued. Ultrasonography with Doppler evaluation is the modality of choice for evaluating adnexal masses during pregnancy. Magnetic resonance imaging is the second-line modality useful when US findings are inconclusive/indeterminate. Most adnexal masses in pregnant patients are benign in origin (e.g., functional cysts, mature cystic teratoma, decidualization of endometrioma), but a few are malignant in origin (e.g., dysgerminoma, granulosa cell tumor). Most cases of adnexal masses are asymptomatic, but complications such as ovarian torsion can occur. This review aims to familiarize the radiologist with the imaging of adnexal lesions during pregnancy so that the radiologist can identify ovarian cancer. Specifically, the review will detail the most common benign and malignant adnexal masses in pregnancy, mimickers, and their corresponding imaging findings on US and MRI.
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Affiliation(s)
- Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Shaun A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Stephanie Nougaret
- Department of Radiology, Cancer Institute of Montpellier, Montpellier, France
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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2
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Daolio J, Sperduti S, Casarini L, Falbo A, Materazzo C, Aguzzoli L, Villani MT. Spontaneous and iatrogenic ovarian hyperstimulation syndrome in the absence of FSHR mutations: a case report of two unexpected cases. BMC Med Genomics 2023; 16:45. [PMID: 36882810 PMCID: PMC9990314 DOI: 10.1186/s12920-023-01473-3] [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: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian hyperstimulation (COH). It is a potentially life-threatening condition that usually occurs either after human chorionic gonadotropins (hCG) administration in susceptible patients or as a result of an implanting pregnancy, regardless of whether it was achieved by natural conception or infertility treatments. Despite many years of clinical experience regarding the adoption of preventive measures and the identification of patients at high risk, the pathophysiology of OHSS is poorly understood and no reliable predictive risk factors have been identified. CASES PRESENTATION We report about two unexpected cases of OHSS following infertility treatments, occurring after freeze-all strategy with embryo cryopreservation approaches. The first case developed spontaneous OHSS (sOHSS), despite efforts to prevent its manifestation by a segmentation approach, including frozen embryo replacement cycle. The second case developed a late form of iatrogenic OHSS (iOHSS), even though the absence of any risk factors. No mutations in the follicle-stimulating hormone (FSH) receptor (FSHR)-encoding gene were detected, suggesting that the high levels of hCG due to the twin implanting pregnancies could be the only triggering factor of OHSS outbreak. CONCLUSION Freeze-all strategy with embryo cryopreservation cannot entirely prevent the development of OHSS, which may occur in its spontaneous form independently from the FSHR genotype. Although OHSS remains a rare event, all infertile patients requiring ovulation induction or controlled ovarian stimulation (COS) may be at potential risk of OHSS, either in the presence or in the absence of risk factors. We suggest closely monitoring cases of pregnancy following infertility treatments in order to provide early diagnosis and adopt the conservative management.
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Affiliation(s)
- Jessica Daolio
- Quality and Accreditation Office, Medical Directorate ASMN, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, viale Umberto I 50, 42123, Reggio Emilia, Italy.
| | - Samantha Sperduti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Campi 287, 41125, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, via Campi 287, 41125, Modena, Italy
| | - Livio Casarini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, via Campi 287, 41125, Modena, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, via Campi 287, 41125, Modena, Italy
| | - Angela Falbo
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Caterina Materazzo
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Maria Teresa Villani
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, viale Risorgimento 80, 42123, Reggio Emilia, Italy
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3
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Agarwal S, Chamoun D, Flyckt R, Lindheim SR. Clinical Conundrum: Spontaneous Ovarian Hyperstimulation Syndrome. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1181-1184. [PMID: 36410935 DOI: 10.1016/j.jogc.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Shruti Agarwal
- Camran Nezhat Institute, Minimally Invasive & Robotic Surgery, Woodside, CA.
| | | | - Rebecca Flyckt
- University Hospitals of Cleveland, Department of Obstetrics and Gynecology, Beachwood, OH
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH; University of Central Florida College of Medicine, Department of Obstetrics and Gynecology, Orlando, FL; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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4
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Agarwal S, Chamoun D, Flyckt R, Lindheim SR. Raisonnement clinique : Syndrome d'hyperstimulation ovarienne spontanée. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:1185-1189. [PMID: 36410936 DOI: 10.1016/j.jogc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Shruti Agarwal
- Camran Nezhat Institute, Chirurgie minimalement invasive et robotisée, Woodside, Californie.
| | | | - Rebecca Flyckt
- University Hospitals de Cleveland, Département d'obstétrique et gynécologie, Beachwood, Ohio
| | - Steven R Lindheim
- Département d'obstétrique et gynécologie, École de médecine Boonshoft, Université d'État Wright, Dayton, Ohio; Collège de médecine de l'Université de Floride centrale, Département d'obstétrique et gynécologie, Orlando, Floride; Centre de médecine reproductive de l'hôpital Renji, École de médecine, Université Jiao Tong de Shanghai, Shanghai, République populaire de Chine
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5
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Imaging of complications following treatment with assisted reproductive technology: keep on your radar at each step. Abdom Radiol (NY) 2022; 47:328-340. [PMID: 34535828 DOI: 10.1007/s00261-021-03245-y] [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: 05/26/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
Since the advent of assisted reproductive technology (ART), the utilization of ART procedures has become increasingly popular among women seeking to establish pregnancy. Radiologists are therefore likely to encounter the various complications of ART therapy. The most common is ovarian hyperstimulation syndrome; others are multiple, ectopic, and heterotopic pregnancies. Ultrasonography is considered the initial modality to investigate ART complications, However, nonspecific symptoms might need the use of an additional imaging modality, such as computed tomography or magnetic resonance imaging, as a problem-solving tool. This article briefly discusses the steps involved in assisted reproduction. Its aim is to help radiologists become familiarized with the multimodality imaging features of the spectrum of ART-related complications. Their key imaging features and differential considerations are emphasized. This will facilitate the provision of precise and timely diagnoses, and aid the avoidance of fatal consequences.
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De Lucia DR, Castaldo A, D'Agostino V, Ascione R, Pesce I, Coppola L, Catelli A, Radice L. Metastatic choriocarcinoma with hemorrhagic complications and spontaneous ovarian hyperstimulation syndrome: A case report. Radiol Case Rep 2021; 16:3868-3874. [PMID: 34703509 PMCID: PMC8526915 DOI: 10.1016/j.radcr.2021.09.031] [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: 08/24/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023] Open
Abstract
Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as "Choriocarcinoma Syndrome". We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.
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Key Words
- CE-CT, Contrast Enhancement Computed Tomography
- Choriocarcinoma syndrome
- FSH, Follicle Stimulating Hormone
- Gestational choriocarcinoma
- HU, Hounsfield Unit
- Hemorrhagic metastases
- Hypervascular metastases
- LH, Luteinizing Hormone
- MIP, Maximum Intensity Projection
- MPR, Multiplanar Reconstruction
- MRI, Magnetic Resonance Imaging
- OHSS, Ovarian Hyperstimulation Syndrome
- Ovarian hyperstimulation syndrome
- TSH, Thyroid Stimulating Hormone
- US, Ultrasonography
- b-hCG, Beta Human Chorionic Gonadotropin
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Affiliation(s)
- Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Anna Castaldo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Valerio D'Agostino
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Ilaria Pesce
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Luigi Coppola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Antonio Catelli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Leonardo Radice
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
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7
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Nwafor NN, Nyoyoko NP. Spontaneous Ovarian Hyperstimulation Syndrome: A Report of Two Cases from Different Pathogenesis. Niger Med J 2021; 61:269-272. [PMID: 33487851 PMCID: PMC7808280 DOI: 10.4103/nmj.nmj_183_20] [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: 05/25/2020] [Revised: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
Spontaneous ovarian hyperstimulation syndrome (s-OHSS) is a rare finding that occurs in early pregnancy. There is a rapidly increasing ovarian size secreting vasoactive substances that lead to fluid shift into third spaces. This occurs in the absence of exogenous hormonal therapy. We present two cases of s-OHSS. A 35-year-old gravida 4 para 3 presented with complaints of progressive abdominal pain, distension, nausea, vomiting, and difficulty in breathing at 10 weeks gestation. On imaging, a singleton intrauterine gestation, enlarged ovaries containing multiple cysts, and moderate ascites were seen. Second, a 17-year-old primigravida presented with abdominal distension and pain and bleeding per vaginam following 4 months amenorrhea. A bulky uterus containing a large hyperechoic structure with multiple cystic spaces in keeping complete molar gestation and enlarged ovaries containing multiple cysts were seen on ultrasound imaging. The singleton gestation was managed successfully to term with conservative therapy tailored to clinical symptoms.
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Affiliation(s)
- Nkem Nnenna Nwafor
- Department of Radiology, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Nsikak Paul Nyoyoko
- Department of Obstetrics and Gynecology, University of Uyo Teaching Hospital, Uyo, Nigeria
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8
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Al-Shukri MN, Gowri V, Al-Ghafri WM, Nair A. Indications for Abdominal Surgery in Spontaneous Ovarian Hyperstimulation: A Literature Review. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2018.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maryam Nasser Al-Shukri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Wadha Mohammed Al-Ghafri
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
| | - Asha Nair
- Department of Obstetrics and Gynecology, College of Medicine, Sultan Qaboos University, Al-Khoudh, Muscat, Sultanate of Oman
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9
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Patel S, Nath P. Spontaneous Ovarian Hyperstimulation Syndrome: Looking Beyond the Ovary. FERTILITY & REPRODUCTION 2020. [DOI: 10.1142/s2661318220500127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 22-year-old single female with spontaneous ovarian hyperstimulation syndrome (s-OHSS) referred for transvaginal aspiration of follicles. Investigations revealed primary hypothyroidism, mild hyperprolactinaemia and unelevated levels of both follicle stimulating hormone (FSH) and estradiol. Supplementation with L-thyroxine lead to euthyroid status and gradual resolution of signs and symptoms of ovarian hyperstimulation syndrome (OHSS) over 4 months.
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10
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Gui J, Zhang J, Xu WM, Ming L. Spontaneous ovarian hyperstimulation syndrome: Report of two cases. World J Clin Cases 2019; 7:4384-4390. [PMID: 31911922 PMCID: PMC6940325 DOI: 10.12998/wjcc.v7.i24.4384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spontaneous ovarian hyperstimulation syndrome (sOHSS) is extremely rare. It can be divided into four types according to its clinical manifestations and follicle stimulating hormone receptor mutations.
CASE SUMMARY Here we report two cases of sOHSS in Chinese women, one with a singleton gestation developing sOHSS in the first trimester who conceived naturally and the other with a twin pregnancy developing sOHSS in the second trimester after a thawed embryo transfer cycle. Both patients were admitted to the hospital with abdominal distension, ascites, and enlarged ovaries. Conservative treatment was the primary option of management. The first patient had spontaneous onset labor at 40 wk of gestation and underwent an uncomplicated vaginal delivery of a male newborn. The second patient delivered a female baby and a male baby by caesarean section at 35 wk and 1 d of gestation.
CONCLUSION Patients with a history of ovarian hyperstimulation syndrome should be closely monitored. Single embryo transfer might reduce the risk of this rare syndrome.
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Affiliation(s)
- Juan Gui
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
| | - Jie Zhang
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
| | - Wang-Ming Xu
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
| | - Lei Ming
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
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Tonolini M, Foti PV, Costanzo V, Mammino L, Palmucci S, Cianci A, Ettorre GC, Basile A. Cross-sectional imaging of acute gynaecologic disorders: CT and MRI findings with differential diagnosis-part I: corpus luteum and haemorrhagic ovarian cysts, genital causes of haemoperitoneum and adnexal torsion. Insights Imaging 2019; 10:119. [PMID: 31853900 PMCID: PMC6920287 DOI: 10.1186/s13244-019-0808-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/18/2019] [Indexed: 01/06/2023] Open
Abstract
Acute gynaecologic disorders are commonly encountered in daily clinical practice of emergency departments (ED) and predominantly occur in reproductive-age women. Since clinical presentation may be nonspecific and physical findings are often inconclusive, imaging is required for a timely and accurate diagnosis. Although ultrasound is the ideal non-invasive first-line technique, nowadays multidetector computed tomography (CT) is extensively used in the ED, particularly when a non-gynaecologic disorder is suspected and differential diagnosis from gastrointestinal and urologic diseases is needed. As a result, CT often provides the first diagnosis of female genital emergencies. If clinical conditions and scanner availability permit, magnetic resonance imaging (MRI) is superior to CT for further characterisation of gynaecologic abnormalities, due to the excellent soft-tissue contrast, intrinsic multiplanar capabilities and lack of ionising radiation. The purpose of this pictorial review is to provide radiologists with a thorough familiarity with gynaecologic emergencies by illustrating their cross-sectional imaging appearances. The present first section will review the CT and MRI findings of corpus luteum and haemorrhagic ovarian cysts, gynaecologic haemoperitoneum (from either ruptured corpus luteum or ectopic pregnancy) and adnexal torsion, with an emphasis on differential diagnosis. Additionally, comprehensive and time-efficient MRI acquisition protocols are provided.
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Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Valeria Costanzo
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luca Mammino
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties, Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies, Radiology I Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Morotti E, Battaglia C. Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report. Gynecol Endocrinol 2019; 35:657-660. [PMID: 30806108 DOI: 10.1080/09513590.2019.1579791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Spontaneous hyperstimulation syndrome (spOHSS) is a rare event in pregnancies following natural conception. Only a few cases are reported in the scientific literature and result associated with massive ovarian enlargement with multiple cysts, dehydration, and fluid accumulation in the "third space". We report a novel case of spOHSS in a naturally conceived singleton pregnancy. The spOHSS was characterized by massive ovarian enlargement with multiple cysts. No dehydration and no signs of ascites were observed. The pregnancy uneventful evolved up to term.
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Affiliation(s)
- Elena Morotti
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
| | - Cesare Battaglia
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
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13
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Ovarian hyperstimulation syndrome: A review for emergency clinicians. Am J Emerg Med 2019; 37:1577-1584. [PMID: 31097257 DOI: 10.1016/j.ajem.2019.05.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION A great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management. OBJECTIVE This narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature. DISCUSSION OHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications. CONCLUSIONS OHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.
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14
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Ovarian Hyperstimulation Syndrome as a Growing Diagnostic Problem in Emergency Department Settings: A Case Report. J Emerg Med 2019; 56:217-221. [DOI: 10.1016/j.jemermed.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/26/2018] [Accepted: 11/09/2018] [Indexed: 11/20/2022]
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15
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Rao A. Potential imaging findings following assisted reproduction: complications and clinical implications. Emerg Radiol 2017; 25:73-86. [PMID: 28988371 DOI: 10.1007/s10140-017-1561-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022]
Abstract
Recent rapid advances in assisted reproduction (ART) have led to global increase in usage of in vitro fertilization. This in turn has resulted in clinicians and imaging specialists encountering increase in complications associated with ART. The specialists dealing with infertility should be aware of potential complications associated with ART. Early diagnosis of these problems is based on clinician's suspicion and radiologist's awareness of these complications. Many of these conditions may be life threatening. Hence, early diagnosis and treatment of these complications can safeguard the fetal and maternal health.
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Affiliation(s)
- Anuradha Rao
- Associate Consultant, Apollo Hospitals, Bangalore, Karnataka, 560078, India.
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16
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Gil Navarro N, Garcia Grau E, Pina Pérez S, Ribot Luna L. Ovarian torsion and spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report. Int J Surg Case Rep 2017; 34:66-68. [PMID: 28371633 PMCID: PMC5377435 DOI: 10.1016/j.ijscr.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/15/2022] Open
Abstract
Spontaneous ovarian hyperstimulation syndrome (OHSS) can result from hyperstimulation of the follicle-stimulating hormone (FSH) receptor by FSH or other glycoprotein hormones such as chorionic gonadotrophin hormone (hCG), thyroid-stimulating hormone (TSH), and luteinizing hormone (LH); mutations of the FSH receptor gene can make these receptors abnormally sensitive to hCG, TSH, or both. In patients with ovarian cysts and suspected spontaneous OHSS, it is important to determine whether hydatidiform mole, multiple pregnancie, hypothyroidism, glycoprotein-secreting adenoma or FSH receptor mutation are present. Although rare, in the context of spontaneous OHSS and abdominal pain, ovarian complications such as follicular rupture, cyst hemorrhage, or ovarian torsion should always be considered.
Introduction Ovarian hyperstimulation syndrome (OHSS) is extremely rare in spontaneous pregnancies. Spontaneous OHSS can result from glycoprotein hormones stimulating follicle-stimulating hormone receptors (FSHR). Presentation of case We report a twin pregnancy in which ovarian torsion and hemoperitoneum complicating OHSS were treated with left adnexectomy and aspiration. The only trigger for spontaneous OHSS in this case was high levels of chorionic gonadotropin hormone. Discussion Multiple pregnancy, gestational trophoblastic disease, primary hypothyroidism, thyroid-stimulating hormone/gonadotropin-secreting adenomas, and mutations of the FSHR gene may trigger spontaneous OHSS. Conclusion Spontaneous OHSS should be included in the differential diagnosis of acute abdomen in pregnant women; if spontaneous OHSS is diagnosed, the etiology should be determined in order to focus the treatment and avoid future complications.
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Affiliation(s)
- Núria Gil Navarro
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain.
| | - Emma Garcia Grau
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
| | - Sílvia Pina Pérez
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
| | - Laia Ribot Luna
- Department of Obstetrics and Gynecology, Corporació Sanitària Parc Taulí, Parc Tauli, 1, 08208 Sabadell, Spain
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Bellapu S, Guttman J. Use of Point-of-Care Ultrasound for the Diagnosis of Ovarian Hyperstimulation Syndrome. J Emerg Med 2016; 52:e101-e104. [PMID: 27998636 DOI: 10.1016/j.jemermed.2016.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/09/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) occurs when ovaries are overstimulated and enlarged due to fertility treatments resulting in a shift of serum from the intravascular space to the third space, mainly the abdominal cavity. It is the most serious complication of ovarian hyperstimulation for assisted reproduction. CASE REPORT We present the case of a 40-year-old woman who presented with abdominal bloating and nausea 2 weeks after undergoing in vitro fertilization (IVF); she was diagnosed by an outside radiology ultrasound as having a ruptured ovarian cyst. A point-of-care emergency ultrasound performed by the emergency physician made the diagnosis of ovarian hyperstimulation syndrome. This led to more expedient management and obstetrical consultation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Abdominal bloating and nausea are common presenting complaints in pregnant women. OHSS is a rare but potentially fatal complication of IVF. Recognition and early diagnosis by the emergency physician can lead to appropriate intervention and consultation.
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Affiliation(s)
- Sowdhamani Bellapu
- Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Joshua Guttman
- Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
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