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GYN ultrasound

17 studies9 challenges

Describe the uterus, the endometrium and each adnexa before naming anything. Every image opens with how to read it; switch to Practice when you are ready to be tested.

Sagittal transvaginal ultrasound with a short bright line behind the uterus, outside the endometrial cavity, marked by calipersTransvaginal, sagittal

GYN ultrasound · Contraception

IUD not found in the cavity

Diagnosis

Perforated IUD lying behind the uterus within a foreign-body granuloma (inserted 36 years earlier)

Normal against abnormal

The plane, and which way is up

Transvaginal sagittal and transverse, and three-dimensional coronal when available: the intrauterine device is a bright echogenic line with shadowing, expected in the upper cavity.

Look for, in order

  1. Is the device in the cavity, and where: the vertical arm in the endometrial canal, the arms at the fundus?
  2. The distance from the top of the device to the fundal serosa and to the top of the cavity.
  3. If it is not in the cavity: in the myometrium (embedded or perforating), in the cervix, or absent (expelled, or in the abdomen; an X-ray finds it).

What normal looks like

The device's stem in the endometrial cavity with its arms in the cornua; a copper device is brightly echogenic along its length, a levonorgestrel device shows its ends and an acoustic shadow.

Trap. Strings not seen at the cervix do not mean expulsion; scan first, then X-ray if the uterus is empty.

Describe it in this order

  1. The plane and the approach
  2. Uterus: size, position, outline, myometrium
  3. Endometrium: thickness, echogenicity, outline, cavity contents
  4. Cervix
  5. Right adnexa, then left: ovary seen, any mass described not named
  6. Pouch of Douglas: free fluid
  7. Then, and only then, the impression

Findings

  • The endometrial cavity does not contain a device
  • A 2 cm hyperechoic line lies behind the uterus, surrounded by a hypoechoic rim

What it means for the patient

Perforation usually happens at insertion and is often silent. A device outside the cavity is removed, usually laparoscopically. This example, decades after insertion, shows the granuloma that forms around an old copper device.

Framework: SOGC, Canadian contraception consensus (2015).

OBGynSpace Tutor

It coaches the description; it does not read the image for you and will not name the diagnosis before you commit.