Role of transvaginal sonography in the diagnosis of retained products of conception

Introduction The aim of this study was to evaluate the criteria of endometrial thickness to detect retained products of conception following first trimester spontaneous abortion or elective pregnancy termination. Methods This was a retrospective study on 116 patients who underwent uterine re-evacuation with a diagnosis of retained products of conception based on clinical and sonographic findings. Pathologic reports of samples obtained during re-evacuation were reviewed for the presence of gestational tissue. Endometrial thickness determined by transvaginal sonography and certain clinical features (gestational age and interval between initial curettage and re-evacuation, which may affect presence or absence of gestational tissue, parity, indication for initial curettage) were noted. The sensitivity and specificity of sonographic measurement of endometrial thickness for detecting retained products of conception were assessed. Results Histopathologic reports confirmed the diagnosis of retained products of conception in 66 of 116 patients (56.9%). Percentage of nulliparity and the time elapsed between initial curettage and re-evacuation were significantly high in patients with retained products of conception. The sensitivity and specificity of endometrial thickness greater than 13 mm for detecting retained products of conception were 85 and 64%, respectively. Conclusion An endometrial thickness of 13 mm or more, detected by transvaginal sonography, has the best diagnostic efficiency for detection of retained products of conception following first trimester spontaneous abortion or elective pregnancy termination.     

Recurrent bilateral renal agenesis

Bilateral renal agenesis is usually a sporadic occurrence; recurrence in the same family is rare. A case of recurrent bilateral renal agenesis is presented.     

Size of the fetal adrenal in bilateral renal agenesis

Bilateral renal agenesis is a fetal malformation incompatible with extrauterine life. Accurate prenatal diagnosis is essential for patient counseling. False-negative diagnoses have been reported and were attributed to the sonographic misidentification of apparently hypertrophied fetal adrenal glands as fetal kidneys. To study the relationship between renal agenesis and adrenal size, we reviewed autopsy records from 11 affected fetuses that had undergone careful autopsy and organ weight determination in our laboratory. Anomalies of distant structures were present in five affected fetuses. A sonographic diagnosis of adrenal hypertrophy had been made in two cases. In four of 11 fetuses, the glands had taken on a flattened discoid appearance. The autopsy records of 240 normal fetuses were similarly reviewed, and regression lines were generated for adrenal weight based on foot length and crown-rump length. The adrenal weights from affected fetuses were well within normal limits when compared with these normal regression lines and with organ weight standards from the literature. We conclude that adrenal hypertrophy is not a common finding in this syndrome and that the reported false-negative diagnoses are more likely attributable to a change in adrenal shape rather than a true increase in adrenal mass.     

Cost-effectiveness of transvaginal sonography and saline infused sonography in the evaluation of menorrhagia.

OBJECTIVES: To assess the cost-effectiveness of transvaginal sonography (TVS) and saline infused sonography (SIS) in the diagnostic work-up of women with menorrhagia. METHODS: We performed a decision analysis in which we compared the percentage of patients treated successfully and cost of six strategies for the evaluation of menorrhagia: (0) hormonal treatment, (I) treatment of all patients with balloon ablation, (II) TVS and therapeutic hysteroscopy, (III) TVS, SIS and therapeutic hysteroscopy, (IV) SIS and therapeutic hysteroscopy, and (V) diagnostic hysteroscopy and therapeutic hysteroscopy. Hormonal treatment was considered to be the reference strategy to which the five strategies were compared. Data were obtained from the published literature. In order to evaluate the robustness of our results, we performed extensive sensitivity analyses, in which we varied sensitivity and specificity of TVS and hysteroscopy, the prevalence of intracavitary abnormalities, as well as costs of TVS and SIS. RESULTS: We found that the strategy starting with SIS (IV) and the strategy with diagnostic hysteroscopy (V) revealed the highest number of patients treated successfully for menorrhagia. In terms of cost-effectiveness, SIS for all patients was superior over immediate diagnostic hysteroscopy for all patients. Strategies starting with TVS were less effective than the strategy starting with SIS. CONCLUSIONS: We recommend SIS as the procedure of first choice in the work-up for women with menorrhagia.     

彩色多普勒阴道超声对诊断恶性畸胎瘤的价值

目的探讨彩色多普勒阴道超声及血清甲胎蛋白（AFP）测定对诊断恶性畸胎瘤的价值。方法对2000年～2005年我院收治畸胎瘤患者465例，其中未成熟畸胎瘤13例，成熟畸胎瘤恶变3例，进行回顾性分析，着重探讨彩色多普勒阴道超声下肿物声像图特征及血流情况。部分患者进行了血清AFP测定。结果彩色多普勒阴道超声术前诊断恶性畸胎瘤及恶性卵巢肿瘤10例（10／16），符合率62．5％。未成熟畸胎瘤组9例进行了AFP测定，阳性6／9例（66．7％）；在成熟畸胎瘤恶变3例患者中，AFP均为阴性。结论彩色多普勒超声对恶性畸胎瘤诊断符合率较高，结合血清AFP含量测定，有助于对未成熟畸胎瘤，畸胎瘤恶变及卵黄囊瘤的鉴别。     

Anencephaly in a fetus with osteogenesis imperfecta: early diagnosis by transvaginal sonography.

Early prenatal diagnosis of osteogenesis imperfecta at 14 weeks' gestation by transvaginal sonography is reported. An anencephalic fetus was found at autopsy, although on sonographic examination complete brain tissue had been observed. A possible explanation for these findings and theories on the pathogenesis of anencephaly are discussed.     

Familial bilateral vas deferens agenesis.

Two brothers with bilateral vas deferens agenesis are described, one of them with a chromosome mosaicism (46,XX/47,XXY). To our knowledge, there are not any previous reports of both conditions existing simultaneously. The patients consulted us because of infertility; they have normal sexual function, normal physical examination, but typical semen analyses with azoospermia, low semen volume, low pH, and negative fructose test. It appears to us that bilateral vas deferens agenesis may be genetic in origin in some patients.     

阴道超声对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值

目的探讨阴道超声及血清CA125测定对诊断治疗卵巢子宫内膜异位囊肿及子宫腺肌病的价值。方法对卵巢子宫内膜异位囊肿及子宫腺肌病患者631例进行回顾性分析，术前均经阴道超声检查，部分患者进行了血清CA125测定。结果阴道超声检查卵巢子宫内膜异位囊肿符合率98．7％；子宫腺肌病符合率91．7％；卵巢子宫内膜异位囊肿合并子宫腺肌病符合率95．1％。血清CA125检查卵巢子宫内膜异位囊肿，阳性率39．4％；子宫腺肌病阳性率52．2％；卵巢子宫内膜异位囊肿合并子宫腺肌病阳性率59．2％。结论阴道超声可做为较准确诊断卵巢子宫内膜异位囊肿及子宫腺肌病的首选方法。阴道超声下囊肿穿刺是治疗卵巢子宫内膜异位囊肿的简便、有效的方法之一。血清CA125测定可做为卵巢子宫内膜异位囊肿及子宫腺肌病的协助诊断方法，应进一步完善对照组的研究。     

Prenatal diagnosis of bilateral diaphragmatic hernia by fetal sonography

This report describes a case of prenatally diagnosed bilateral diaphragmatic hernia. At 22 weeks' gestation, ultrasound revealed a cystic structure behind the fetus's heart on the axial image at the level of the cardiac four-chamber view. This suggested a left-sided congenital diaphragmatic hernia with herniation of the stomach into the left hemithorax. However, the left-to-right midline shift of the heart was minimal, which is not typical of left-sided congenital diaphragmatic hernia. Throughout the 30th week of gestation, the right and left branches of the pulmonary artery were hypoplastic compared with the values in normal fetuses of the same gestational age. The presumptive diagnosis was bilateral congenital diaphragmatic hernia. A female newborn weighing 2900 g was delivered at 37 weeks' gestation, and she died at 7 h of age. An autopsy revealed large defects on both sides of the diaphragm. In conclusion, prenatal diagnosis of bilateral diaphragmatic hernia is possible with fetal sonography.     

Transabdominal and transvaginal sonography of ovarian masses.

This chapter outlined the sonographic appearances of most ovarian tumors using both transabdominal and transvaginal sonography. The use of transabdominal and transvaginal sonography for the early detection of ovarian carcinoma seems promising and should be pursued in several institutions as clinical trials.     

Accuracy of transvaginal sonography,sonohysterography and hysteroscopy in diagnosis of intrauterine pathology

OBJECTIVES: Sonohysterography (SHG) is a relatively new technique in evaluation of intrauterine disorders. We compared the diagnostic accuracy of this method with that of transvaginal sonography(TVS) and diagnostic hysteroscopy (DH) in diagnosis of intracavitary abnormalities in women with abnormal uterine bleeding, inconclusive endometrial view at TVS and thickened endometrium. METHODS: In prospective study, pre- and postmenopausal women underwent TVS, SHG, and DH. The findings at TVS and SHG were compared with hysteroscopic and histologic findings (obtained from operative hysteroscopy, hysterectomy and d&c). Sensitivity, specificity, positive and negative predictive values were calculated for focally growing lesions. RESULTS: 150 patients were included in the study. There was very good agreement between SHG and DH in the diagnosis of focally growing lesions. SHG was more sufficient in detecting intracavitary abnormalities than TVS. Problems with distention of the uterine cavity were due to cervical stenosis and endometrial carcinoma. CONCLUSION: SHG is more accurate in the diagnosis of intracavitary abnormalities than is TVS. SHG is almost as good as DH at detecting focally growing lesions in the uterine cavity.     

Alobar holoprosencephalic embryo detected via transvaginal sonography.

The incorporation of high-frequency transvaginal probes in commercial ultrasonic equipment allows now for the earlier detection of fetal malformations and the possibility of interrupting pregnancy when such an anomaly is incompatible with postnatal life. We describe here a case of alobar holoprosencephaly associated with serious facial anomalies, diagnosed via transvaginal sonography during the 10th week of amenorrhea. A cytogenetic study was carried out by transabdominal chorial biopsy and diagnostic confirmation by necropsy was made after termination. In order to be able to counsel patients on the advisability of future pregnancies we stress the importance of making a cytogenetic study of the embryo.     

阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

经阴道三维超声诊断子宫内膜癌肌层浸润的价值

目的　探讨经阴道三维超声诊断子宫内膜癌肌层浸润的价值。方法　收集 2 0 0 2年1月至 2 0 0 3年 3月经诊刮确诊并首选手术治疗的子宫内膜癌患者 53例 ,术前 1周内行经阴道二维超声 ,并应用三维超声的多平面成像技术和体积测量功能对肌层浸润深度作出评估 ;同时记录其临床病理指标。结果　 (1)患者年龄 3 8～ 77岁 ;肌层浸润深度 :无、浅、深肌层浸润者分别为 4、3 1、18例 ;病理类型 :子宫内膜样腺癌、非子宫内膜样腺癌分别为 43、10例 ;病理分化程度 :高、中、低分化分别为2 8、13、12例 ;手术病理分期 :Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为 3 3、10、8、2例。 (2 )三维超声的多平面成像技术和二维超声诊断浅肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别 92 %、10 0 %、10 0 %、67%和 44%、10 0 %、10 0 %、2 1% ,两者分别比较 ,差异均有极显著性 (χ2 =13 2 0 11,P =0 0 0 5) ;三维超声的多平面成像技术和二维超声诊断深肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别为 72 %、86%、72 %、86%和 75%、84%、67%、89% ,两者分别比较 ,差异均无显著性 (χ2 =0 0 0 0 0 ,P>0 0 5)。(3 )三维超声的体积测量功能测量的浅、深肌层浸润肿瘤的体积分别为 1 12cm3(Q2 5 75 =1 12～ 4 49)和 9 16cm3(     

Recurring bilateral renal agenesis diagnosed by ultrasound with the aid of amnioinfusion at 18 weeks' gestation.

Recurrent bilateral renal agenesis in siblings is very rare. Presented is a case diagnosed with sonographically aided amnioinfusion at 18 weeks in a woman with an infant affected with the same condition in a previous pregnancy.     

Diagnosis of ureterocele with transvaginal sonography

We report here the case of a 49-year-old Japanese woman who presented to the clinic for uterine cervical cancer screening and who had a history of repeated cystitis. Normal imaging demonstrated no abnormalities of the genital organs; however, transvaginal ultrasound revealed ureterocele. Given the lack of ureterocele-related symptoms and the absence of hydronephrosis, the patient was followed up using repeat sonographic studies and intravenous pyelography. In conclusion, transvaginal sonography is a useful tool in the diagnosis of urinary diseases. In patients with recurring urological symptoms, it is important to check for gynecological diseases as well as urologic diseases. This can be provided well with transvaginal sonography.     

First and early second-trimester diagnosis of fetal urinary tract anomalies using transvaginal sonography

Urinary tract anomalies are common. Prenatal diagnosis is important and enables either special obstetric management or termination of pregnancy and probably in the future, intrauterine intervention. Transvaginal sonography (TVS) allows visualization of the normal and anomalous fetal urinary tract at an early stage. One thousand nine hundred and forty women were examined via TVS at an early stage of pregnancy between 10 and 16 weeks from the last menstrual period (LMP) and 35 anomalies (1.8 per cent) were clearly identified: 29 cases of low urinary tract obstruction, 2 cases of multicystic dysplastic kidney, 2 cases of polycystic kidney (infantile type), 1 case of double collecting system, and 1 case of horseshoe kidney. Potter syndrome could be ruled out in three patients who had delivered fetuses suffering from this anomaly in previous pregnancies. The concise and early identification of anomalies makes TVS an important aid in the hands of the obstetrician, ultrasonographer, and neonatologist.