case report of Ggeneralized uterine arteriovenous malformation after molar pregnancy in an infertile woman

Background: Uterine arteriovenous malformation [UAVM] is a rare vascular condition in reproductive age presented mostly with bleeding. Although this malformation is infrequent, it is potentially life-threatening. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method

Case: The case is a 30-yr-old woman with a history of eight-yr infertility.following intrauterine insemination treatment, she had a molar pregnancy. Despite methotrexate treatment, there was persistent vaginal bleeding. Assessment of this patient was done with transvaginal sonography and color Doppler. According to suspicious appearances, angiography was planned for confirmation of UAVM

Conclusion: UAVM is one of the molar pregnancy complications. The first step for diagnosis of UAVM is transvaginal ultrasonography and color Doppler assessment. Embolization is the best treatment for women who intend to preserve fertility

Hysterosalpingography in the assessment of congenital cervical anomalies

Cervical abnormalities may be congenital or acquired. Congenital anomalies of the cervix are rarely isolated, and more commonly accompany other uterine anomalies. Various imaging tools have been used in the assessment of Müllerian duct anomalies [MDAs]. Currently, magnetic resonance imaging [MRI] is the modality of choice for definitive diagnosis and classification of these MDAs. Hysterosalpingography is a basic tool for evaluation of infertility and allows us to detect a spectrum of anatomical malformations of the utero-cervix in the setting of MDAs. It provides good outlines of the uterine cavity and fallopian tubes, as well as the cervical canal and isthmus. However, hysterosalpingograms [HSG] cannot be performed in patients with isolated congenital maldevelopment [agenesis/disgenesis] of the cervix. This part of pictorial review illustrates the various radiographic appearances of congenital malformations of the utero-cervix with a brief overview of the embryologic features. Accurate diagnosis of such cases is considered essential for optimal treatment and categorization of each anomaly

Adnexal masses or perineural [tarlov] cysts? Differentiation by imaging techniques: a case report

Background: Perineural cysts formed within the nerve-root sheath at the dorsal root ganglion. They are most commonly located in the arachnoid covering the junction of the dorsal ganglion and nerve root. They are usually asymptomatic, incidental findings, usually located in the lumbar and sacral region of the spinal canal. It is important to consolidate the imaging findings of this rare disease so clinicians can become more clinically relevant in the evaluation of these cysts

Case: Herein we report a case of perineural cyst misdiagnosed with hydrosalpinx by pelvic ultrasonography and finally diagnosed with magnetic resonance image

Conclusion: Perineural cyst should be considered, in the presence of bilateral adnexal masses separated from the ovaries in pelvic sonography

Outcome of isolated fetal choroid plexus cyst detected in prenatal sonography among infertile patients referred to Royan Institute: a 3-year study

Several studies have assessed the correlation of fetal choroid plexus cyst [CPC] and the risk of congenital anomalies, but few ones have discussed isolated CPC [with no other abnormal sonographic finding]. The aim of this study was to determine the outcome of isolated fetal choroid plexus cyst and to specify its clinical significance. This cross sectional study was carried out at Royan Institute in Tehran, Iran, between April 2009 and December 2012. All prenatal sonographies in this period of time were assessed using a computerized database and fetuses who had isolated CPC were recruited in the study. Sonography reports, mother serum screening test results, fetal echocardiography and amniocentesis were evaluated until birth. A follow-up phone call was made to all individuals to learn about the neonatal outcomes. Overall, 6240 prenatal sonographies were performed in this setting during this period. Isolated CPC was detected in 64 fetuses. The results of double test [N=30], triple test [N=5] and fetal echocardiography [N =24] were normal. Quadruple test result showed 3 abnormal out of 29 cases that all had normal karyotypes. Four samples were dropped out due to premature rupture of membranes [N=3] and intrauterine fetal death [N=1]. It was found that the outcomes of all remaining fetuses [N=60] were normal and no anomaly ones were seen until birth. Isolated CPC is a benign regressive condition with no clinical significance

Hysterosalpingographic appearances of female genital tract tuberculosis: part I. fallopian tube

Female genital tuberculosis [TB] remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome [AIDS]. Genital TB is commonly asymptomatic, and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools, such as computerized tomography [CT] scan, magnetic resonance imaging [MRI] and ultrasongraphy, hysterosalpingography is still the standard screening test for evaluation of tubal infertility and a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography [HSG] from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and "leopard skin tube". Part II describes adverse effects of tuberculosis on structure of endometrium and radiological specific findings such as "dwarfed" uterus with lymphatic intravasation and occluded tubes, "T-shaped" tuberculosis uterus, "pseudounicornuate" uterus and "Collar-stud abscess", which have not been encountered in the majority of non-tuberculosis cases

Sonographic findings in partial type of trisomy 18

Trisomy 18 [Edwards syndrome] is the second most common trisomy among live born fetuses, with poor prognosis. Estimate of its incidence is between 1 in 4000- 16000 live births. Most of the chromosomal abnormalities in fetuses are detected by prenatal ultrasound findings in the first and second trimesters. In this case report, we present a partial type of trisomy 18 occurring through de novo unbalanced translocation of chromosomes 18 and 21. The ultrasound features enabling the early detection of trisomy 18 include a delayed ossification of calvarium combined with early onset of fetal growth restriction [FGR] and the absence of nasal bone through performing triple test followed by amniocentesis. Finally, the parents decided to terminate the pregnancy

Hysterosalpingographic appearances of female genital tract tuberculosis: part II: uterus

Female genital tuberculosis remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome. Genital tuberculosis [TB] is commonly asymptomatic and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools such as computed tomography [CT] scan, magnetic resonance imaging [MRI] and ultrasongraphy, hysterosalpingography has been considered as the standard screening test for evaluation of tubal infertility and as a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography [HSG] from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and the "leopard skin tube". Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases

Various hysterosalpingography findings of female genital tuberculosis: a case series

Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography [HSG]. The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis

Uterine cavity assessment in infertile women: sensitivity and specificity of three-dimensional hysterosonography versus hysteroscopy

Assessment of uterine abnormalities is a core part in infertility evaluation. The aim of this study was to evaluate the sensitivity and specificity of three-dimensional hysterosonography [3-DHS] in the diagnosis of uterine abnormalities in infertile women. The infertile women who visited Royan Institute and referred to 3-DHS consecutively, prior to in vitro fertilization, from 2010-2011 included in this cross-sectional study. For patients who underwent hysteroscopy in addition to 3-DHS [214/977], the verification bias adjusted sensitivity and specificity of 3-DHS which were calculated by global sensitivity analysis method. Hysteroscopy was used as the gold standard for diagnosis of uterine abnormalities. Histological diagnosis of resected endometrial tissues by hysteroscopy was assessed and the adjusted sensitivity and specificity of 3-DHS and hysteroscopy in detection of polyp or hyperplasia were determined. Histopathologic results were considered as the gold standard for diagnosis of polyp or hyperplasia. The overall sensitivity and specificity for 3-DHS in diagnosis of uterine anomalies considering hysteroscopy as the gold standard were 68.4% and 96.3% respectively. Sensitivity and specificity of hysteroscopy in diagnose of polyp or hyperplasia was calculated at 91.3% and 81.4% respectively. Sensitivity and specificity of 3-DHS in diagnosis polyps or hyperplasia was calculated at 91.4% and 80.2% respectively. The results of present study proved that, compared to hysteroscopy; 3-DHS has a reliable specificity for diagnosis of uterine abnormalities. Sensitivity and specificity of 3-DHS and hysteroscopy in detecting polyp or hyperplasia regarding histopathology as the gold standard was the same

Incomplete cesarean scar rupture

Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies

Evaluation of Intrauterine structural pathology by three-dimensional sonohysterography using an extended imaging method

Structural intrauterine abnormalities are an important cause of infertility, recurrent pregnancy loss and bleeding or pain associated with a poor reproductive outcome. Various diagnostic methods have been applied to detect these lesions such as hysterosalpingography, hysteroscopy and sonohysterography. More recently, three-dimensional extended imaging [3DXI] provides the ability to obtain sequential sections of acquired volume scans in A, B and C planes. Here, we briefly discuss the technique of saline infusion sonography, followed by a review of sonohysterographic characteristics of intracavitary pathologies with more focus on some definitions and measurements

Cervical ectopic pregnancy following assisted reproductive technology: a case report

Cervical ectopic pregnancy [EP] is an infrequent, life-threatening form of ectopic gestation pregnancy that implants within the endocervical canal. With the increase in use of assisted reproductive technology [ART] worldwide and more liberal use of transvaginal sonography [TVS] during early pregnancy, more cases of cervical ectopic pregnancy are being diagnosed. Early diagnosis of this condition by using ultrasound imaging allows for prevention of maternal morbidity due to hemorrhage and leads to conservative management of this condition.We present the case of a 38-year old woman [gravida 1, para 0] who was found to have acervical ectopic pregnancy at six weeks of gestation.

True unicornuate uterus- Pseudounicornuate uterus

A 27 year old patient presented with primary infertility of 3 years' duration and also a history of myomectomy [5 years ago] was referred to our infertility clinic for investigation of infertility. The latest Hysterosalpingography [HSG] revealed an obstructed left fallopian tube with apparently a unicornuate uterus with luminal contour irregularity and normal left fallopian tube [Figure 1]. Significant information in her past medical history revealed that she had another HSG two years before and her first hysterosalpingography [HSG] showed a apparently unicornuate uterus. Additional significant information in comparison with second HSG revealed that both fallopian tubes were opacified [Figure 2]. In this case medical history also included hysteroscopic diagnosis of adhesion following open myomectomy at the age of 22. Comparison of previous graphies and hysteroscpic findings lead to a suggestion of pseudounicornuate uterus. Intrauterine adhesions develop after trauma to the basal layer of the endometrium. Unilateral excessive scarring of the uterus may lead to an obliteration of the uterine lumen resulting in an image that can mimic a unicornuate uterus [pseudounicornuate uterus] [1]. A true unicornuate uterus should be excluded from pseudounicornuate uterus by a] horizontally oriented in its long axis due to deficient development of mullerian ducts b] smooth or regular contour c] with one tube. While pseudounicornuate uterus look like acquired lesion and cicatrisation leads to a usually irregular contour and uterus is more vertical in its long axis [2]. Obtaining an accurate history, comparison of previous sonographic or laparoscopic findings, and awareness about this image of synechiae are the critical steps in differentiating a pseudounicornuate uterus from true unicornuate uterus

Application of 3D ultrasonography in detection of uterine abnormalities

Structural pathologies in the uterine cavity such as m_llerian duct anomalies [MDAs] and intrauterine lesions [fibroids, polyps, synechiae] may have important roles in subinfertility, implantation failure and pregnancy outcome. Various imaging modalities such as hysterosalpingography [HSG], sonography, laparoscopy and hysteroscopy are used in the evaluation of MDAs and intrauterine lesions. Recently, three-dimensional ultrasound [3DUS] has been introduced as a non-invasive, outpatient diagnostic modality. With increased spatial awareness, it is superior to other techniques used for the same purpose

[Effect of ultrasound on parthenogenic activation of mouse oocyte]

Artificial stimulation of mouse oocyte, in the absence of sperm contribution, can induce its parthenogenic activation of oocyte. Ultrasound is one of the newest methods for artificial activation of mammal oocytes, and its successful utilization in pig oocyte activation has been recently reported. Our objective was to assess the effect of ultrasound on mouse oocyte activation. Our groups included1 control group, 3 experimental groups consisting of 1, 2 and 3 repetitions of ultrasound exposure, and 3 sham groups handled similar to experimental groups but ultrasound system was off during treatments. In experimental groups, adult female NMRI mice at the interval between pregnant mare serum gonadotropin [PMSG] and human corionic gonadotropin [hCG] injections, were exposed to continuous ultrasound with 3.28 MHz frequency and peak intensity [I pk]=355 mW/cm2. Sixteen hours after injection of hCG, the mice were euthanized and their oocytes were collected; thereafter, parthenogenic oocytes were counted. Data analysis using the ANOVA test shows a significant increase in the number of parthenogenic oocytes in mice with 3 overall exposures to ovarian ultrasound [p<0.05]. A significant decrease in the number of metaphase II [MII] oocytes numbers was also seen in mice treated with ultrasound [p<0.05]. Ultrasound is thought to induce pores generation in oocyte membranes and provides an easier inward transport of Ca++ into oocytes. This phenomenon can induce meiosis resumption in immature oocytes. With increased exposure repetitions from 1 to 3 times and greater Ca++ arrival, oocytes can be parthenogenetically activated

Holoprosencephaly: a case report and review of prenatal sonographic findings

Holoprosencephaly is a rare intracranial abnormality. The incidence of holoprosencephaly is between 0.56-0.63 of 10,000 live-born infants 10. It has classified into three degrees, alobar, semilobar and lobar. In this case report we are introducing a case of Holoprosencephaly, in 13 weeks of pregnancy which was twin. We could identified this abnormality and the reduction was done in the appropriate time. The role of prenatal sonography in recognition of the malformation and prognostic value of these features are discussed