Intrauterine Fluid Collection Research Articles

Characteristics of the magnetic resonance imaging findings of cervical gastric-type adenocarcinoma

This study identified the distinct magnetic resonance imaging findings of cervical gastric-type adenocarcinoma (GAS) that can help differentiate it from squamous cell carcinoma (SCC) and usual-type endocervical adenocarcinoma (UEA) and reveal the radiologic-pathologic correlation. All consecutive patients with cervical GAS treated at our hospital from November 2009 to August 2021 were included. The SCC and UEA cases were considered controls. Tumor location, tumor shape, presence and size of cysts, presence of uterine fluid, and apparent diffusion coefficient (ADC) were evaluated. Overall, 18 GAS, 55 SCC, and 23 UEA cases were evaluated. The tumor was located in the entire cervix in 13/18 GAS cases, whereas it was predominantly located in the lower cervix in 38/55 SCC cases and 14/23 UEA cases. Most GAS cases exhibited a diffuse infiltration growth pattern (17/18), whereas most SCC and UEA cases exhibited a mass-forming pattern (39/55 and 20/23, respectively). Moreover, the percentages of cases presenting microcysts or macrocysts and undergoing uterine fluid collection were significantly higher in the GAS group (14/18 and 13/18) than in the SCC and UEA groups. ADC was significantly higher in the GAS group than in the SCC group (1.092×10-3 vs. 0.819×10-3 mm2/s). This study revealed that GAS is characterized by tumor presence in the entire cervix, infiltrative growth pattern, intrauterine fluid collection, and frequent microcyst or macrocyst formation. Moreover, ADC was significantly higher in the GAS group than in the SCC group.

The incidence and importance of the pseudogestational sac revisited

In a pregnancy of unknown location, an intrauterine fluid collection may represent either the early gestational sac of an intrauterine pregnancy, or as reported in previous literature, the pseudogestational sac of an ectopic pregnancy. Various sonographic features have been used to distinguish these 2 entities, but the clinical relevance of the pseudogestational sac remains unclear. To establish the incidence and relative rate of intrauterine fluid collection among ectopic and intrauterine pregnancies and to determine if the size of the collection differs between ectopic and intrauterine pregnancies STUDY DESIGN: We performed a retrospective cohort study of women with pregnancies of unknown location and pelvic or abdominal pain or bleeding. We calculated the incidences of intrauterine fluid collections among ectopic and intrauterine pregnancies, including both ongoing pregnancies and spontaneous abortions, given that that our focus was location and not viability. We calculated the relative risk of ectopic pregnancy if an intrauterine fluid collection was present, adjusting for age and vaginal bleeding. We compared the incidences of ectopic and intrauterine pregnancies among those with and without intrauterine fluid collections. Among those with collections, we compared the mean sac diameter between ectopic and intrauterine pregnancies in continuous and categorical fashions. We evaluated 1236 women presenting with a pregnancy of unknown location. The rates of ectopic and intrauterine pregnancies (including spontaneous abortions) were 13.1% and 63.9%, respectively, with the remainder lost to follow-up. On ultrasound, 452 women (36.6%) had an intrauterine fluid collection. Eight of 162 ectopic pregnancies (4.9%) had a collection, compared with 363 of 789 intrauterine pregnancies (46.0%) (P=.01). Of the ectopics with a fluid collection, 5 had an adnexal mass. The presence of intrauterine fluid collection decreased the risk of ectopic pregnancy (adjusted relative risk, 0.09; 95% confidence interval, 0.05-0.19) after adjusting for age and the presence of bleeding. Among those with an intrauterine fluid collection, the rate of ectopic pregnancy was 2.2%, and the rate of intrauterine pregnancy was 97.8%; among those without a collection, the rate of ectopic pregnancy was 26.7%, and the rate of intrauterine pregnancy was 73.3%. The mean sac diameter did not differ between ectopic and intrauterine pregnancies, whether analyzed continuously or categorically. In the presence of an intrauterine fluid collection, the rate of ectopic pregnancy is very low. The size of the intrauterine fluid collection in a woman with a pregnancy of unknown location cannot be used to distinguish between a gestational sac and a pseudogestational sac. Pseudogestational sacs are uncommon and of little clinical consequence. In assessing pregnancies of unknown location, clinicians should incorporate the entire clinical picture, including other sonographic findings, to avoid incorrect or delayed diagnoses.

THE INCIDENCE AND IMPORTANCE OF THE PSEUDOGESTATIONAL SAC REVISITED

To establish the incidence and relative rate of intrauterine fluid collections (IFCs) among ectopic pregnancies (EPs) and intrauterine pregnancies (IUPs); to determine if size of the collection differs between EPs and IUPs

Case Report: Recurrent Pyometra in an Adolescent

Pyometra is an uncommon but serious condition that is generally diagnosed in postmenopausal women. It rarely occurs in premenopausal patients, particularly adolescents. A 16-year-old girl with multiple comorbidities including severe intellectual disability, neurogenic bladder, and recurrent urinary tract infection presented with fever, abdominal pain, and vaginal discharge after prolonged treatment with depot medroxyprogesterone acetate. Ultrasound imaging showed an intrauterine fluid collection consistent with hematometra; however, hysteroscopic evaluation confirmed pyometra, which was evacuated using a suction curette. Despite postoperative antibiotic therapy, she re-presented with similar findings requiring additional hysteroscopic evaluation and evacuation. After a third evacuation, an intrauterine catheter was placed to aid in drainage. This was not tolerated by the patient, and she ultimately required total laparoscopic hysterectomy for definitive management, which was performed without incident. Pyometra is a rare occurrence that typically presents after menopause; however, it should be considered in patients with poor genitourinary hygiene and medically induced endometrial atrophy. In severe cases, hysterectomy might be required for definitive management.

Sonographic Criteria for Uterine Curettage: Suspecting Endometrial Neoplasia.

The aim of the work is to determine the Suspicious sonographic findings associated with endometrial hyperplasia or cancer in premenopausal and perimenopausal women requiring uterine curettage other than endometrial thickness. Transvaginal ultrasonography examinations of premenopausal and perimenopausal women were reported here. These women underwent endometrial biopsy based on abnormal uterine bleeding or discharge and sonographic endometrial abnormalities. Histologically, hyperplasia was found in PCOS patients, endometrial cancer on top of tamoxifen therapy was found in others. The highly related ultrasound criteria are thick irregular endometrium, ill-defined endometrial myometrial junction, myometrial invasion with pseudowidening of the endometrium, turbid intrauterine fluid collection, associated complex adnexal masses, and cystic areas in the endometrium. Endometrial stripe abnormality by transvaginal ultrasonography is considered to be important in the recommendation of endometrial biopsy to exclude cancer along with positive complains in addition to thickness abnormalities.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

MRI findings for primary fallopian tube cancer: correlation with pathological findings.

To clarify the MRI findings for primary fallopian tube cancer (PFTC). MRI findings for 11 patients who were pathologically diagnosed with PFTC at our institute were retrospectively reviewed. MRI findings (shape, appearance, signal intensity, ADC value, enhancement patterns, and location of the primary tumor, the morphologic appearance of the ipsilateral ovary, and intrauterine fluid collection) were evaluated and compared with pathological findings including histological subtype and PFTC location. On MRI, PFTCs with a tubal component (n=8) exhibited a sausage-like shape in five cases and a nodular or irregular shape in three cases. PFTCs located at the fimbria (n=3) presented a nodular shape. The PFTC was solid in nine cases (82%), and the solid portion showed high intensity on diffusion-weighted images in all cases. The mean ADC value was 0.86×10-3mm2/s. Rim enhancement of the tumor was seen in six of nine cases (67%), all with a tubal component. PFTCs with a tubal component are sausage-shaped and PFTCs located at the fimbria have a nodular shape. Rim enhancement is frequently seen in PFTCs with a tubal component, which may suggest a tubal origin.

OP27.11: HDlive, HDliveFlow and HDliveFlow silhouette mode for the diagnosis of gestational trophoblastic disease

We present our experience of using HDlive, HDliveFlow, and the HDliveFlow silhouette mode for the diagnosis of gestational trophoblastic disease. Five patients with complete hydatidiform mole and one with clinical invasive mole were evaluated using HDlive, HDliveFlow, and the HDliveFlow silhouette mode. In the case of an early-stage nonhydropic complete hydatidiform mole, smooth, lobulated masses were clearly recognised using HDlive, and small, irregular, cystic spaces inside the mass were also evident. In the case of a complete mole, colour Doppler showed numerous vesicles without blood vessels, while HDliveFlow with the HDlive silhouette mode clearly depicted these vesicles forming a mass with the clear demarcation of its edges, and demonstrated no blood flow inside the mass. The HDlive silhouette inversion mode clearly depicted the number, size, and spatial position of molar vesicles, compared with conventional two-dimensional(2D) sonography or the HDlive inversion mode. Moreover, spatial relationships among molar vesicles, intrauterine anechoic fluid collection, and the uterine wall enabled the clear localisation of the lesion. The HDliveFlow silhouette mode showed new visualisation of numerous small vesicles in the uterine cavity surrounded by silky vitreous-like clarity of the uterine blood flows. In the case of clinical invasive mole, abundant blood flows were clearly recognised in the posterior uterine wall using with HDliveFlow and the HDliveFlow silhouette mode. These novel techniques provide new insights, and have the potential to supplement conventional 2D sonography and colour/power Doppler ultrasound in the diagnosis of gestational trophoblastic disease.

Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21.

Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21.

Epidemiology and spectrum of positive bacteriological culture in intrauterine fluid collected from women with postmenopausal bleeding

This study aims to examine the prevalence and bacteriological findings of different types of intrauterine fluid collection in women presenting with postmenopausal bleeding and the risk factors for predicting positive microbiological culture, mixed growth, and anaerobic growth. This is a retrospective cohort study. Data from all of the women who were assessed in our one-stop postmenopausal bleeding clinic between 2008 and 2011 and who were found to have intrauterine fluid collection were reviewed. Endometrial aspirates of all women were sent for bacterial culture and histological examination. The risk factors for positive culture were assessed by both univariate and multivariate analyses. A total of 228 cases of intrauterine fluid collection were included for analysis. There were 109 (47.8%) cases of pyometra, 98 (43.0%) cases of hydrometra, and 21 (9.2%) cases of hematometra. Escherichia coli, Bacteroides fragilis, and Enterococcus were the commonest microorganisms isolated from endometrial aspirates. Both endometrial malignancy and benign intrauterine pathologies are not risk factors for positive culture. Advanced age (>75 y) is an independent risk factor for positive culture (odds ratio, 2.89; 95% CI, 1.39-6.01) and mixed growth (odds ratio, 2.18; 95% CI, 1.02-4.67). Residency in nursing homes is an independent risk factor for mixed growth (odds ratio, 2.61; 95% CI, 1.21-5.63) and anaerobic growth (odds ratio, 2.55; 95% CI, 1.01-6.44). E. coli, B. fragilis, and Enterococcus are the commonest microorganisms isolated from intrauterine fluid. Apart from drainage of the intrauterine fluid collection, successful management also requires appropriate antibiotics and improvement in perineal hygiene.

Double Sac Sign and Intradecidual Sign in Early Pregnancy

To assess the interobserver agreement, frequency of occurrence, and prognostic importance of the double sac sign (DSS), intradecidual sign (IDS), and other sonographic findings in early intrauterine pregnancies. We retrospectively identified all sonograms obtained between January 1, 2006, and December 31, 2011, in which: (1) the scan demonstrated an intrauterine fluid collection without a yolk sac or embryo; (2) a follow-up scan confirmed an intrauterine pregnancy; and (3) the first-trimester outcome was known. Each coinvestigator characterized the 199 study sonograms as demonstrating or not demonstrating a DSS or an IDS, based on judgment about whether the scan met published criteria defining these signs. Interobserver agreement was poor for the DSS (κ= 0.24) and IDS (κ= 0.23). Scans frequently demonstrated neither sign: 150 cases (75.4%) if we considered a sign to be present when both investigators graded it as present and 69 cases (34.7%) using the looser criterion that either graded it as present. The presence of a DSS or an IDS was unrelated to the β-human chorionic gonadotropin (β-hCG) value (P > .05, t test, all comparisons). An inner echogenic ring was present in 158 cases (79.4%), and the decidua was brighter peripherally than centrally in 102 (51.3%). The first-trimester outcome was unrelated to the presence of a DSS or an IDS, presence of an inner echogenic ring, or decidual appearance (P > .05, χ(2), all comparisons). The sonographic appearance of early gestational sacs, before visualization of a yolk sac or embryo, is highly variable. The DSS and IDS are often absent; there is poor interobserver agreement regarding these signs; and the prognosis is unrelated to their presence or absence. A round or oval intrauterine fluid collection in a woman with positive β-hCG should be treated as a gestational sac until proven otherwise, regardless of whether it demonstrates a DSS or an IDS.

Echogenic Uterine Fluid Collection as an Unusual Presentation of Endometrial Squamous Metaplasia

Background: The optimal management of intrauterine fluid accumulation in postmenopausal women with cervical stenosis is currently debatable. Diagnostic challenge still remains, because of the low accuracy of sonographic histologic prediction. Case: In the case described, an asymptomatic postmenopausal woman was found to have an echogenic endometrial fluid collection on pelvic ultrasound, suspicious for uterine malignancy. Results: After a failed attempt at endometrial sampling secondary to cervical stenosis, the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The fluid-filled endometrial cavity was found to have extensive benign squamous differentiation. Conclusions: Extensive endometrial squamous metaplasia should be considered as a rare differential diagnosis when postmenopausal women are found to have echogenic intrauterine fluid collections on ultrasound. (J GYNECOL SURG 29:148)

Further Evidence Against the Reliability of the Human Chorionic Gonadotropin Discriminatory Level

The human chorionic gonadotropin (hCG) discriminatory level-the maternal serum β-hCG level above which a gestational sac should be consistently visible on sonography in a normal pregnancy--has been reported to be 1000 to 2000 mIU/mL for transvaginal sonography. We assessed whether a woman with a β-hCG above 2000 mIU/mL and no intrauterine fluid collection on transvaginal sonography can subsequently be found to have a live intrauterine gestation and, if so, what the prognosis is for the pregnancy. We identified all women scanned between January 1, 2000, and December 31, 2010, who met the following criteria: serum β-hCG testing and transvaginal sonography were performed on the same day; β-hCG was positive and sonography showed no intrauterine fluid collection; and a live intrauterine pregnancy was subsequently documented. We tabulated the β-hCG levels in these cases and assessed pregnancy outcome. A total of 202 patients met the inclusion criteria, including 162 (80.2%) who had β-hCG levels below 1000 mIU/mL on the day of the initial scan showing no intrauterine fluid collection, 19 (9.4%) with levels of 1000 to 1499, 12 (5.9%) 1500 to 1999, and 9 (4.5%) above 2000 mIU/mL. There was no significant relationship between initial β-hCG level and either first-trimester outcome or final pregnancy outcome (P > .05, logistic regression analysis and Fisher exact test). The highest β-hCG was 6567 mIU/mL, and the highest value that preceded a liveborn term baby was 4336 mIU/mL. The hCG discriminatory level should not be used to determine the management of a hemodynamically stable patient with suspected ectopic pregnancy, if sonography demonstrates no findings of intrauterine or ectopic pregnancy.

Computed tomography findings of spontaneous perforation of pyometra

We report herein a case of spontaneous perforation of pyometra leading to diffuse peritonitis. This pathological condition is rare, and preoperative diagnosis is difficult. We were able to make the correct diagnosis preoperatively using contrast-enhanced abdominopelvic computed tomography. Both intrauterine and extrauterine fluid collections and defects of the uterine fundus were key findings, and reconstructed sagittal and coronal images were useful. In elderly female patients presenting with acute abdomen, ruptured pyometra should be considered as a possibility.

Intra-uterine fluid collection in postmenopuasal women with cervical stenosis

Objectives The aim of the study was to assess the clinical significance of intra-uterine fluid collection in postmenopausal women with cervical stenosis with and without vaginal bleeding. Methods A group of 82 consecutive postmenopausal women with cervical stenosis and sonographically confirmed intra-uterine fluid collection underwent D&C with or without hysteroscopy. Diagnostic hysteroscopy was performed in all patients with an endometrial thickness (ET) was greater than 8 mm, or with irregular endometrium at any degree of ET. The patients were divided and evaluated prospectively into two groups according to the presence or absence of postmenopausal bleeding (PMB). Twenty-six women were with PMB and 56 women were asymptomatic. Results The groups were similar as far as endometrial thickness and histopathological results were concerned. Atrophic endometrium was found in 69 patients (84%), 23 in the PMB group (89%) and 46 in the other group (82%), proliferative endometrium in 7 (9%) and endometrial polyps were found in 35 patients (43%), 12 in the PMB group (46%) and 23 in the other group (41%). When ET was ≥8 mm, in 93% of the cases an endometrial polyp was found (25 out of 27). No case of endometrial cancer was found. A premalignant condition was diagnosed in one patient with an endometrial polyp in the PMB group. All patients with endometrial thickness of less than 3 mm in ultrasound had atrophic endometrium. The incidence of intrauterine pathology increased with the increasing thickness of endometrium as observed by ultrasound. Conclusions The presence of intra-uterine fluid collection in postmenopausal patients with cervical stenosis seems to be a benign condition. Normal endometrium of less than 3 mm observed by ultrasound in postmenopausal women without vaginal bleeding does not necessarily need further surgical investigation.

Sonographic appearance of Mycobacterium pyometra mimicking carcinoma of uterine corpus

Mycobacterium pyometra is extremely rare, and only 12 cases have so far been reported in the English literature (1–4). We report a case of Mycobacterium pyometra in an 84-year-old woman presenting with bloodstained vaginal discharge. Preoperative transvaginal ultrasound scan showed an intrauterine echogenic shadow, the appearance of which mimics carcinoma of uterine corpus. An 84-year-old woman was admitted because of bloodstained vaginal discharge. She suffered from diabetes, hypertension, dementia and stroke. There was no known history of pulmonary tuberculosis or tuberculosis infection of other organs. Pelvic examination revealed foul-smelling bloodstained discharge in the vagina. The uterus was of normal size and there was no adnexal mass. There was no tenderness. She was afebrile and her white cell count was 8.3 × 109/L. Transvaginal ultrasound scan showed fluid collection inside the uterine cavity and there was a 12.5 × 9.4 mm intrauterine echogenic shadow (Fig. 1). The provisional diagnosis was pyometra with suspected carcinoma of the uterine corpus. Transvaginal ultrasound image showing intrauterine fluid collection and an echogenic shadow. She underwent cervical dilatation under general anesthesia and a moderate amount of pus was drained upon dilatation. Hysteroscopy was performed using normal saline as the distending medium. The endometrium appeared inflamed but was smooth with no evidence of malignancy or other intrauterine growth. The cervical canal was normal. Uterine curettage was performed. She made a good recovery and was discharged two days after the procedure. Histological examination of the uterine curettage revealed endometrium with granulatomatous inflammation. There was no evidence of malignancy. Acid-fast bacilli were identified by Ziehl–Neelsen stain. Fungal stain was negative. A chest X-ray did not reveal any evidence of past tuberculosis infection. She was treated with a course of antituberculosis therapy that included isoniazid, rifampicin, ethambutol and pyrazinamide. Pyometra is an uncommon gynecologic condition that occurs mainly in postmenopausal women. The main risks of pyometra are its association with genital tract malignancy and spontaneous perforation of the uterus (5). The most common bacteria isolated are Escherichia coli and Bacteroides fragilis (6). Mycobacterium infection of the female genital tract mainly occurs in premenopausal women. Mycobacterium infection manifest as pyometra in postmenopausal women is extremely rare, with only 12 cases having been reported in the English literature so far (1–4). In the present case, the diagnosis of pyometra was made base on the clinical symptom of foul-smelling vaginal discharge and sonographic appearance of intrauterine fluid collection. In addition, there was an intrauterine echogenic shadow with features suggestive of endometrial carcinoma (7). The echogenic intrauterine shadow probably represented calcified tissue such as that seen in mycobacterium infection of the lung. The appropriate management of patients with suspected pyometra should comprise cervical dilatation to drain the pus, together with antibiotics. Assessment of the endometrial cavity should be deferred until the acute inflammation has subsided. Performing hysteroscopy in the presence of pyometra is potentially dangerous and should be contraindicated (8). This is because the infected material inside the uterine cavity may disseminate into the peritoneal cavity via the fallopian tube during hysteroscopy (9), resulting in peritonitis and septicemia. In addition, hysteroscopic examination of the endometrial cavity may be difficult in the presence of acute inflammation. The absence of complication in this patient may be related to the possible tubal blockage secondary to the mycobacterium infection, thus preventing the intraperitoneal spread of the infected materials. It is important to make the diagnosis of Mycobacterium pyometra so that antituberculous therapy can be given to cure the infection and to prevent recurrence and spread of disease to other organs. Mycobacterium infection is very prevalent in our community (10). There are also data to suggest that the incidence of mycobacterium infection of the genital tract in postmenopausal women is rising (11). Hence gynecologists may encounter more cases of Mycobacterium pyometra in the future. Although routine culture of uterine curettage with Lowenstein–Jensen medium in patients with pyometra is probably not justified, a careful histologic examination of the uterine curettage would be valuable and the presence of granulatomatous inflammation may suggest Mycobacterium pyometra. Clinicians and pathologists should be aware of this condition in order to avoid delay in diagnosis and appropriate therapy.

Differential indication for histological evaluation of endometrial fluid in postmenopause

Objectives: The endometrium carcinoma is the most frequent malignancy of the female genital tract. Approximately, 10–20% of all patients with an endometrial carcinoma are free of symptoms until the time of diagnosis. The frequent occurrence of an endometrial carcinoma in connection with intrauterine cavity fluid collection (sero- or mucometra) has been discussed controversially in literature. What are the hysteroscopic and histological findings in patients with sonographically determined endometrial fluid in postmenopause, and how should these findings be interpreted?. Methods: 74 patients, in whom endometrial fluid without bleeding disorders had been diagnosed during routine transvaginal sonography, underwent hysteroscopy conducted with a 4.5 mm optics and dilatation and curettage (D&C). The median age of the patients was 68 years with a range of 32 years. Results: The simple thickness of the endometrium, i.e. single layer measured sonographically at the point of maximal thickness, was on average 5.7 mm ± 3.6 mm (2–15 mm). Hysteroscopically, an endometrium polyp was found in 23 cases (31.1%), endometrium hyperplasia in 12 (16.2%), and an atrophy in 35 cases (47.3%). In four cases (5.4%), an endometrial carcinoma was suspected. The histological results were consistent with the hysteroscopic findings. In all instances, in which the simple endometrial thickness amounted to 3 mm or less, an atrophic endometrium was found. The frequency of intrauterine pathologies increased significantly with a greater thickness of the endometrium. In 80% of patients, a cervical stenosis existed. Conclusions: Endometrial fluid by itself, without assessment of the endometrium, does not indicate the requirement for additional histological clarification. As diagnostics, the authors suggest especially the endometrial morphology.

Transabdominal Sonography Before Uterine Exploration as a Predictor of Retained Placental Fragments

To evaluate the diagnostic accuracy of sonography in postpartum patients thought to have retained placental fragments. The study group consisted of 39 postpartum women in whom inspection of the placenta brought up suspicion of retained placental fragments. All these women underwent manual exploration of the uterine cavity. Before the procedure, all patients had two-dimensional sonographic imaging, after which they were divided into 2 groups. The first group comprised women who were judged to have had an empty uterus or nothing but intrauterine fluid collection. The second group consisted of those in whom sonography showed echoes of what might appear as residual trophoblastic tissue, that is, echogenic, hypoechoic, or mixed echo intracavitary patterns. The sonographic patterns were then correlated with the presence or absence of retained placental fragments as found on uterine manual exploration and pathologic examination. In 18 patients, no suspected contents were observed on sonography. In 17 of these patients, the uterus was empty on manual uterine exploration. One of these patients had residual trophoblastic tissue, which was of minimal quantity and clinically unimportant. In 21 patients, sonography suggested retained placental tissue. In 15 of these patients, pathologic examination confirmed residual trophoblastic tissue, and in the remaining 6, the uterus contained blood clots, decidua, or both. Sonography is an effective tool for evaluating postpartum patients thought to have retained placental fragments. Normal sonographic findings might obviate the need for manual exploration of the uterine cavity. A questionable sonographic result is not an effective tool for distinguishing between placental fragments and blood clots.

Imaging the endometrium: disease and normal variants.

The endometrium demonstrates a wide spectrum of normal and pathologic appearances throughout menarche as well as during the prepubertal and postmenopausal years and the first trimester of pregnancy. Disease entities include hydrocolpos, hydrometrocolpos, and ovarian cysts in pediatric patients; gestational trophoblastic disease during pregnancy; endometritis and retained products of conception in the postpartum period; and bleeding caused by polyps, submucosal fibroids, endometrial hyperplasia, or endometrial adenocarcinoma. Other findings include tamoxifen-associated changes, intrauterine fluid collections, and endometrial adhesions. Although ultrasound (US) is almost always the first modality used in the radiologic work-up of endometrial disease, findings at sonohysterography, hysterosalpingography, magnetic resonance imaging, and computed tomography are often correlated with US findings. It is important to understand that the appearance of the endometrium is related to multiple factors, including the patient's age, stage in the menstrual cycle, and pregnancy status and whether she has undergone hormonal replacement therapy or tamoxifen therapy. Accurate diagnosis requires that these factors be taken into account in addition to clinical history and physical examination findings.

Chorionic Rim Sign on Transvaginal Sonography

The purpose of this study was to assess the value of the chorionic rim sign as evidence of intrauterine pregnancy on transvaginal sonography. The chorionic rim sign (a curvilinear echogenic rim separate from the underlying decidua that borders an outwardly convex intrauterine fluid collection) has b