1
|
Zaki-Metias KM, Hosseiny M, Behzadi F, Balthazar P. Uterine Inversion. Radiographics 2023; 43:e230004. [PMID: 37200219 PMCID: PMC10802903 DOI: 10.1148/rg.230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Kaitlin M Zaki-Metias
- From the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.)
| | - Melina Hosseiny
- From the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.)
| | - Fardad Behzadi
- From the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.)
| | - Patricia Balthazar
- From the Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, 44405 Woodward Ave, Medical Education, Pontiac, MI 48341 (K.M.Z.M.); Department of Radiology, University of California San Diego, San Diego, Calif (M.H.); Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, Mass (F.B.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.B.)
| |
Collapse
|
2
|
Beesley V, Thng C. Testing for
Mycoplasma genitalium
in pelvic inflammatory disease: A clinical audit. Aust N Z J Obstet Gynaecol 2022; 62:826-829. [PMID: 36089701 PMCID: PMC10087567 DOI: 10.1111/ajo.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
The records of women attending Gold Coast health hospital sites were retrospectively analysed to determine if women diagnosed with pelvic inflammatory disease (PID) were being tested for Mycoplasma genitalium (MG). Only 11.4% of 299 women were tested for MG despite 74.2% being tested for Chlamydia trichomonas (CT) and Neisseria gonorrhoeae (NG). Only 9% of the women were treated with antibiotics which would treat macrolide-sensitive MG infection. Increasing education and awareness of MG and utilising reflex macrolide testing for MG will help direct effective antibiotic therapy and prevent the long-term sequalae of PID.
Collapse
Affiliation(s)
- Victoria Beesley
- Rotational Resident Medical Officer Gold Coast University Hospital Gold Coast Queensland Australia
| | - Caroline Thng
- Sexual Health Consultant Gold Coast Sexual Health Service Gold Coast Queensland Australia
| |
Collapse
|
3
|
Gopireddy DR, Virarkar M, Kumar S, Vulasala SSR, Nwachukwu C, Lamsal S. Acute pelvic pain: A pictorial review with magnetic resonance imaging. J Clin Imaging Sci 2022; 12:48. [PMID: 36128358 PMCID: PMC9479569 DOI: 10.25259/jcis_70_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Acute uterine emergencies constitute both obstetric and gynecologic conditions. The superior image resolution, superior soft-tissue characterization, and lack of ionizing radiation make magnetic resonance imaging (MRI) preferable over ultrasonography (USG) and computed tomography (CT) in investigating uterine emergencies. Although USG is the first-line imaging modality and is easily accessible, it has limitations. USG is an operator dependent and limited by patient factors such as obesity and muscle atrophy. CT is limited by its risk of teratogenicity in pregnant females, poor tissue differentiation, and radiation effect. The non-specific findings on CT may lead to misinterpretation of the pathology. MRI overcomes all these limitations and is emerging as the most crucial imaging modality in the emergency room (ER). The evolving 3D MR sequences further reduce the acquisition times, expanding its ER role. Although MRI is not the first-line imaging modality, it is a problem-solving tool when the ultrasound and CT are inconclusive. This pictorial review discusses the various MRI techniques used in uterine imaging and the appearances of distinct etiologies of uterine emergencies across different MRI sequences.
Collapse
Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | | | - Chidi Nwachukwu
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Sanjay Lamsal
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| |
Collapse
|
4
|
Okazaki Y, Tsujimoto Y, Yamada K, Ariie T, Taito S, Banno M, Kataoka Y, Tsukizawa Y. Diagnostic accuracy of pelvic imaging for acute pelvic inflammatory disease in an emergency care setting: a systematic review and meta‐analysis. Acute Med Surg 2022; 9:e806. [PMID: 36381955 PMCID: PMC9646938 DOI: 10.1002/ams2.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
The aim of this review is to investigate the diagnostic accuracy or performance of contrast‐enhanced computed tomography (CT) and magnetic resonance imaging (MRI) for acute pelvic inflammatory disease (PID) in an emergency care setting. We searched for studies on the diagnostic test accuracy of contrast‐enhanced CT or MRI for women of reproductive age with acute abdominal pain using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, and ClinicalTrials.gov. The reference standard was gynecological examinations by gynecologists using standard diagnostic criteria with or without laparoscopy or transcervical endometrial biopsy. Two reviewers undertook screening of records, data extraction, and assessment of the risk of bias in each included study using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. A bivariate model was used for the meta‐analysis. Of 2,619 screened studies, three studies investigating contrast‐enhanced CT and one study investigating MRI were eligible, including a total 635 patients and with a median prevalence of acute PID of 29%. All of the included studies had a high risk of bias for a reference standard and had some applicability concerns. Contrast‐enhanced CT had a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.52–0.93) and specificity of 0.99 (95% CI, 0.94–1.00). Magnetic resonance imaging had a sensitivity of 0.95 (95% CI, 0.76–1.00) and specificity of 0.89 (95% CI, 0.52–1.00). Contrast‐enhanced CT might serve as a practical alternative to gynecological examination in the diagnosis of acute PID in an emergency care setting, however, the evidence was uncertain. The evidence on MRI was also very uncertain.
Collapse
Affiliation(s)
- Yuji Okazaki
- Department of Emergency Medicine Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
| | - Yasushi Tsujimoto
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
- Oku Medical Clinic Osaka Japan
- Department of Health Promotion and Human Behavior Kyoto University Graduate School of Medicine/School of Public Health, Kyoto University Kyoto Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine National Defense Medical College Hospital Saitama Japan
| | - Takashi Ariie
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
- Department of Physical Therapy, School of Health Sciences at Fukuoka International University of Health and Welfare Fukuoka Japan
| | - Shunsuke Taito
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
- Division of Rehabilitation, Department of Clinical Practice and Support Hiroshima University Hospital Hiroshima Japan
| | - Masahiro Banno
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
- Department of Psychiatry Seichiryo Hospital Nagoya Japan
- Department of Psychiatry Nagoya University Graduate School of Medicine Nagoya Japan
| | - Yuki Kataoka
- Scientific Research Works Peer Support Group (SRWS‐PSG) Osaka Japan
- Section of Clinical Epidemiology, Department of Community Medicine Kyoto University Graduate School of Medicine Kyoto Japan
- Department of Internal Medicine Kyoto Min‐Iren Asukai Hospital Kyoto Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health Kyoto University Kyoto Japan
| | - Yoshiaki Tsukizawa
- Department of Obstetrics and Gynecology Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| |
Collapse
|
5
|
Gulati S, Rathi V, Jain S, Bhatt S. Incidentalomas of the female genital tract on 64-slice MDCT: a clinico-radiological pictorial review. Abdom Radiol (NY) 2021; 46:4420-4431. [PMID: 33890122 DOI: 10.1007/s00261-021-03086-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Abstract
Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management.
Collapse
Affiliation(s)
- Shrea Gulati
- Department of Radio Diagnosis, University College of Medical Sciences, Delhi, India
| | - Vinita Rathi
- Department of Radio Diagnosis, University College of Medical Sciences & GTB Hospital, 89/2 Radhey Puri Extension-II, Delhi, 110051, India.
| | - Sandhya Jain
- Department of Obstetrics & Gynaecology, University College of Medical Sciences, Delhi, India
| | - Shuchi Bhatt
- Department of Radio Diagnosis, University College of Medical Sciences, Delhi, India
| |
Collapse
|
6
|
Aggarwal A, Das CJ, Manchanda S. Imaging Spectrum of Female Genital Tuberculosis: A Comprehensive Review. Curr Probl Diagn Radiol 2021; 51:617-627. [PMID: 34304946 DOI: 10.1067/j.cpradiol.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/25/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Abstract
Female genital tuberculosis is a relatively uncommon form of extrapulmonary tuberculosis that is under-reported and under-recognized. The early course of the disease has fewer manifestations, resulting in late presentation with grave complications like infertility and ectopic pregnancy. Also, difficulty in isolation of the causative bacteria further delays the diagnosis. The radiologist should be well versed with imaging findings of female genital TB to help the clinicians to initiate prompt treatment. This review shall cover imaging findings of female genital TB involving fallopian tubes, uterus, ovaries, cervix, vagina, and vulva on different imaging modalities. Fallopian tubes are almost always involved in genital TB followed by uterus and ovaries. Hysterosalpingogram and ultrasound can best detect tubercular changes in fallopian tubes and uterus whereas cross-sectional imaging is essential for the diagnosis of ovarian or peritoneal TB as they closely mimic malignancy. Cervical, vaginal, or vulval TB produces nonspecific changes and histopathological diagnosis is required for confirmation of the diagnoses. Close differential diagnosis on imaging like malignancy or pelvic inflammatory disease, are also discussed with a brief discussion of the pathogenesis.
Collapse
Affiliation(s)
- Ankita Aggarwal
- Department of Radiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
7
|
El-Badrawy A. MDCT evaluation of synchronous breast carcinoma and other solid malignancies. Breast Dis 2021; 40:275-281. [PMID: 34120894 DOI: 10.3233/bd-201065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple primary malignancies are two or more malignancies in an individual without any relationship between the tumors. The development of improved diagnostic techniques, increased survival of cancer patients and the growing life expectancy have all contributed to the increased frequency of this phenomenon. OBJECTIVE The aim of this study is to review the multidetector computed tomography (MDCT) findings of synchronous breast carcinoma and other solid malignancies. METHODS This retrospective study included 65 patients confirmed with diagnosis of synchronous breast carcinoma and other solid malignancies. CT scanning was performed using 128 MDCT in all patients. All one hundred-thirty malignancies underwent pathological evaluation. RESULTS Out of 4120 patients with breast carcinoma; 65 patients were diagnosed with other synchronous primary solid malignancy. All one hundred-thirty malignancies were confirmed pathologically. Breast carcinoma detected in all 65 patients; of them metastatic breast carcinoma detected in 8 patients. Hepatocellular carcinoma was detected in 18 patients, Non-Hodgkin lymphoma (NHL) in 12 patients, endometrial carcinoma in 8 patients, uterine sarcoma in 3 patients, malignant mixed Müllerian tumor in one patient, ovarian carcinoma in 5 patients, renal cell carcinoma in 4 patients, thyroid carcinoma in 4 patients, gastric carcinoma in 2 patients, colonic carcinoma in 2 patients, ano-rectal carcinoma in one patient, hilar cholangiocarcinoma in 2 patients, malignant melanoma in 2 patients and bronchogenic carcinoma in one patient. CONCLUSIONS Patients with breast carcinoma have a risk of other synchronous primary malignancy. So, careful preoperative examination is recommended to improve the patients' prognosis. MDCT scanning is accurately imaging modality for evaluation of synchronous breast carcinoma and other solid malignancies. The aim of treatment in cancer patients should always be curative even in the presence of multiple malignancies.
Collapse
Affiliation(s)
- Adel El-Badrawy
- Radiology Department, Mansoura University Faculty of Medicine, Mansoura, Dakahlya, Egypt
| |
Collapse
|
8
|
Computer Tomography in the Diagnosis of Ovarian Cysts: The Role of Fluid Attenuation Values. Healthcare (Basel) 2020; 8:healthcare8040398. [PMID: 33066370 PMCID: PMC7711840 DOI: 10.3390/healthcare8040398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/18/2022] Open
Abstract
Pathological analysis of ovarian cysts shows specific fluid characteristics that cannot be standardly evaluated on computer tomography (CT) examinations. This study aimed to assess the ovarian cysts’ fluid attenuation values on the native (Np), arterial (Ap), and venous (Vp) contrast phases of seventy patients with ovarian cysts who underwent CT examinations and were retrospectively included in this study. Patients were divided according to their final diagnosis into the benign group (n = 32) and malignant group (n = 38; of which 27 were primary and 11 were secondary lesions). Two radiologists measured the fluid attenuation values on each contrast phase, and the average values were used to discriminate between benign and malignant groups and primary tumors and metastases via univariate, multivariate, multiple regression, and receiver operating characteristics analyses. The Ap densities (p = 0.0002) were independently associated with malignant cysts. Based on the densities measured on all three phases, neoplastic lesions could be diagnosed with 89.47% sensitivity and 62.5% specificity. The Np densities (p = 0.0005) were able to identify metastases with 90.91% sensitivity and 70.37% specificity, while the combined densities of all three phases diagnosed secondary lesions with 72.73% sensitivity and 92.59% specificity. The ovarian cysts’ fluid densities could function as an adjuvant criterion to the classic CT evaluation of ovarian cysts.
Collapse
|