To Evaluate and Explain the Occurrence of Recurrent Ectopic Pregnancy after Ipsilateral Salpingectomy, Using the Ultrasound.

The current case report evaluated a female patient with a history of right salpingectomy subsequent to right tubal ectopic pregnancy that was presented with amenorrhea followed by vaginal bleeding and lower abdominal severe pain. The transvaginal ultrasound examination revealed the presence of ipsilateral right interstitial ectopic pregnancy. The patient was subjected to cornual wedge resection and uterine repair. The pathology report of the excised specimen revealed decidua, chorionic villi, and blood. Recurrent interstitial ectopic pregnancy after previous ipsilateral tubal ectopic pregnancy managed with salpingectomy is very rare, with only a few cases described in the literature. The current study was to evaluate and explain the occurrence of recurrent ectopic pregnancy after ipsilateral salpingectomy using the ultrasound.

Use of Ultrasonography in Clarifying the Etiology of Anal Pain.

INTRODUCTION: Anal pain is defined as pain originating from the anal canal or the perianal area that can be attributed to a variety of medical problems. The current study's aim was to evaluate the role of combined endoanal, transperineal, and in married women, transvaginal ultrasound in clarifying the etiology of anal pain among our patient study group. METHODOLOGY: A total of 180 patients presented to our radiology department complaining of anal pain and were examined using transperineal, endoanal, and in women, transvaginal ultrasound aided with three-dimensional capability. The final diagnosis was reached, according to the surgical results and the histopathology reports in cases diagnosed with anorectal neoplasms and perianal masses. RESULTS: A total of 100 patients were diagnosed with perianal fistulas. Twenty-five cases presented with anal abscesses. In four cases, pilonidal sinus extended to the perianal spaces. Three cases had hiradenitis suppurativa, 13 cases showed occult anal sphincter defects, two cases had anorectal neoplasms, and one case was diagnosed with soft tissue ependymoma overlying the coccyx. Three cases were diagnosed with perianal soft tissue masses. One case was detected with recto vaginal fistulas, 10 cases showed thick internal anal sphincter, two cases had perianal cysts, and one case had perianal hematoma. Two cases showed hemorrhage in Douglas' pouch, and one case had pelvic collection sequelae of perforated pelvic appendicitis. Three cases had pelvic endometriosis; one case was detected with missed contraceptive device in the rectum. Three cases were diagnosed with prostatitis and two cases with prostatic abscesses. Two cases had prostatic carcinoma and one case had prostatic sarcoma. CONCLUSION: The combined approaches of endoanal, transperineal, and in women, transvaginal ultrasound aided with three-dimensional capability proved highly valuable in clarifying the etiology of anal pain in our study group.

Rare occurrence of ovarian choriocarcinoma: ultrasound evaluation.

Choriocarcinoma of the ovary is a rare, highly malignant tumor showing malignant trophoblastic cells and produces human chorionic gonadotropins. It can be classified as gestational and non-gestational choriocarcinoma. Non-gestational choriocarcinoma is extremely rare. Treatment is Methotrexate-based chemotherapy for the gestational type. This case study is a rare case of ovarian choriocarcinoma managed by surgical resection, followed by methotrexate-based chemotherapy, and aimed to evaluate the ultrasound characteristics of ovarian choriocarcinoma and how to arrive at the diagnosis. In cases with an elevated serum beta-human chorionic gonadotropin (beta hCG), the finding of a highly vascularized adnexal mass on ultrasound evaluation should be underlined as a clue for suspecting choriocarcinoma, particularly if the female was young with no marriage history or history of sexual intercourse and also to be highly considered in married females with history of repeated abortions, molar pregnancy or uterine choriocarcinoma.

Uterine vascular abnormalities linked to pregnancy complications: color and power Doppler-assisted transvaginal ultrasound evaluation.

Aim: Abnormal uterine vascular pattern can be observed during transvaginal ultrasound examination used for investigating post-abortion bleeding and secondary postpartum hemorrhage. The purpose of this series of cases was to evaluate almost all the rare causes of uterine vascular abnormalities linked to pregnancy complications, and determine how to arrive at the diagnosis to optimize patient management, which is crucial for preventing life-threatening massive vaginal bleeding. Material and methods: Retrospective observational case series study including 20 women with postpartum or post-abortion vaginal bleeding who were found to have an abnormal uterine vascular pattern during a transvaginal color duplex assessment. Results: The study yielded the following findings: 10 cases of enhanced myometrial vascularity, two cases of pseudoaneurysm in the uterine artery, one case of myometrial venous varix, one case of large uterine venous pseudoaneurysm, one case of uterine arteriovenous malformation, one case of retained placental polyp, one case of invasive vesicular mole, and three cases of subinvolution of the placental implantation site. Conclusions: Transvaginal color duplex ultrasound plays a crucial role in detecting uterine vascular abnormalities as a cause of post-abortion or secondary postpartum hemorrhage and can help differentiate the pathologies responsible for the abnormal vascular pattern, which is highly recommended to optimize patient management.

The ultrasound of subcutaneous extrapelvic endometriosis.

Background: The presence of ectopic functional endometrial glands and struma anywhere except in the lining of the uterine cavity is considered as endometriosis. Extrapelvic endometriosis involving the abdominal wall cesarean section scar is uncommonly seen, and it rarely involves the perineum, umbilicus, pleura, kidneys, lungs and liver. Objectives: The purpose of the present study is to highlight rare ectopic sites, explain the pathogenesis of extrapelvic endometriosis, and evaluate the diagnostic significance of clinical findings, serum CA 125 level, and ultrasonography. Materials and methods: 24 female patients with extrapelvic endometriomas in whom the final diagnosis was based on the surgical results and histopathological reports of the excised specimens. The patients underwent a clinical examination, an ultrasound scan, and evaluation of the serum CA 125 level. They were also examined by transvaginal ultrasound to rule out ovarian endometriosis or uterine adenomyosis. They were further subjected to abdominal wall ultrasound in cases of cesarean section scar or umbilical region swellings, and transperineal ultrasound for perianal lesions. Transvaginal ultrasound was performed in patients with perineal endometrioma to assess the relation between the lesion and the external anal sphincter. Results: In 19 patients, abdominal wall cesarean section scar endometrioma was detected. Three patients had perianal endometriomas, and two patients - umbilical endometriomas. Conclusion: Ultrasound scanning was a useful diagnostic tool to evaluate extrapelvic endometriosis and its extension, especially in cases without typical clinical features that can be suggestive of endometrioma, low diagnostic sensitivity of serum CA 125, and low incidence of concomitant intrapelvic disease.

Uncommon obstetric and gynecologic emergencies associated with pregnancy: ultrasound diagnosis.

INTRODUCTION: Many uncommon obstetric and gynecologic problems associated with pregnancy and the early postpartum period can lead to severe abdominal pain and be life-threatening. The patient will be in urgent need of a quick and accurate decision. The means of management will depend on the ability to differentiate between these problems to achieve an optimal diagnosis. MATERIALS AND METHODS: 30 pregnant females attended a private obstetric ultrasound clinic with clinical picture of acute abdomen with pregnancy. All were subjected to an ultrasound exam, the results were recorded, and the final diagnosis was reached based on the postoperative results. RESULTS: Patients were classified according to their duration of pregnancy into cases with acute abdomen that occurred during the first trimester, during the second trimester, during the third trimester, and in the early postpartum period. CONCLUSION: Ultrasonography is a valuable tool for detecting the etiology and guiding the management in cases of emergency situations faced by the obstetrician and gynecologist during pregnancy and the early postpartum period.

Intrauterine arterial pseudoaneurysm, a rare cause of per vaginal bleeding.

The current study evaluated two cases of pervaginal bleeding subsequent of intrauterine arterial pseudoaneurysm. Each case was complaining of intermittent attacks of heavy vaginal bleeding: one case with history of cesarean section and the other case after uterine curettage. Intrauterine arterial pseudoaneurysm can be caused by a traumatic injury to the vessel wall with subsequent formation of periarterial hematoma that liquefies forming periarterial bloody cyst, which communicates through the narrow neck with the arterial lumen. Transvaginal ultrasound aided with color duplex capability is an accurate tool for assessment.

Endosonography of benign myometrium cysts and cyst-like lesions.

INTRODUCTION: Many pathological causes are responsible for the sonographic presentation of myometrium cysts and cyst-like lesions, where the distinction between these etiologies is required. THE AIM OF THE WORK: The current work is aimed at discerning between different etiologies of myometrium cysts and cyst-like lesions for an optimum management. METHODOLOGY: In the course of daily practice of gynecological transvaginal ultrasound, 66 cases of myometrium cysts and cyst-like lesions have been discerned, where all were examined with endovaginal ultrasound using a multifrequency endocavitary probe having color Doppler capability. RESULTS: Adenomyosis uteri detected in 15 cases, invasive mole in 4 cases, congested arcuate veins in 20 cases, incidental cysts in 4 cases, cystic degeneration of myoma in 3 cases, C-section scar cysts and cyst-like lesions in 13 cases, interstitial ectopic pregnancy in 2 cases, incomplete abortion with congested myometrium vessels in 4 cases, and arteriovenous malformation in 1 case. The number of cases with cervical nabothian cysts was not considered since they were too frequent. CONCLUSION: Endosonography is an important tool in differentiating between the various diseases that are responsible for benign myometrium cysts and cyst-like lesions, which are all important since some of them are visualized as serious clinical situations and others turn out to be of little clinical significance.

The value of superficial parts and endoanal ultrasonography in evaluating pilonidal disease and exclusion of perianal sepsis.

INTRODUCTION: Pilonidal disease is a benign anorectal inflammatory disease that involves the subcutaneous adipose tissue overlying the sacrococcygeal region. THE AIM OF THE WORK: The current study aimed to assess the value of preoperative evaluation of pilonidal disease and the exclusion of perianal sepsis using superficial parts ultrasonography and endoanal ultrasound. METHODOLOGY: Referred 30 patients were clinically diagnosed as pilonidal disease, all were examined with superficial parts ultrasonography and if the disease was extending to the perianal region further endoanal US was performed to exclude perianal sepsis. RESULTS: 7 patients showed subcutaneous abscesses and 23 patients showed pilonidal sinus tracts. Among patients with pilonidal sinus tracts, six tracts (26 %) seen as superficially situated, short narrow tracts with straight course, no side branches and with a blind end situated away from the anal canal wall. 2 (9 %) tracts showed vertical orientation and three tracts (13 %) were wide and deeply situated reaching the presacral fascia. 7 cases (30 %) showed branching pilonidal sinus tracts, two cases of them showed more than one external opening. 5 patients (22 %) showed abnormally long tracts seen reaching the perianal region. CONCLUSION: Ultrasonography is an available, inexpensive, safe imaging modality that yields a high degree of accuracy in evaluating pilonidal disease and in exclusion of perianal sepsis.