0:01

Our next case is of a 50-year-old

0:03

again for an IUD check.

0:04

I'm just going to start at

0:05

this point with our cine clips.

0:08

This is a sagittal uterus.

0:10

We'll let you know that this is a

0:11

retroverted and retroflexed uterus.

0:13

Those again are very hard

0:15

to get in a single plane.

0:16

Sometimes even sagittally it can be difficult

0:18

and sometimes it can be near impossible

0:21

to get it in a good transverse plane.

0:22

So that's why it looks,

0:24

can look a little tricky here.

0:25

So as we're scrolling through this

0:26

one, we can see some IUD for sure.

0:29

I see shadowing down here.

0:30

It's definitely an IUD.

0:31

We have a fibroid right here,

0:35

but I do not see an IUD up here closer

0:38

to the fundus where it should be.

0:40

We'll go to our, you know, quote-unquote

0:42

transverse plane, which is as best as we could get.

0:45

And you can already see there's

0:46

uterus endometrium over here

0:48

and there's shadowing over here.

0:49

I don't know where this structure is,

0:50

but that doesn't look okay.

0:52

So we follow it up towards the fundus.

0:54

Again, I see nothing where it should be.

0:56

There's no IUD up towards the fundus.

0:58

Fibroid here, fibroid here.

1:00

Lots going on in this busy uterus.

1:02

And some IUD way over here.

1:04

Another fibroid coming into view.

1:06

Really hard to tell until we get

1:07

down to here where we definitely see

1:09

that classic shadowing from the IUD.

1:13

So I don't know exactly where this is again.

1:15

I do know that it's

1:16

extraordinarily abnormal, however.

1:20

So if we go to our 3D imaging here at the end.

1:24

Here's our 3D imaging.

1:25

Remembering this is a retroverted, retroflexed.

1:27

3D still works for them.

1:29

You might have to play around with it a little bit

1:30

more, but you can get diagnostic images from it.

1:33

So this is flipped.

1:35

Here's the fundus down here in this

1:36

particular case, and here's your IUD.

1:39

So that's that long body of it that we were

1:41

seeing, that shadowing, really low right here.

1:43

The left arm is over here,

1:45

the right arm is over here.

1:46

So now I understand exactly how

1:47

that IUD is positioned right there.

1:49

I can't tell definitively if it's embedded,

1:51

but based off of this, anything I'm worried

1:54

about is either going to be the body right

1:55

here, and maybe that right arm. The left

1:57

arm looks like it's going to be okay.

1:59

So with that in mind, I'll go back to

2:01

my cine clips one more time to try and

2:02

figure out exactly what's going on.

2:07

So we'll do that here.

2:10

This is another transverse cine

2:12

clip that they took again later on.

2:14

We're going to follow it again down here.

2:19

We can follow this over here, endometrium over

2:22

here, and then this, paraovarian cyst right

2:25

there, is not in the endometrium right here.

2:30

So I think now that we know what's going

2:31

on a little bit better based off of

2:33

that 3D, we can follow this up again.

2:37

We can try and follow those arms to see

2:39

what is embedded in these particular cases.

2:43

So again, I think that 3D not only helps

2:44

because you can visualize it better, but

2:46

now you can go back to your cine clips

2:48

and try and decide whether something is

2:50

embedded or not, and if so, how much.

2:52

So it can be a little bit difficult when that

2:54

endometrium, like in this case, is really

2:56

super thin to figure out what's going on.