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Interventional ultrasound diagnosis and treatment for intrauterine adhesion
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Ultrasound in Medicine and Biology
stones. We conclude that the possibility of visceral abscess should be kept in mind after lap-chol and that careful observation using ultrasonography is required, especially in cases where perforation of the gallbladder with spreading of bile and stones was recognized. 31728 Fine needle aspiration of the breast: Single institution experience Weisberg S,* Da Costa D, Brofman N, Gal-Gombos E, Poppiti R, Comprehensive Breast Center, Mount Sinai Medical Center, Miami Beach, FL Objective: Although image-guided core biopsy with an 11-gauge vacuum-assisted device is the preferred method for diagnosis of breast lesions at our institution, our goal is to show that fine needle aspiration (FNA) using ultrasound guidance remains an effective tool for imageguided diagnosis particularly for certain BIRADS 5 lesions and for those lesions close to the chest wall, breast implants, or in the axilla. Methods: We reviewed fine needle aspirations, using a 21-gauge needle, that were performed under ultrasound guidance between 10/ 20/01 and 10/20/02. Results: Seventy-three patients with a total of 100 lesions were aspirated. Eleven samples were considered inadequate for diagnosis. Of the 89 remaning lesions, 40 were interpreted as malignant or suspicious for malignancy. All these lesions went on to surgical excision, and 38 were confirmed malignant on excisional biopsy. Two of the suspicious cases were benign. Forty-nine lesions were interpreted as negative for malignant or atypical cells, or with mild atypia, consistent with a benign process. Of these, 22 lesions were considered concordant with radiographic findings, and patients were placed on 6-month or 1-year followup. The other 27 lesions underwent additional workup with core biopsy or excision due to discordant imaging/pathologic correlation. Twentyfive were confirmed benign, and 2 were malignant. Conclusions: Image-guided percutaneous core biopsy is the standard for presurgical evaluation of breast lesions. The role of FNA has diminished due to reports of insufficient samples and the increased diagnostic accuracy and histologic information provided by use of 14-gauge and 11-gauge trucut and vacuum-assisted devices. Our experience demonstrates that FNA is an accurate method, especially useful in 1) BIRADS 5 lesions, particularly in the elderly, disabled, or anticoagulated patients; 2) in patients with multiple lesions and a dominant BIRADS 5 mass; and 3) in lesions risky for core technique due to location. With proper technique, a trained cytopatholgist and meticulous post-biopsy evaluation for radiologic/pathologic correlation, FNA remains a low-risk, minimally invasive, and accurate method of image-guided biopsy. 31729 Prenatal diagnosis of a fetal liver mass utilizing targeted sonography and magnetic resonance imaging Mastrobattista JM,*1 Berens PD,1 Schumacher VL,1 Metcalf J,1 Kramer L,2 1. Obstetrics, Gynecology & Reproductive Sciences, University of Texas Health Science Center-Houston, Houston, TX, and 2. Radiology, University of Texas Health Science CenterHouston, Houston, TX Description of case(s): A 26-year-old nulligravid woman was referred for targeted sonography at 18 weeks after an office ultrasound revealed a right-sided echogenic mass in the fetal abdomen. Patient denied history of travel, recent viral illnesses, and owned no pets. Targeted ultrasound demonstrated an echogenic complex mass with cystic and solid components in the right upper quadrant that pushed up into the right hemithorax. The mass obscured clear deliniation of the diaphragm making it difficult to localize the mass to the fetal right upper abdomen or thorax. No Doppler flow was noted. No fetal ascites, hydrops, or
Volume 29, Number 5S, 2003 additional fetal abnormalities were identified. Fetal echocardiogram was normal, and TORCH titers were negative. Fetal MRI revealed a 3-cm mass in the right hepatic lobe with compression of the right hemithorax representing a cavernous hemangioma or hemangioendothelioma. Serial ultrasounds performed throughout the remainder of the pregnancy demonstrated adequate interval growth and no evidence of fetal hydrops. The patient presented in active labor at 34 weeks and delivered a vigorous female infant weighing 2645 grams. The neonate was admitted to the Level II nursery and had a hemoglobin of 18.2 g/dL. Chest X-Ray on day of life (DOL) one revealed no active disease. Liver ultrasound on DOL 2 demonstrated an echogenic, partially cystic mass in the right lobe of the liver consistent with a mesenchymal hamartoma or hemangioendothelioma. The neonate was discharged home on DOL 11 for expectant management. At 2 months of life, the infant is thriving; the mass will be reevaluated by CT scan at 6 months of life. Proof of diagnosis: Targeted sonography identified a cystic and solid mass in the fetal RUQ that compressed the right hemithorax. Fetal MRI revealed a 3-cm hepatic mass consistent with either a cavernous hemangioma or hemangioendothelioma. Postnatal liver ultrasound demonstrated an echogenic, partially cystic mass in the right lobe of the liver representing a mesenchymal hamartoma or hemangioendothelioma. Relevance: Fetal liver masses diagnosed prenatally are rare. Targeted sonography may identify fetal liver masses. Fetal MRI greatly aided in the prenatal diagnosis of this cystic liver mass. 31737 Interventional ultrasound diagnosis and treatment for intrauterine adhesion Zhang D, Department of Ultrasound, Fuxing Hospital, Beijing, China Objective: The aim of this study was to discuss the method of interventional ultrasound diagnosis and treatment for intrauterine adhesion. Methods: From 1995 to 2002, 94 patients evaluated for infertility, amenorrhea, and periodic abdominal pain underwent interventional ultrasonographic examination, and all patients underwent transcervical resection of adhesion (TCRA) under ultrasound guidance. Results: 93 patients (98.94%) were diagnosed with interuterine adhesion by interventional ultrasound. 91 of 94 patients successfully underwent operative hysteroscopy. In the remaining 3 patients, uteri were perforated. The study followed 69 women treated by TCRA. The symptoms were relieved or improved in 48 patients; 4 of them were later on pregnant and 2 women with normal delivery. The intrauterine device, residual fetal bone, and gestational sac in 19 patients were removed after TCRA. The uterine cavity relapsed into adhesion in 3 patients; 2 of them underwent hysterectomy, which diagnosed adenomyosis, and another one is being followed up. Conclusions: Our study showed that interventional ultrasonography is an effective method in diagnosing and treating intrauterine adhesion. 31740 A comparison study of ultrasound, hysteroscopy, and laparoscopy in diagnosing septate uterus Zhang D, Fuxing hospital, Department of Ultrasound, Beijing, China Objective: The aim of this study was to compare the value of ultrasound, hysteroscopy, and laparoscopy in diagnosing septate uterus. Methods: 137 patients with primary infertility (n⫽27), secondary infertility (n⫽7), and recurrent pregnancy loss (n⫽103) were evaluated prospectively during a 10-year period. Transabdomal and transvaginal ultrasound were performed in 128 patients, whereas hysteroscopy and laparoscopy were used in 118 and 117 patients, respectively. Results: The accuracy of transvaginal ultrasound (TVS) in diagnosing septate uterus was greater than that of transabdominal ultrasound, and
Ultrasound in Medicine and Biology
stones. We conclude that the possibility of visceral abscess should be kept in mind after lap-chol and that careful observation using ultrasonography is required, especially in cases where perforation of the gallbladder with spreading of bile and stones was recognized. 31728 Fine needle aspiration of the breast: Single institution experience Weisberg S,* Da Costa D, Brofman N, Gal-Gombos E, Poppiti R, Comprehensive Breast Center, Mount Sinai Medical Center, Miami Beach, FL Objective: Although image-guided core biopsy with an 11-gauge vacuum-assisted device is the preferred method for diagnosis of breast lesions at our institution, our goal is to show that fine needle aspiration (FNA) using ultrasound guidance remains an effective tool for imageguided diagnosis particularly for certain BIRADS 5 lesions and for those lesions close to the chest wall, breast implants, or in the axilla. Methods: We reviewed fine needle aspirations, using a 21-gauge needle, that were performed under ultrasound guidance between 10/ 20/01 and 10/20/02. Results: Seventy-three patients with a total of 100 lesions were aspirated. Eleven samples were considered inadequate for diagnosis. Of the 89 remaning lesions, 40 were interpreted as malignant or suspicious for malignancy. All these lesions went on to surgical excision, and 38 were confirmed malignant on excisional biopsy. Two of the suspicious cases were benign. Forty-nine lesions were interpreted as negative for malignant or atypical cells, or with mild atypia, consistent with a benign process. Of these, 22 lesions were considered concordant with radiographic findings, and patients were placed on 6-month or 1-year followup. The other 27 lesions underwent additional workup with core biopsy or excision due to discordant imaging/pathologic correlation. Twentyfive were confirmed benign, and 2 were malignant. Conclusions: Image-guided percutaneous core biopsy is the standard for presurgical evaluation of breast lesions. The role of FNA has diminished due to reports of insufficient samples and the increased diagnostic accuracy and histologic information provided by use of 14-gauge and 11-gauge trucut and vacuum-assisted devices. Our experience demonstrates that FNA is an accurate method, especially useful in 1) BIRADS 5 lesions, particularly in the elderly, disabled, or anticoagulated patients; 2) in patients with multiple lesions and a dominant BIRADS 5 mass; and 3) in lesions risky for core technique due to location. With proper technique, a trained cytopatholgist and meticulous post-biopsy evaluation for radiologic/pathologic correlation, FNA remains a low-risk, minimally invasive, and accurate method of image-guided biopsy. 31729 Prenatal diagnosis of a fetal liver mass utilizing targeted sonography and magnetic resonance imaging Mastrobattista JM,*1 Berens PD,1 Schumacher VL,1 Metcalf J,1 Kramer L,2 1. Obstetrics, Gynecology & Reproductive Sciences, University of Texas Health Science Center-Houston, Houston, TX, and 2. Radiology, University of Texas Health Science CenterHouston, Houston, TX Description of case(s): A 26-year-old nulligravid woman was referred for targeted sonography at 18 weeks after an office ultrasound revealed a right-sided echogenic mass in the fetal abdomen. Patient denied history of travel, recent viral illnesses, and owned no pets. Targeted ultrasound demonstrated an echogenic complex mass with cystic and solid components in the right upper quadrant that pushed up into the right hemithorax. The mass obscured clear deliniation of the diaphragm making it difficult to localize the mass to the fetal right upper abdomen or thorax. No Doppler flow was noted. No fetal ascites, hydrops, or
Volume 29, Number 5S, 2003 additional fetal abnormalities were identified. Fetal echocardiogram was normal, and TORCH titers were negative. Fetal MRI revealed a 3-cm mass in the right hepatic lobe with compression of the right hemithorax representing a cavernous hemangioma or hemangioendothelioma. Serial ultrasounds performed throughout the remainder of the pregnancy demonstrated adequate interval growth and no evidence of fetal hydrops. The patient presented in active labor at 34 weeks and delivered a vigorous female infant weighing 2645 grams. The neonate was admitted to the Level II nursery and had a hemoglobin of 18.2 g/dL. Chest X-Ray on day of life (DOL) one revealed no active disease. Liver ultrasound on DOL 2 demonstrated an echogenic, partially cystic mass in the right lobe of the liver consistent with a mesenchymal hamartoma or hemangioendothelioma. The neonate was discharged home on DOL 11 for expectant management. At 2 months of life, the infant is thriving; the mass will be reevaluated by CT scan at 6 months of life. Proof of diagnosis: Targeted sonography identified a cystic and solid mass in the fetal RUQ that compressed the right hemithorax. Fetal MRI revealed a 3-cm hepatic mass consistent with either a cavernous hemangioma or hemangioendothelioma. Postnatal liver ultrasound demonstrated an echogenic, partially cystic mass in the right lobe of the liver representing a mesenchymal hamartoma or hemangioendothelioma. Relevance: Fetal liver masses diagnosed prenatally are rare. Targeted sonography may identify fetal liver masses. Fetal MRI greatly aided in the prenatal diagnosis of this cystic liver mass. 31737 Interventional ultrasound diagnosis and treatment for intrauterine adhesion Zhang D, Department of Ultrasound, Fuxing Hospital, Beijing, China Objective: The aim of this study was to discuss the method of interventional ultrasound diagnosis and treatment for intrauterine adhesion. Methods: From 1995 to 2002, 94 patients evaluated for infertility, amenorrhea, and periodic abdominal pain underwent interventional ultrasonographic examination, and all patients underwent transcervical resection of adhesion (TCRA) under ultrasound guidance. Results: 93 patients (98.94%) were diagnosed with interuterine adhesion by interventional ultrasound. 91 of 94 patients successfully underwent operative hysteroscopy. In the remaining 3 patients, uteri were perforated. The study followed 69 women treated by TCRA. The symptoms were relieved or improved in 48 patients; 4 of them were later on pregnant and 2 women with normal delivery. The intrauterine device, residual fetal bone, and gestational sac in 19 patients were removed after TCRA. The uterine cavity relapsed into adhesion in 3 patients; 2 of them underwent hysterectomy, which diagnosed adenomyosis, and another one is being followed up. Conclusions: Our study showed that interventional ultrasonography is an effective method in diagnosing and treating intrauterine adhesion. 31740 A comparison study of ultrasound, hysteroscopy, and laparoscopy in diagnosing septate uterus Zhang D, Fuxing hospital, Department of Ultrasound, Beijing, China Objective: The aim of this study was to compare the value of ultrasound, hysteroscopy, and laparoscopy in diagnosing septate uterus. Methods: 137 patients with primary infertility (n⫽27), secondary infertility (n⫽7), and recurrent pregnancy loss (n⫽103) were evaluated prospectively during a 10-year period. Transabdomal and transvaginal ultrasound were performed in 128 patients, whereas hysteroscopy and laparoscopy were used in 118 and 117 patients, respectively. Results: The accuracy of transvaginal ultrasound (TVS) in diagnosing septate uterus was greater than that of transabdominal ultrasound, and