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Age: 27

Sex: Female

Indication: Pelvic pain, negative pregnancy test

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Case #25


Findings

  • The stem of the IUD extends into the myometrium in the anterior wall of the lower uterine segment
  • The arms of the IUD are positioned in the uterine fundus, in their expected location
  • Otherwise normal appearance of the uterus and ovaries
  • No free fluid in the cul-de-sac


Diagnosis

Malpositioned IUD

Sample Report

Malpositioned IUD with stem extending into the myometrium in the anterior wall of the lower uterine segment. The arms of the IUD appear to be in their expected location. Recommend gynecologic evaluation.

Otherwise normal appearance of the uterus and ovaries.


Discussion

  • Intrauterine devices (IUDs) are commonly used for contraception and should be positioned within the endometrial canal with the arms extending laterally at the uterine fundus
  • The retrieval string can often be visualized by ultrasound and should extend through the cervical canal
  • When malpositioned, IUDs can be a source for pain and may be less effective as contraceptive devices
  • IUDs can migrate into the uterine wall (embedment) and may even rarely extend through the serosa (perforation) with subsequent intraabdominal migration
  • Perforated IUDs commonly result in intraabdominal adhesions, which can lead to chronic pain, bowel obstructions, and infertility
  • Also remember that although rare, pregnancy occurring in patients with IUDs is at higher risk for complications including ectopic implantation and spontaneous abortion – a patient with an IUD and a positive pregnancy test has an ectopic pregnancy until confidently disproven


Images

IUD stem (red arrows) extends into the myometrium in the anterior wall of the lower uterine segment, clearly separate from the endometrial canal (yellow arrow).

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