Sonohysterography (SHG) in infertility

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Copyright © 2014 Wolters Kluwer All Rights Reserved Chapter 14 Infertility.

Endometrial cancer. A, B: Long-axis images of a polypoid mass surrounded by a thin sliver of intraluminal fluid. This tumor occupied the entire uterine.

Myoma. Longitudinal sonogram of the pelvis demonstrating an enlarged myomatous uterus. A large anterior uterine myoma (M) can be seen displacing the endometrial.

A: Chemical shift artifact (arrows) on T1-weighted gradient echo scan in right ovarian dermoid cyst. This finding is the white on black line that occurs.

Middle cerebral artery Dopplers to screen for fetal anemia

TV-CDS of early intrauterine pregnancy

TV-CDS of early intrauterine pregnancy

This is a dual view of a fetal spine

Normal 5-week intrauterine pregnancy (IUP)

3D and 4D ultrasound volume ultrasound can obtain image planes and provide depth far beyond the capability of 2D ultrasound. Source: VOLUME SONOGRAPHY:

Workflow diagram depicting the main steps in scanning with 2D and 3D/4D ultrasound. The scan is always started in 2D and the area of interest is mapped.

This is a composite image of various 3D/4D ultrasound instruments

Ultrasonography of Uterine Leiomyomas

Complex, predominantly cystic masses

Complex, predominantly cystic masses

Color Doppler image from a sonohysterography study shows a broad-based, hypoechoic, and well-defined solid mass (arrow) projecting into the endometrial.

Completely cystic masses

Miscellaneous conditions

This figure presents a dual view of a conventional 2D image and VCI-A volume contrast imaging in plane A) still TIFF image generated from a 4D video sequence.

TV-CDS of early intrauterine pregnancy

Solid masses. A: Transverse sonogram showing enlarged right ovary (between +'s) with echogenic areas consistent with hemorrhage due to ovarian rupture.

Solid masses. A: Transverse sonogram showing enlarged right ovary (between +'s) with echogenic areas consistent with hemorrhage due to ovarian rupture.

Complex predominantly solid masses

Multiple transabdominal and transvaginal ultrasound images of a different patient with an ectopic pregnancy demonstrating (A) echogenic debris in the endometrial.

TV-CDS of early intrauterine pregnancy

Color/power Doppler (HD-flow™, GE Healthcare, Milwaukee, WI, USA) in other renal abnormalities. A, A': In a case of horseshoe kidney, color Doppler sonography.

Amplitude versus frequency transvaginal color Doppler sonography (TV-CDS). A: Frequency-based TV-CDS shows solid mass within the left ovary without significant.

Tubal obstruction (extrinsic)

Cervical pregnancy. A. Transvaginal sonography, sagittal view of a cervical pregnancy. Sonographic findings with cervical pregnancy may include: (1) an.

This is a composite image of 2 different cases of 3D sonohysterography

Other adnexal masses and conditions

Complicated early pregnancy. A: TVS of an embryonic demise

Fibroids. A: Transabdominal sonogram (TAS) of large uterine fibroid (arrow) extending from uterine fundus. B: Transverse TAS of degenerated fibroid (arrow)

Major scanning planes for transabdominal sonography (TAS) and transvaginal sonography (TVS). A: Normal adult, parous uterus in long and short axis as depicted.

(Reproduced, with permission, from Emiliano Chavira, MD.)

Sonographic images of retained products of conception shown on longitudinal (A) and transverse (B) views as echogenic material in the lower uterine segment.

Fixed flexion deformity of the hips

Sonographic images of monochorionic twins

Intrauterine insemination (IUI)

Normal 5-week intrauterine pregnancy (IUP)

Ultra Sonography In Assisted Reproduction

Graphic illustration of different volume ultrasound probes, volume acquisitions, and beam characteristics. A: Free-hand acquisition where the probe is.

Myoma. Longitudinal sonogram of the pelvis demonstrating an enlarged myomatous uterus. A large anterior uterine myoma (M) can be seen displacing the endometrial.

Twins commonly experience decreased growth after 26 to 28 weeks and, as in this set, the effect may be more pronounced on the smaller of the twins. At.

Moderate to severe urinary tract dilation

(A) Ultrasound of a midtrimester 18 weeks fetus showing bowel extruded (dashed arrows) to the right of the umbilical cord insertion (arrow). No membrane.

Tomographic ultrasound image obtained on a normal fetal brain at 22 weeks' gestation showing successive sagittal sections displayed from left to right.

Venous Doppler ultrasound for DVT

A, B: Numerous fibroid tumors alter the normal contours of the uterus

Sonohysterography (SHG) in infertility

Equipment needed for central venous catheterization. A

Normal 6- to 7-week IUP. A: Magnified TV sonogram of 3-mm embryo/yolk sac (arrow). Compare to Figure 3-1H. B: TV sonogram of 6-week IUP with 6-mm embryo.

Normal 6- to 7-week IUP. A: Magnified TV sonogram of 3-mm embryo/yolk sac (arrow). Compare to Figure 3-1H. B: TV sonogram of 6-week IUP with 6-mm embryo.

Twelve representative volumes arranged by gestational age

Multifetal pregnancy. A: TAS of normal 7-week diamniotic, dichorionic twin IUP. B: TVS of demised embryo (+'s) adjacent to living twin at 7 weeks. C: TAS.

Fibroids. A: Transabdominal sonogram (TAS) of large uterine fibroid (arrow) extending from uterine fundus. B: Transverse TAS of degenerated fibroid (arrow)

Septate ovarian cyst. A: Traditional 2D image of a septate ovarian cyst. B: Surface rendering of the inside of the cyst showing a smooth wall and a single,

Septate ovarian cyst. A: Traditional 2D image of a septate ovarian cyst. B: Surface rendering of the inside of the cyst showing a smooth wall and a single,

Renal dysplasia secondary to posterior urethral valves

Solid masses. A: Transverse sonogram showing enlarged right ovary (between +'s) with echogenic areas consistent with hemorrhage due to ovarian rupture.

Endometrioma. A: Transverse sonogram through the pelvis in a patient with a left adnexal mass. A thick-walled left adnexal cystic mass (E) is seen adjacent.

Multiple transabdominal and transvaginal ultrasound images of a different patient with an ectopic pregnancy demonstrating (A) echogenic debris in the endometrial.

Fetal endoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia. (Used with permission from Dr. Rodrigo Ruano, Texas Children’s Hospital,

Open maternal-fetal repair for fetal myelomenigocele

Ectopic pregnancy: uterine sonographic findings

This is a first trimester scan in a fetus with monosomy X

Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination Yvette.

Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous.

Presentation transcript:

Sonohysterography (SHG) in infertility Sonohysterography (SHG) in infertility. A: Diagram of SHG using balloon-tipped catheter. The balloon is filled with saline and then retracted into the distal internal cervical os to prohibit reflux and obtain maximal distention. (Drawing used with permission from Paul Gross, MS.) B: Sonohysterography shows multiple polyps. C: Hysteroscopic view of multiple polyps seen in (B). D: Sonohysterography showing adhesion appearing as echogenic interface crossing the lumen. E: Hysteroscopic view of adhesion in patient in (D). (Used with permission from Esther Eisenberg, MD.) F: Initial transvaginal sonogram of patient before SHG. The endometrium (between cursors) is slightly irregular in this patient who has a history of several miscarriages. G: After saline distention, there is mild irregularity of the endometrium in the fundus. H: Same patient as in (F) and (G), with more distention confirming slightly in the irregular fundal endometrium. I: Hysteroscopic images of patient in (F-H), showing “heaped up” endometrium fundal area. J: Sonohysterography showing a submucosal fibroid (between cursors). K: Hysteroscopic view of patient in (J) showing submucosal fibroid. L: Sonohysterography showing double lumina of bicornuate uterus. Three-dimensional US would be helpful in distinguishing a bicornuate from a septated uterus. Note the fundal cleft. M: Sonohysterography in an infertility patient showing a fundal polyp. N, O: Transvaginal color Doppler sonogram of patient in (M) showing vascular pedicle of the polyp in long (N) and short (O) axes. Source: Transvaginal Sonography in Gynecologic Infertility, Fleischer's Sonography in Obstetrics and Gynecology: Textbook and Teaching Cases, 8e Citation: Fleischer AC, Abramowicz JS, Gonçalves LF, Manning FA, Monteagudo A, Timor IE, Toy EC. Fleischer's Sonography in Obstetrics and Gynecology: Textbook and Teaching Cases, 8e; 2017 Available at: http://obgyn.mhmedical.com/DownloadImage.aspx?image=/data/books/2231/fleischer8_ch39_f006e-1a.png&sec=172969037&BookID=2231&ChapterSecID=172968989&imagename= Accessed: December 24, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved