Radiology Quiz!
A young lady in her 30s was referred to me for having serous mixed with blood(haemoserous) discharge from her previous abdominal incision. This discharge increased during her menses and with the same consistency. She had an emergency surgery a year ago for a ruptured uterus from pyometra (pus within the uterus) She was found to have a congenital (from birth) anomaly. This is her hysterogram
and fistulogram from the skin discharge.
Any guesses?
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May 19th, 2007 at 9:03 pm
The first couple look like a possible bicornuate uterus. One of the subtypes.
May 20th, 2007 at 6:27 am
The HSG images show uterus bicornis bicollis with mildly dilated right fallopian tube. Left horn is not completely filled. Left fallopian tube is not seen - ? rudimentary horn.
The fistulogram is very confusing. I think there is a communication of the fistula with the left horn and the rectum. Only frontal views have been shown. An oblique or lateral view would be ideal to show the communication between the subcutaneous fistula, the Uterus and the rectum.
Do you have a lateral or oblique image to show?
May 20th, 2007 at 7:02 pm
srp and vijay - wah such good description. I actually have the oblique view but the quality is so poor that I will have to probably get it again later.
However, the description is a little short. Something else is untold.
May 21st, 2007 at 5:27 pm
Ok George, Now I’m going to go all out…. and Guess
First things first…
Does this lady have endometriosis?
What was the previous surgery, Cesarian section or something else (to do with endometriosis, maybe)?!
Is the dome like contrast-filled thing in the 2nd picture, the bladder? So is it a cutaneous-vesico-utero-rectal fistula
I would like to revise my finding on HSG to Uterus Didelphis, you have cannulated one cervical canal, the contrast is leaking out through the other canal on the right into the vagina.
The large blotchy contrast filled areas overlapping everything else in the fistulogram are likely to be sinuses in the subcutaneous or parietal muscular planes.
You could have done a CT (plain) after the fistulogram, it would have shown you the anatomical findings better.
Don’t keep us waiting too long for the answer. The suspense is killing me
May 21st, 2007 at 5:59 pm
Excellent Vijay!
It is a case of uterine didelphy who presented a year earlier for a ruptured pyometra. The fistulogram is unclear but shows communication to the uterus, an cutaneoureteric fistula.
May 22nd, 2007 at 3:15 pm
[…] showed her Xrays a few days ago and Dr Vijay answered the quiz correctly. We took her into surgery again hoping to […]
July 13th, 2007 at 11:56 pm
[…] A young lady in her 30s was referred to me for having serous mixed with blood(haemoserous) discharge from her previous abdominal incision. This discharge increased during her menses and with the same consistency. … …more […]