Ovulation induction .
E2=2849.
History of left unicornuate uterus and solitary left kidney .
FINDINGS:
Transabdominal and transvaginal scans were performed.
Correlation is made with previous ultrasounds and MRI pelvis
17/9/2013 .
Uterus: The left uterine horn and cervix is identified, as seen on
previous imaging . It has endometrial thickness 16 mm .
Today, it is also apparent that there is an atretic right uterine
horn. This is confirmed on retrospective review of the MRI from
17/9/2013. The right horn has a small cervix which does not appear to
be in communication with the vagina or left cervical canal and is
most likely stenosed . Distal to this there is a tortuous tubular
structure extending towards the right inferolateral pelvic sidewall
which measures up to 6 mm in diameter consistent with dilated uterine
cavity/fallopian tube . Tubular content is anechoic on ultrasound
consistent with fluid, and high signal on the T1 MRI sequence
consistent with blood products .
Left ovary: normal appearance and size, normal location.
26 x 15 x 33 mm, volume 6.7 mL.
There are 19 small follicles measuring up to 7 mm in diameter . No
dominant follicle .
Today, after review of the MRI scan, we scanned her right upper
quadrant where we discovered the right ovary in the right lower
abdomen, just below the lower liver margin . It measures 56 x 26 x 29
mm, volume 22 mls, and contains a dominant 25 mm follicle, a further
follicle measuring 21 mm and several small follicles .
Laterally in the right adnexa, adjacent to the pelvic vessels, there
is again an ovoid solid lesion which measures 33 x 9 x 21 mm . It
does not contain any definite follicles . This was previously thought
to be ovarian tissue but given that there is definitely right ovary
in the right abdomen lower quadrant, I wonder whether this is a
pelvic right kidney .
COMMENT:
Normally located left ovary contains 19 small follicles .
Today we have discovered several new findings in this patient which
are confirmed on retrospective review of the MRI scan . The uterus is
in fact bicornuate, bicollis, with an atretic right horn, likely
stenosed at the level of the cervix .
In addition, she has a right ovary which is located in the right
lower quadrant of the abdomen, and contains a dominant 25 mm follicle
. On MRI there is a tortous tubular structure extending inferiorly
from the right ovary ? fallopian tube.
Previously right adnexal tissue has been identified and this is again
seen and I wonder whether it may be a small non-functioning pelvic
right kidney .
No comments:
Post a Comment