X-ray of intrauterine devices

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Author: Mikael Häggström [notes 1]

Planning

Indications

For intrauterine devices (IUDs), indications for imaging are mainly suspected perforation or expulsion, such as painful insertion and missing strings on vaginal examination.

Choice of modality

  • Transvaginal ultrasonography is generally the initial investigation of choice.[1]
  • Projectional radiography ("X-ray") of intrauterine devices can detect the absence versus presence of an intrauterine device, which is useful when an IUD is not found on vaginal examination and ultrasonography.[1]
  • Low dose CT is indicated when specific anatomic location of the IUD is needed.
  • Normal dose CT is indicated in suspected complications such as perforation of nearby organs and/or abscess formation.[1]
  • MRI is rarely indicated, but can visualize an IUD with both 1.5-T and 3.0-T magnets.[1]

Settings

Anteroposterior view of whole abdomen,[2] preferably standing.[3] A lateral view may be taken as well[3][1] in non-pregnant and relatively older patients. When the sole purpose is to determine the presence versus absence of an IUD, the radiographer should preferably be notified that the examination is finished if the IUD is visualized already on an initial scout image or an otherwise suboptimal projection.

Evaluation

Note the presence or absence of an IUD. When present, note the location of the IUD. A location inconsistent with the uterus indicates perforation. It is not necessary to distinguish the type of IUD.

Report

Example:

X-ray of abdomen with perforated IUD.jpg

IUD located to the left in the pelvic cavity, indicating perforation.

See also: General notes on reporting

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.

References

  1. 1.0 1.1 1.2 1.3 1.4 Boortz, Hillary E.; Margolis, Daniel J. A.; Ragavendra, Nagesh; Patel, Maitraya K.; Kadell, Barbara M. (2012). "Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care ". RadioGraphics 32 (2): 335–352. doi:10.1148/rg.322115068. ISSN 0271-5333. 
  2. "Expulsion of a Spontaneously Broken Arm of a T- Shaped IUD: a Case Report ". ARC Journal of Public Health and Community Medicine 3 (2). 2018. doi:10.20431/2456-0596.0302005. ISSN 24560596. 
  3. 3.0 3.1 Sarah Hagood Milton. Intrauterine Device Extraction Technique. Medscape. Updated Nov 29, 2018