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【读片】产科疑难超声病例（301）：宫内胎骨残留

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上一病例：【读片】产科疑难超声病例（300）：孕妇主动脉夹层

Case report

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版主点评：此病例有两点是可以作为诊断线索的：1、题目都明说了是产科疑难病例，肯定和产科有关，呵呵；2、G6P4，那应该还有2次流产病史。大家分析的都很不错，很多人都想到了异物或者产后残留。凡是提到胎骨残留的均加分，其他的请继续努力。

This is a case of a 52-year-old G6 P4 who presented to our gynecology department with a lower abdominal pain and recurrent fever. Patient was postmenopausal and had a long history of a dull pain in the lower abdomen, mostly on the left side.
患者52岁，G6P4。因下腹部疼痛以及阵发性回归热来我院妇产科就诊。患者已经绝经，既往有长时间的下腹部钝痛病史，大都位于左侧。

The transvaginal ultrasound scan revealed the following findings:
经阴超声检查发现如下：

Images 1,2: Transvaginal ultrasound.

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2011-09-02 15:49 浏览 : 14765 回复 : 238

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xihuansushi 编辑于 2011-09-20 20:56

• 「规培真心话」第9期：你们医院的规培待遇怎么样？

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Case report

This is a case of a 52-year-old G6 P4 who presented to our gynecology department with a lower abdominal pain and recurrent fever. Patient was postmenopausal and had a long history of a dull pain in the lower abdomen, mostly on the left side. This pain started 14 years ago after spontaneous abortion which occurred in 16 weeks of her pregnancy. Patient was recently loosing some weight and felt tired.
On the pelvic examination, the uterus was tender on palpation and left parametria showed some retraction. The blood count showed mild anemia.
患者52岁，G6P4。因下腹部疼痛以及阵发性回归热来我院妇产科就诊。患者已经绝经，既往有长时间的下腹部钝痛病史，大都位于左侧。此疼痛始于14年前妊娠16周发生的自然流产之后。患者近期体重减轻并且感觉乏力。经阴体检发现子宫触痛，子宫左侧略有回缩。实验室检查发现有轻度贫血。

We performed a transvaginal ultrasound scan and detected a bright echo filling the uterine cavity, there were no other abnormalities detected on our exam. Patient had no history of intrauterine device (IUD).
We decided for hysteroscopic evaluation of the uterine cavity. Hysteroscopy showed a retained long bone inside the uterine cavity which was a remnant of the spontaneous abortion which occurred 14 years ago.
Pathology examination confirmed our diagnosis of lithopedion.
经阴道超声检查发现宫腔内存在一明亮的强回声，除此之外未见其他异常。患者没有宫内节育器病史。宫腔镜检查发现宫腔内残留的长骨，是14年前自然流产后残留的。病理学检查证实我们的胎儿石化的诊断。

Images 1,2: Image 1 shows the sagittal view of the uterine cavity with an hyperechoic content. Image 2 shows a transverse view of the uterine cavity.
子宫矢状面和横切面显示宫腔内的强回声结构。

Images 3-8: Hysteroscopy, images show a bone located within the uterine cavity.
宫腔镜检查显示宫腔内的骨骼结构。

Discussion

Prolonged retention of intrauterine bone has been recognized and described in the literature as a cause of secondary infertility. The retained bones are usually result of a spontaneous or induced abortion in the second trimester.
The most common complaints are secondary infertility, menorrhagia, irregular bleeding, pelvic pain and vaginal discharge. [1] Retained bones act in a manner similar to that of an IUD.
Diagnosis is usually based on the history of abortion and is made by the ultrasound and follow-up hysteroscopy. If retained bones cause infertility, the chance of pregnancy is usually preserved after the removal of the retained bone.
Retained bones can also cause pelvic inflammatory disease or pelvic actinomycosis which is usually characteristic for women using an IUD. [2]
作为导致继发性不孕的原因，宫内骨骼结构的长时间残留已有文献报道，通常是由于妊娠中期的自然流产或者人工流产所致，常合并有继发性不孕、月经过多、不规则流血、下腹部疼痛以及阴道溢液，其导致的影响与宫内节育器作用相似。其诊断可以根据流产的病史以及超声检查和宫腔镜检查做出。如果是由于残留骨结构导致的不孕，通常在清除残留骨骼以后可妊娠。骨骼的残留也可导致盆腔炎或者盆腔的放射菌病，而这些疾病通常在IUD妇女容易出现。

References

1. Graham O, Cheng LC, Parsons JH. The ultrasound diagnosis of retained fetal bones in West African patients complaining of infertility. BJOG 2000,107(1), pp. 122-124
2. White T, Felix JC. Pelvic actinomycosis with retained intrauterine fetal bone: a case report. J Reprod Med. 2007 Mar;52(3):220-2.

2011-09-15 21:15

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xihuansushi 编辑于 2011-09-15 21:37

• 月薪从6500降到3000元的医学定向生，后来怎么样了？

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【读片】产科疑难超声病例（301）：宫内胎骨残留

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