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Vesicouterine fistulas: imaging findings in three cases
Tarek Smayra1, Michel A Ghossain, Jean-Noël Buy
1Department of Radiology, Hôtel-Dieu de France, Blvd. Alfred Naccache, Achrafieh, PO Box 16-6830, Beirut, Lebanon.
AJR. American Journal of Roentgenology
|December 24, 2004
Summary
Diagnosing vesicouterine fistulas, rare connections between the bladder and uterus, can be challenging due to delayed presentation and inconclusive imaging. Definitive diagnosis often requires advanced CT scans after initial contrast studies.
Area of Science:
- Urology
- Gynecology
- Radiology
Background:
- Vesicouterine fistulas are rare, abnormal connections between the bladder and uterus.
- They can arise secondary to cesarean delivery, uterine rupture, or radiation therapy.
Observation:
- Three cases are presented with diagnostic delays ranging from 3 to 7 years.
- Initial diagnostic attempts using sonography, urography, CT, MRI, cystoscopy, vaginoscopy, and hysterography yielded variable and often inconclusive results.
Findings:
- Definitive diagnosis was achieved using contrast-enhanced helical CT (after cystography) in one case.
- Unenhanced helical CT (after hysterography) and cystography were diagnostic in the other two cases.
- Diagnosis relies on imaging after uterine or bladder opacification, influenced by pressure gradients and fistula location.
Implications:
- Vesicouterine fistulas are infrequently considered in differential diagnoses due to their rarity.
- Advanced imaging techniques, particularly CT, are crucial for accurate diagnosis when initial tests are negative.
- Understanding the diagnostic imaging nuances is essential for timely and correct patient management.