SIS Saline Infusion Flashcards
what Delineates the contour, layers, echotexture and thickness of the endometrium and Allows for clarification / identification of suspected uterine pathology
SIS. - Provides detailed imagining of the
endometrial cavity
_____ ml of saline is infused into the endometrium through a _______ that has been passed through the cervix
• The balloon on the end of the catheter is distended to keep the infused saline in the endometrium so fluid remains in the endometrium until imaging can be completed
5‐30, catheter
The SIS procedure is scheduled during the
patients early _______ phase of her menstrual
cycle for several reasons
why?
proliferative
The endometrial lining during the proliferative phase is
thin and smooth making it easier to identify pathology
• A secretory endometrium may simulate disease
– During the insertion of the catheter shearing of the
endometrium can occur and this possibility decreases
when the endometrium is thin
– The threat of disturbing an unknown pregnancy is
reduced
what goes on the sterile tray is prepped for sis?
what else neds to be out?
– A tiny catheter (such as a feeding tube) or other
appropriate catheter
– Cervical dilators
– Saline, gauze, syringes etc.
light and stool for physician
what is this?
Note themicrobubbles as the saline dilates the balloon and the posterio enhancement from the balloon
what’s happening here?
Infusion of the Saline
A sonographer can move the probe so the catheter is not a distraction on the image Note the small amount of fluid in the posterior culde- sac (arrow)
_______ is dynamic and variable upon the patients age
and phase of the menstrual cycle if of
reproductive age
what does it vary by?
what does saline help with?
Normal Endometrium
Thickness varies throughout the menstrual cycle
– Sonographic appearance varies
Is symmetrical anechoic saline should prove
this symmetry or help delineate irregularities
what is the difference?
what are teh blue arrows pointing to?
Thickened Endometrium (blue arrows) in Sagittal
what is the protocole for sis?
Same protocol with the addition of the cervix and culde‐ sac as the transducer is withdrawn after the catheter has been removed
• Important to make sure entire uterus & pelvis has been
imaged
Make sure ______ equipment is available for balloon deflation & catheter removal
– Manipulation of the cervix may produce a ______ reaction especially in nulliparous women
– Patients may experience dizziness, pain or bradycardia
• Have a sanitary pad and towels
available to the patient following
the procedure
resuscitative
vasovagal
what are the indications for SIS?
Pre & post menopausal women with abnormal bleeding
• Pain
• A thickened or irregular endometrium seen on TV US
• Infertility &/or habitual abortion
• Fibroids
• Locate suspected polyps
• Pre and post operative assessment
– Example post myomectomy (removal of fibroid)
• Women who are taking Tamoxifen or other exogenous hormone therapy
____ is a Antagonist drug that interferes with the
activity of estrogen in the breast (breast cancer
treatment) but acts like estrogen in other parts of the body which means the uterus/endometrium reacts as if it is getting too much estrogen which causes increased risk for
– Endometrial hyperplasia, polyps
– Endometrial carcinoma
– Uterine sarcoma
tamoxifen
what are contraindications for SIS?
– Anyone who could be pregnant
– Active pelvic infection
what are the limitations of SIS?
– An enlarged uterus measuring more than a 12‐14 week pregnancy
– Fibroids larger than 4 cm
– Cervical stenosis or inability to thread the catheter
– Intrauterine septations or air bubbles
– Sharply retroverted uterus or patulous(open,
distended or spread apart) cervix
what types of pathology can be diagnoses by sis?
All types of Fibroids (submucosal, intramural and subserosal)
• Endometrial – Polyps, – Hyperplasia, – Carcinoma
what are these?
Endometrial Polyps on SIS
• Sagittal images demonstrate two areas in the
fundus, note a base (connecting stalk) was found
for each (red arrows)
what is this?
Endometrial Polyps on SIS
• Coronal image demonstrates two lesions in the fundus , note how they are measuring the bases for the physician’s surgical planning (red arrow)
• A third polyp was found in this patient (green arrow)
what are some common us findings w/ sis?
– Undulate (slight movement may be seen in saline)
– Echogenic mass surrounded by anechoic fluid
– Variable in • Size, • Location, • Vary in number
– Usually homogenous
– May have microcystic changes
what do these US Findings describe –
– Distorts endometrial symmetry
– May have along stalk, protrude into cervix or vagina
– Non‐specific echogenic endometrial thickening
(diffuse or focal)
– Focal round echogenic mass in endometrial cavity
– Identified best during proliferative phase
Endometrial Polyps
TV US images of a 51 year old with post
menopausal bleeding
• What can you identify?
She has a retroverted uterus (blue dotted lines)
• The endometrial size is abnormal (8 mm is upper
limit) & hers is 1.83 cm
TV US images demonstrate a prominent
hyperechoic, heterogeneous endometrium
(dotted lines) with anechoic areas
she has endometrial hyperplasia
what are the arrows pointing at?
Endometrial Hyperplasia • Arrows point to the echogenic line represents where the anterior and posterior layers touch
what ist his?
Endometrial Hyperplasia on SIS
• There is a small amount of air bubbles ‐ echogenic foci
in saline see the dirty shadow (versus a clean shadow)
can
Asherman’s syndrome
• Intrauterine adhesions orsepta
• Cervical pathology
be diagnoses by sis?
yes
what is asherman’s syndrom aka
• AKA Uterine synechiae or intrauterine adhesions
what is a Rare, acquired condition caused by trauma to
the endometrium by an aggressive D & C
procedure (usually pregnancy related), other
uterine surgery or infection
asherman’s syndrome
– Too much endometrium is removed/destroyed
leaving myometrium as the ‘new’ uterine cavity
which leads to scanty periods or amenorrhea
because there is little to no endometrial lining
how does scar tissue heal in asherman’s syndrom?
The scar tissue heals by causing the anterior
and posterior walls to adhere to each other
which can distort the endometrium making the
uterus difficult to distend
• The adhesions appear as thin bridging bands
• Symptoms – Amenorrhea – Pain could indicate ____. as well as Repeated spontaneous abortions and infertility
asherman’s syndrome
– Similar symptoms of other disease however if the
symptoms occur suddenly following a D&C or
other uterine surgery then Asherman’s Syndrome
is a strong possibility
what is this?
TA Ultrasound Findings
– Thin endometrial lining, note this patient has endometrial fluid too
– Not well visualized, the arrowhead points to the area the sonographer suspected as synechiae, note how the endometrial anterior & posterior walls come close together (arrow)
Asherman’s Syndrome
what is this?
TV Ultrasound Findings – Thin endometrial lining – Not well visualized – Endometrial contents may
be hyperechoic, attenuate the sound beam and shadow
SIS Findings – Demonstrates the synechiae if saline can distend the endometrium enough
– Thin, irregular endometrial lining may be visualized depending on degree of disease
– Adhesions are demonstrated (red arrows
43 year old female with abnormal uterine bleeding and anemia
• What can you identify on her pre SIS TV images?
42 year old female with a family history of ovarian cancer and abnormal bleeding
• This is her TV image pre‐SIS
– What can you identify on this image? Can you identify borders?
