Bicontrast gynecography
Last reviewed: 23.04.2024
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Bicontrast gynecography is a combination of hysterosalpingography with pneumogynecography.
Indications: determination of the contours of the uterine cavity and the lumen of the tubes, the external borders of the internal genital organs (infertility for the exclusion of the tubal factor or sclerocystic ovaries), tumors of the uterus, tubes, ovaries, anomalies of the development of internal genital organs.
Contraindications: anamnesis, 3-4 degree obesity, heart and lung diseases with circulatory disorders in small and large circles.
The method of bicontrane gynecography includes the following steps:
- preparation of the patient,
- creation of pneumoperitoneum,
- introduction of a radiocontrast substance into the uterine cavity;
- biocontrast X-ray photography.
Produced in the 2 nd phase of the menstrual cycle. Use carbon dioxide, oxygen or nitrous oxide. The patient is given a position according to Trendelenburg. To get a clear radiographic picture of the uterus and ovaries, careful preparation of the patient is necessary. To this end, during the three days before the study, the intake of food containing carbohydrates, fiber (to reduce gassing) is restricted, and activated charcoal is administered 2 tablets 3 times a day. In the evening on the eve of the study and in the morning they put a cleansing enema.
The amount of injected gas should not be less than 2000 ml, and in large women with an increased body weight - 3000 ml. Shadows of genital organs on radiographs exceed their true sizes by 15-20%.
Abroad and in our republic in clinical institutions, where echoscopy and laparoscopy are widely used, this method is rarely used.
X-ray examination of the adrenal gland in conditions of retroplexperitoneum. In the gynecological clinic, it is rarely used. As a rule, this research is performed in the endocrinological or urological departments of multi-field hospitals with suspected adrenal neoplasm or their hyperplasia, which is usually accompanied by a clinical picture of virilization. The study is preceded by the same preparation as before pneumopylography.
Gas enters the presacral area through a needle inserted between the coccyx and rectum, with the patient in the elbow position. The needle is directed strictly along the middle line between the anus and the coccyx. The amount of gas introduced is 2000-3000 ml. On loose fiber, the gas spreads to the periphary region. Uniform distribution of gas is facilitated by slow walking for 30 minutes after its introduction. Radiographic or tomographic studies are performed within 2-3 hours after the introduction of gas.
Contraindications: inflammatory processes in the pararectal tissue, hemorrhoids, cardiopulmonary insufficiency.
Normally, on the roentgenogram, the adrenals are triangular in shape, located above the upper poles of the kidneys. With hyperplasia, enlarged adrenals are visible. With a tumor, the adrenal gland is enlarged on the side of the lesion; the dimensions of normal non-magnified adrenals on the tomogram vary in length and width from 1 to 4 cm.
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